Premature Ovarian Failure

Premature Ovarian failure (POF) occurs when a woman stops having her menstrual cycle before she turns 40. For those who get it, the most likely age is 27, though it may be earlier or later. 1 in 1,000 women between 15 and 29 and 1 in 100 between 30 and 39 will suffer from premature ovarian failure. The symptoms generally manifest similarly to menopause, but too early. These include hot flashes, lack of discharge during period, and vaginal dryness. Periods likely become less and less frequent and predictable before stopping completely. In diagnosing the failure, doctors may find heightened levels of estrogen in the body. Some possible causes of POF include chemotherapy and surgery, but most cases will never identify the exact cause.

 

Potential Causes

Many factors contribute to the possibility of a woman suffering from premature ovarian failure, with some very difficult to identify. These can go back to fetal development with defects in the growth of the ovaries or ovarian follicles. If the cause lies in a pre-birth defect, it likely stems from an abnormality of fetal chromosomes from disorders like Turner’s syndrome, a condition where part of the X chromosome is missing. Many of these defects will also manifest in other more apparent ways.

For most sufferers, the contributing factors occurred after puberty. Some ovaries develop the ability to resist hormones, leading to a disruption in menstruation. These leads to ovarian follicles that do not absorb the hormones necessary for a normal period. If the problem does not originate from absorption, it may originate from the hormones themselves. Women with a defective 17 hydroxylase enzyme may not form the hormones needed for ovulation at all.

Finally, damage to the ovaries can happen following cancer radiation or drug treatment, especially use of the drug cyclophosphamide.

 

Diagnosis

A diagnosis of premature ovarian failure requires extensive testing. This may include a number of studies recommended by a doctor. These include chromosome, thyroid, parathyroid, ovarian, and blood count studies. It may even include testing hormone absorption by follicles and ovarian biopsy.

 

Treatment

Premature ovarian failure treatment options depend on the problems found during diagnosis. No method has been discovered that reliably stimulates the ovaries allowing pregnancy and normal period function. However, different options may be available that may help depending on the exact circumstances a doctor determines.

A small sample of cases have positively responded to estrogen replacement therapy followed by a round of gonadotropins. First the doctor administers standard estrogen replacement to lower natural levels of FSH in the woman’s system. Then a doctor gives patients a very high dosage of human menopausal gonadotropins after an initial estrogen therapy. This has had some success in allowing patients to become pregnant, but the rates of success remain low and the treatment may not be right for many patients.

If the cause of the problem lies elsewhere, a doctor may be able to treat the underlying cause. For example, steroids may help an autoimmune issue keeping hormones from working properly. Another potential factor, hypothyroidism, can be treated with proper medication. However, most cases of POF never result in a definitive answer as to cause, and those cases prove far harder to treat.

While it will not restore full menstrual function, in vitro fertilization still allows the possibility of pregnancy. The inability to ovulate does not stop an IVF baby from being carried to term, provided a healthy donor egg is provided. Donor IVF occurs when a trusted donor provides the egg to be fertilized with the sperm of the patient’s partner or from another donor. This embryo can then be placed safely in the patient’s uterus after a round of estrogen therapy. Using this method, a woman with POF can still carry a baby to term even if other treatment has failed.