Premature ovarian failure

Premature ovarian failure

Premature ovarian failure is the loss of ovarian function before the age of 40 years. Thus, the ovaries stop producing hormones (estrogen) in normal amounts, which can lead to infertility and other complications.

Premature ovarian failure is called premature menopause, although the two conditions are not identical. Thus, if premature menopause bleeding patterns disappear completely, while women who suffer from premature ovarian failure may have occasional menstrual periods and can even get pregnant.

Restoring normal levels of estrogen in women with premature ovarian failure can help prevent complications (osteoporosis, for example). Instead, infertility is difficult to treat.

Premature ovarian failure affects 1 in 1000 women aged 15 to 29 years.


Signs and symptoms
The most common sign of premature ovarian failure consists of discontinuation of menstruation (amenorrhea) or irregular periods. Some patients with premature ovarian failure shows irregular menstrual cycles for several years, while others observed absence of menstruation after pregnancy or after contraceptive discontinuation.

In general, signs and symptoms are similar to those present at menopause:

»Hot flashes
»Night sweats
»Vaginal dryness
"Irritability or difficulty concentrating

These are typical signs and symptoms of estrogen deficiency.
Causes and risk factors
The ovaries hold thousands of immature follicles that contain eggs. At the beginning of each menstrual cycle, the pituitary gland secretes a hormone that stimulates follicle stimulating hormone (FSH). This hormone, a small number of follicles that contain eggs start to mature, although usually only one follicle actually reaches maturity. Maturing follicles produce estrogen. High levels of estrogen "announce" the pituitary gland that follicle stimulating hormone (FSH) is no longer necessary.

If the follicles do not mature and do not release adequate amounts of estrogen, follicle stimulating hormone levels continue to rise. This explains the fact that women with premature ovarian failure have high levels of FSH in the blood.
Normally, the pituitary releases a hormone called luteinizing hormone (LH). This triggers the release of an egg from the follicle (ovulation). The egg enters the fallopian tube where it can be fertilized by a sperm. Without the increased estrogen levels as a result of maturing follicles and followed by significant increase in the level of luteinizing hormone, ovulation does not occur.

Premature ovarian failure occurs when the ovaries stop follicles, or when they do not respond properly to the hormone stimulation and can be caused:
»Chromosomal abnormalities - some genetic diseases are associated with premature ovarian failure, including Turner syndrome (lack of an X chromosome) and fragile X syndrome.
"Toxins - chemotherapy and radiation therapy are the most common causes of premature ovarian failure caused by toxins. These therapies may affect genetic material of cells. Other toxins such as cigarette smoke, pesticides and other chemicals, and some viruses may be responsible for the appearance of ovarian failure.
»Autoimume disease - rare, the body may produce antibodies against ovarian tissue, affecting egg-containing follicles. It is not known why this occurs, but the process can be initiated by exposure to a virus.
Often it is difficult to say because of premature ovarian failure. In most cases, the cause is unknown.

Risk Factors

Certain factors may increase the risk of premature ovarian failure:
»Age - risk of ovarian failure increases with age. The incidence is 1/250 at age 35 and 1/100 to 40 years.
»Family history - family history positive for premature ovarian failure increases the risk of developing this disease. Approximately 10% of cases are hereditary.
Diagnosis
To diagnose premature ovarian failure, your doctor will ask questions about the signs and symptoms, menstrual cycle and follow therapies (chemotherapy or radiotherapy). Most patients shows few signs of premature ovarian failure, but the doctor will perform a physical exam, including a pelvic exam.

Some tests play an important role in diagnosis:
Pregnancy test - is often performed in women of reproductive age to exclude the possibility of an unplanned pregnancy.
Test FSH (follicle stimulating hormone). FSH is a hormone released by the pituitary gland in the role of ovarian follicles to stimulate growth. Women with premature ovarian failure shows a high level of FSH in the blood.
Test LH (luteinizing hormone). LH triggers the release of an egg from a mature ovarian follicle. In women with premature ovarian failure, the level of LH is lower than that of FSH.
Estradiol test. Serum levels of estradiol (a type of estrogen) is usually low in women with premature ovarian failure.
Karyotype - test that examines all 46 chromosomes. Some women with premature ovarian failure can have only one X chromosome and not two, as is normal, or have other chromosomal abnormalities.
Complications
Infertility
A very small number of women with premature ovarian failure may become pregnant and gives birth to healthy babies so natural conception remains a remote possibility.

Osteoporosis
The hormone estrogen helps maintain strong bones. Women with low estrogen levels have an increased risk of having fragile and easily fractured bones (osteoporosis).
Premature ovarian failure
Addison
This condition occurs when the adrenal glands do not produce enough of certain hormones to regulate body functions. Addison's disease can be fatal in the absence of appropriate treatment. Some types of premature ovarian failure may be associated with an increased risk of developing Addison disease.

Depression and anxiety
The risk of infertility, among other complications associated with low estrogen levels can lead to depression or anxiety in some women.
Treatment
Treatment of premature ovarian failure is the complications associated with estrogen deficiency.

Estrogen therapy
Estrogen replacement product normally functioning ovaries is important to prevent osteoporosis and reduce symptoms associated with estrogen deficiency (eg, hot flashes or vaginal dryness). Prescription of estrogen may be associated with that of another hormone, progesterone, to achieve hormonal balance that exists naturally in the body. Hormone replacement therapy is followed up to 50 years - the average age of natural menopause.
Although HRT was associated with the occurrence of cardiovascular disease and increased incidence of breast cancer in older women, younger patients with premature ovarian failure, the benefits of this therapy outweigh the potential risks are.

Calcium and vitamin D supplements
Taken together, calcium and vitamin D supplements are important for maintaining strong bones and helps prevent osteoporosis.
Premature ovarian failure
Treatment of infertility
Infertility is a common complication of premature ovarian failure.
There is no treatment to restore fertility in women who suffer from this condition. However, some patients turn to in vitro fertilization, a procedure in which eggs are extracted woman, fertilized in the laboratory and then returned to the uterus. If eggs are not viable patient, in vitro fertilization using a donor egg is the best way to achieve a pregnancy.