Premature ovarian failure

What is 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 problems.
Premature ovarian failure is called premature menopause, although the two disorders are not identical. Thus, premature menopause her periods completely disappear, while women with premature ovarian failure may have sporadic menses and may even become pregnant.
Restoring normal levels of estrogen in women with premature ovarian failure can help prevent complications (osteoporosis, for example). Instead, it is difficult to treat infertility.
Premature ovarian failure affects 1 in 1,000 women aged between 15 and 29 years.

What causes premature ovarian failure?
The ovaries hold thousands of immature follicles that contain eggs. At the beginning of each menstrual cycle, the pituitary gland secretes 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. Rising estrogen levels "notify" the pituitary gland that follicle-stimulating hormone (FSH) is no longer necessary.
If the follicles do not mature and do not release a normal amount of estrogen, follicle-stimulating hormone levels continue to rise. This explains the fact that women with premature ovarian failure have an increased level of FSH in the blood.
Normally, the pituitary gland releases another 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 sperm. Without the increased estrogen levels due to the maturing follicles and followed by significant increase in the level of luteinizing hormone, ovulation does not occur.
Premature ovarian failure occurs when the ovaries no follicles, or when they no longer respond properly to stimulation hormone and of causes:
"Chromosomal abnormalities - some genetic diseases are associated with premature ovarian failure, including Turner syndrome (lack of X chromosome) and fragile X chromosome syndrome.
"Toxins - chemotherapy and radiotherapy are the most common causes of premature ovarian failure caused by toxins. These therapies can damage the genetic material of cells. Other toxins such as cigarette smoke, pesticides and other chemicals and some viruses may be responsible for the occurrence of ovarian failure.
»Autoimume diseases - often the body may produce antibodies against ovarian tissue, affecting the egg-containing follicles. There are no known causes of these diseases, but the process can be initiated by exposure to a virus.
Often it is difficult to pinpoint an exact cause of premature ovarian failure. In most cases the cause is unknown.

What are the risk factors?
Certain factors may increase the risk of premature ovarian failure:
»Age - the risk of ovarian failure increases with age. The incidence is 1 / 250 women 35 years and 1 / 100 to 40 years.
»Family history - Family history positive for premature ovarian failure increases the risk of this disease. Approximately 10% of cases are hereditary.

What are the clinical manifestations?
The symptoms of premature ovarian failure are similar to those of menopause. Menstrual cycle may become irregular (in a month and so miss next month) or can be permanently stopped, hot flushes, night sweats, irritability, vaginal dryness, decreased libido, insomnia. The most common sign of premature ovarian failure lies in stopping menstruation (amenorrhea) or irregular periods. Some patients with premature ovarian failure shows irregular menstrual cycles for several years, while others noted the absence of menstruation after pregnancy or after discontinuing the contraceptive.

Complications
• Infertility
A very small number of women with premature ovarian failure may become pregnant and give birth 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).
• Addison's Disease
This condition occurs when the adrenal glands do not produce certain hormones in sufficient quantities 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 Addison's disease.
• Depression and anxiety in some women.