Primary Ovarian Insufficiency

Find out the latest options for women with POI.

Most women are aware that the onset of menopause can bring some unwelcome symptoms including hot flashes, mood swings or depression, night sweats, and sleep disturbances among others. Generally speaking, menopause for most women will occur between the ages of 45 and 55.

However, some women will experience these symptoms much sooner and may have a condition called primary ovarian insufficiency or POI. Women under 40 whose ovaries stop producing estrogen will experience all the symptoms typically experienced by more mature women, including infertility.

Several conditions can cause POI including certain autoimmune diseases, exposure to certain chemotherapy or radiation treatments, and a few types of chromosomal abnormalities, as well as contact with toxins such as chemicals like pesticides, cigarette smoke, and viruses.

Additionally, there is a hereditary component to POI, 10 to 20 percent of women diagnosed will have a mother or sister with the condition. It is estimated that POI affects around 1 percent of women under the age of 40 and 0.1 percent under the age of 30.

Typically, when a woman is born her ovaries contain a finite numbers of eggs. Her ovaries also produce the hormones estrogen and progesterone, which modulate her menstrual and ovulation cycles. As a woman ages, her eggs are depleted and her estrogen and progesterone levels drop, thus ending menstruation and fertility and bringing on the symptoms of menopause.

In rare cases, women can be born with X chromosomal variations, which will affect her ovaries. Turner syndrome and Fragile X are 2 of the most common conditions that are associated with POI, but again these are rare conditions. In addition to chromosomal alterations, women with certain autoimmune diseases have a higher incidence of POI. These include women with Addison’s disease and thyroiditis.

It’s estimated that about 20 percent of POI cases are related to an autoimmune diseases. Thyroiditis or inflammation of the thyroid gland is the most common autoimmune condition associated with primary ovarian insufficiency as the thyroid gland is essential in regulating the body’s metabolism.

Graves disease and Hashimoto’s disease are two of the more common diseases. Addison’s disease is another condition, which involves the adrenal glands, which also affect ovarian function. Women who are treated for cancer with radiation and chemotherapy may find that these treatments, while often life-saving, can affect their ovaries and cause POI.

Today, many girls and young women are often given information about preserving their fertility through oocyte or embryo cryopreservation prior to starting cancer treatments. These options are about preserving fertility, but the symptoms of POI will remain.

In addition to the toxicity of radiation and chemotherapy drugs, it is theorized that exposures to environmental toxins such as pesticides, chemicals, and even viruses may result in damage to the ovaries, bringing about POI. Toxin exposure, chromosomal defects, and autoimmune diseases actually only account for about 10 percent of POI cases. The remaining 90 percent of cases fall generally under the category of unknown or idiopathic.

Consulting with your healthcare provider is important to narrow down what may be the origin of POI. Symptoms in women under 40 such as irregular or absence of menstrual periods, hot flashes, night sweats, change in normal vaginal discharge, loss of libido, mood swings, trouble sleeping, or reduction in breast size should be shared with your physician or health care provider.

He or she can order several blood tests, which can evaluate your ovarian health, including one called Follicle Stimulating Hormone or FSH. A higher than normal FSH may indicate POI. Additionally, your health care provider may want to test your thyroid levels and order other tests to check your overall health.

If a diagnosis of POI is confirmed, it is important to get treatment to help mitigate the complications of this condition. Hormone replacement therapy or HRT of both estrogen and progesterone will help to alleviate the symptoms mentioned above, but most importantly will help to reduce some of the long-term complications, including osteoporosis, heart disease, depression, and early onset dementia.

Unfortunately, HRT will not resolve the complication of infertility. In rare cases, women with POI can achieve pregnancy. If pregnancy is desired, consultation with an infertility specialist is recommended to discuss options such as in vitro fertilization with donor eggs.

For many younger women, particularly those who have not yet had children, the diagnosis of primary ovarian insufficiency can be emotionally difficult. It’s important to discuss these feelings with professionals who can help navigate the complexities of infertility.

Primary ovarian insufficiency can be a troubling diagnosis, particularly for younger women, but treatment can help to lessen both the immediate symptoms and the long-term health complications.

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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