A woman in her 20’s or early 30’s who may have trouble getting pregnant or a woman who is concerned about irregular periods, hot flashes, night sweats and vaginal dryness may present to a physician and learn that she has primary ovarian insufficiency. This can be one of the hardest diagnoses for a woman to face.
What is Primary ovarian insufficiency?
Primary ovarian insufficiency (POI), previously called “premature ovarian failure” (POF), is when menopause occurs before the age of 40.
POI occurs in 1 in 1,000 women between the ages of 15 and 29 and 1 in 100 women between the ages of 30 and 39. Twenty-seven is the average age of onset.
Women with POI have complete or near complete ovarian follicular depletion with resulting low estrogen and high Follicle Stimulating Hormone (FSH) levels. They often will experience menopausal symptoms such as hot flashes, night sweats, and vaginal dryness and will rarely ovulate.
Some women with POI can still ovulate and menstruate and may be able to conceive. However, the odds are low. According to the National Institute of Health, between five to ten percent of women with POI have conceived and have carried normal pregnancies without medical assistance.
Who is at risk?
In about half of the cases, a reason for POI is not found. However, we know that women with a family history of POI are at greater risk. The condition is also associated with autoimmune disorders affecting the thyroid and adrenal glands. And it is also linked to genetic causes such as Turner and Fragile X syndrome. Additionally, women exposed to chemotherapy and radiation are at greater risk for POI.
The low estrogen levels associated with POI may make women particularly prone to develop osteoporosis and early heart disease. Women may also be at greater risk for depression. If POI in a particular case is linked to a genetic condition then there might be a risk to future children.
This can be an emotionally devastating diagnosis for many young women. Dreams of motherhood and ideas about self-worth may be challenged. At the same time, they may have to deal with the physical symptoms of menopause years before their peers. This can take an emotional toll on one’s psyche and relationships. Counseling and support are available.
There is no cure for POI just as is there is no cure for aging eggs. Many women don’t find out about this condition until their FSH level is measured when they see a doctor because their periods are irregular or nonexistent.
To achieve pregnancy, a woman with POI may opt to undergo In Vitro Fertilization (IVF) with her own or with a donor’s eggs. Additionally, a woman with POI will likely be advised to take supplemental estrogen in order to avoid some of the detrimental effects that low estrogen can have on her bones and heart.