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Primary Ovarian Insufficiency – Symptoms And Causes

September 28, 2022

The number of reproductive years among women varies, depending on steroid production by the ovaries. Many of us are aware a woman’s fertility starts decreasing or there are risk of genetic issues in fetus ,once she crosses 35 years of age. The fertility and the functioning of the ovaries start declining over years. However, some women can experience this decline before they turn 40 years. So, is this normal? Can this affect them in any way? Come, let’s find out.

What Is Primary Ovarian Insufficiency

Premature Ovarian Failure, also known as Primary Ovarian Insufficiency (POI) describes a spectrum of declining ovarian function and reduced fecundity due to premature decrease in initial follicle number, an increase destruction, or poor follicular response to gonadotropins. Woman’s ovaries stop functioning properly before she turns 40 years old. When this happens , ovaries don’t produce normal amounts of the hormone estrogen or release eggs regularly. This condition is also called as premature ovarian failure and often leads to infertility .For women with POI, irregular periods and reduced fertility occur before the age of 40, sometimes as early as teenage years.

Menopause is when there is permanent cessation of ovarian function. Premature menopause is diagnosed when women under 40yrs have elevated follicle stimulating hormone levels in menopausal range (at least 30-40mIU/ml) and amenorrhea. Hence women with menopause can never have pregnancy with her own oocytes. POI is a malfunction of the ovaries, 50% of whom can have infrequent ovulation and menstrual cycles after diagnosis and 5-10% of whom may achieve spontaneous pregnancies, while the rest can be managed to a certain extent with treatments like Hormone Replacement Therapy (HRT) and can conceive.

Causes Of Primary Ovarian Insufficiency

Almost 90% of cases of premature ovarian failure are idiopathic. Certain research shows POI could be mostly due to a malfunctioning of the follicles. Follicles are a part of the ovaries where the eggs grow and mature. A problem with the follicles will affect the health of the eggs. In some cases, women may run out of working follicles and in some, the follicles may not work properly.

Some of the possible reasons for the follicles not working properly could be:

  • Genetic disorders such as one X chromosome is damaged(isochromosome X),lost (turners syndrome and turners mosaic) or altered (FMR1 permutation carriers) or fragile X syndrome
  • Autoimmune diseases like thyroiditis and Addison disease
  • Metabolic disorders
  • Insufficient follicles
  • Radiation or chemotherapy
  • Over or constant exposure to chemicals and toxins
  • Lifestyle habits like smoking and alcohol consumption

If you have any of the above or a family history of POI, you may be at risk of POI.

Book an Appointment with Dr. Aruna Kumari V for all Gynecology related concerns.

Must Read: Influencers of Infertility

Symptoms Of POI

Many women have irregular periods. It can be quite easy to mistake it for something else or just ignore it until it is too late. Here are some ovarian dysfunction symptoms in addition to missed periods, that can indicate primary ovarian insufficiency:

  1. Vaginal dryness and urogenital atrophy
  2. Painful intercourse
  3. Low sex drive
  4. Hot flashes
  5. Night sweats
  6. Irritability
  7. Inability to concentrate like usual

In some cases, symptoms of POI can also indicate secondary amenorrhea – a condition where periods stop and do not resume even after 6 months, despite a negative pregnancy test. In case of secondary amenorrhea, your doctor will suggest an amenorrhea treatment to help resume your menstrual cycle.

Problems Caused By POI

Many are aware that in the case of POI-induced infertility, eggs can be insufficient or of low quality. Can POI cause other health issues? Yes, since it is a hormonal imbalance, it can have a multiple effects on your body. Here are some of the health issues POI can trigger:

  • Infertility- low antral follicle count and requiring multiple dose of hormonal injections for follicular growth and stimulation cycles in IVF.
  • Heart issues due to the low estrogen levels, cholesterol can deposit in muscularis layer of arteries leading to atherosclerosis. Sometimes leading to embolic strokes if the plaques dislodge to cerebral vessels.
  • Hypothyroidism - can cause low levels of energy – both physically and mentally and low metabolism. Osteoporosis due to insufficient estrogen- as such post menopause women lose around 2% of their bone mass annually. In case of POI/POF it will be still earlier than expected leading severe bone loss by 50-60yrs leading to fragile fratures and bone deformities.
  • Depression or anxiety.
  • Eye problems- sometimes dryness

Diagnosis of POI

When you complain of irregular periods and difficulty in getting pregnant, your doctor might ask for the following tests to confirm the diagnosis of primary ovarian insufficiency:

  • Family History – To understand if there is a history of POI in the family. About 10- 20% of women with POI have a family history of the condition.
  • Pregnancy Test - To ensure your missed period is not due to pregnancy.
  • Physical examination – To identify if something else could be responsible for the symptoms.
  • Blood Tests – To check the hormonal levels of FSH,AMH,Prolactin,TSH,E2,Vit D levels and to do an analysis of the chromosome by karyotype test
  • Pelvic Ultrasound – To check for enlargement of ovaries and presence of multiple follicles.
  • Dual energy X ray absorptiometry to evaluate bone mineral density

Treating Primary POI

Once your doctor confirms a primary ovarian insufficiency, they might suggest the following treatments:

  • HRT – Hormonal Replacement Therapy for premature ovarian failure is one of  the most recommended treatments for this condition. It can help improve your sexual health and reduce the risks of other health complications.
  • Supplements – Since POI increases the risk for osteoporosis, a premature ovarian failure treatment will include Vitamin D and calcium supplements to improve your bone health.
  • Physical Activity – Becoming physically active by following a good exercise routine to maintain ideal body weight can help reduce the risks of complications related to POI.
  • Treating Other Issues – If POI causes any other health issue, it is important to treat that as well. Even if it cannot help with improving your condition, it can ensure your health does not deteriorate further due to POI.

Must Read: The Cysterhood: Ovarian Cyst Types, Symptoms & Treatments

Getting Pregnant With Primary Ovarian Insufficiency

So, can you get pregnant despite a POI diagnosis? Yes, but the chances are very low. One might even conceive and not know about it for a while.

Since the menstrual cycle is irregular, one may not suspect pregnancy when the menstruation does not start on time. You may get pregnant spontaneously, without having to try much, and in some cases, no matter how hard the couple tries, they may not get pregnant.

If you plan on undergoing any radiation or chemotherapy, you may consider freezing your eggs or embryos. You can use it when you feel ready and your body is up for it. Alternatively, you can use donor eggs and also get pregnant if you find out about your POI late and are unable to get pregnant despite all treatments.

Conclusion

Primary ovarian insufficiency is life altering diagnosis that presents numerous medical psychosocial challenges for affected women. It need not be the end of your pregnancy attempts. You can consult a fertility specialist and get some guidance. With today’s advancement in the field of infertility, one has multiple options to make their family expansion dreams come true. All you need is a good fertility specialist and a well-reputed fertility institution.

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