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This topic contains information about loss of ovarian function before age 40. If you want information about the normal loss of ovarian function around age 50 or about symptoms in the few years before it, see the topic Menopause and Perimenopause.
What is primary ovarian insufficiency?
Primary ovarian insufficiency (sometimes called premature ovarian failure) occurs when your ovaries—which store and release eggs—stop working before age 40. You may have no or few eggs. Depending on the cause, primary ovarian insufficiency may develop as early as the teen years, or the problem may have been present from birth.
A woman who has primary ovarian insufficiency is very likely to have irregular or no periods, infertility problems, and menopause-like symptoms. It is difficult, though not impossible, for women who have primary ovarian insufficiency to become pregnant.
What causes primary ovarian insufficiency?
Although the exact cause of primary ovarian insufficiency may be unknown, a genetic factor or a problem with the body's immune system may play a role in some women. In an immune system disorder, the body may attack its own tissues—in this case, the ovaries.
Primary ovarian insufficiency may develop after a hysterectomy or other pelvic surgery or from radiation or chemotherapy treatment for cancer. In some of these cases, the condition may be temporary, with the ovaries starting to work again some years later.
What are the symptoms?
The symptoms of primary ovarian insufficiency are similar to those of menopause. Your menstrual periods may become irregular—you have a period one month but not the next—or they may stop. You also may have some or all of the symptoms of menopause, such as hot flashes, night sweats, irritability, vaginal dryness, low sex drive, or trouble sleeping.
How is primary ovarian insufficiency diagnosed?
If your periods become irregular or stop, your doctor will give you a physical examination and ask you questions about your general health and whether you have other symptoms of primary ovarian insufficiency. You will also have a pregnancy test. And your blood will be tested for other possible causes of irregular periods.
To check for possible ovarian failure, your blood level of follicle-stimulating hormone (FSH) will be checked. FSH signals your body to release an egg every month. If the amount of FSH in your blood is higher than normal on more than one day, you may have primary ovarian insufficiency. Another blood test also may be done to measure the amount of estradiol (or estrogen) in your blood. Very low estrogen with a high FSH is a sign of primary ovarian insufficiency.
Some women find out they have primary ovarian insufficiency when they see a doctor because they are having trouble getting pregnant.
How is it treated?
Treatment for primary ovarian insufficiency will help you manage your symptoms. But there is currently no treatment that will make the ovaries start to work properly again. Your doctor may prescribe hormone therapy or other medicines to help with hot flashes. Hormone therapy can also help prevent early bone loss in women who have this condition. Talk to your doctors about which treatments may be right for you.
Some women with primary ovarian insufficiency may choose to try to become pregnant using donor eggs and in vitro fertilization. For more on this treatment, see the topic Fertility Problems.
Finding out you have primary ovarian insufficiency can be extremely upsetting, especially for a woman who hopes to become pregnant. You may want to get support through counselling. You also can find information and support at http://fertilitymatters.ca from Fertility Matters Canada.
Can primary ovarian insufficiency be prevented?
At this time, there is no way to prevent primary ovarian insufficiency. But you can take steps to protect your overall health. Women with this condition have a higher risk of bone thinning and fractures (osteoporosis), diabetes, and heart disease. A balanced and low-fat diet, regular exercise, and not smoking can help protect your bones and heart. Getting enough calcium and vitamin D may help slow bone loss. Talk to your doctor about other steps you can take.
Current as ofSeptember 5, 2018
Author: Healthwise Staff
Medical Review: Kathleen Romito MD - Family Medicine
Anne C. Poinier MD - Internal Medicine
Adam Husney MD - Family Medicine
Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology