Premature ovarian failure

Premature Ovarian Failure (POF), also known as premature menopause, affects approximately 1-4% of the female population in the U.S., which is about 150,000 to 600,000 women. Normally, ovaries supply women with eggs until about age 51, the average age of natural menopause.

POF is not the same as a natural menopause, in that the dysfunction of the ovaries, loss of eggs, or removal of the ovaries at a young age is not a natural physiological occurrence.

Infertility is the result of this condition, and is the most discussed problem resulting from it, but there are additional health implications of the problem, and studies are ongoing. For example, osteoporosis or decreased bone density affects almost all women with POF due to an insufficiency of estrogen. There is also an increased risk of heart disease, hypothyroidism in the form of Hashimoto's thyroiditis, Addison's disease, and other auto-immune disorders.

Hormonally, POF is defined by abnormally low levels of estrogen and high levels of FSH, which demonstrate that the ovaries are no longer responding to circulating FSH by producing estrogen and developing fertile eggs. The ovaries will likely appear shriveled.

Age of onset can be as early as the teenage years but varies widely. If a girl never begins menstruation, it is called primary ovarian failure. The age of 40 was chosen as the cut-off point for a diagnosis of POF. This age was chosen somewhat arbitrarily, as all women's ovaries decline in function over time, however an age needed to be chosen to distinguish usual menopause from the abnormal state of premature menopause. Premature ovarian failure however often has components to it that distinguish it from normal menopause.

By the age of 40, approximately one percent of women have POF. Women suffering from POF usually experience menopausal symptoms, which are generally more severe than the symptoms found in older menopausal women.

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Causes

The cause of POF is usually idiopathic. Some cases of POF are attributed to autoimmune disorders, others to genetic disorders such as Turner syndrome and Fragile X syndrome. In many cases, the cause cannot be determined. Chemotherapy and radiation treatments for cancer can sometimes cause ovarian failure. In natural menopause, the ovaries usually continue to produce low levels of hormones, but in chemotherapy or radiation-induced POF, the ovaries will often cease all functioning and hormone levels will be similar to those of a woman whose ovaries have been removed. Women who have had their tubes tied, or who have had hysterectomies, tend to go through menopause several years earlier than average, likely due to decreased blood flow to the ovaries. Family history and ovarian or other pelvic surgery earlier in life are also implicated as risk factors for POF.

The POF Fact Sheet lists potential causes of POF:
English: http://www.pofsupport.org/information/factsheet/fact_sheet_english.pdf

Laboratory

Serum Luteinizing hormone (LH) and follicule-Stimulating hormone (FSH) measurement can be used to diagnose the disease. The anterior pituitary secretes FSH and LH at high levels due to the dysfunction of the ovaries and consequent low estrogen levels.

Fertility

Between 5 and 10 percent of women with POF may spontaneously become pregnant. Currently no fertility treatment has been found to effectively increase fertility in women with POF, and the use of donor eggs and adoption have become more popular as a means of becoming parents for women with POF. Some women with POF choose to live child-free.

Related Conditions

Impaired Ovarian Reserve

• U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, NICHD Information Resource Center, Do I have Premature Ovarian Failure? NIH pub. No. 03-5159, August 2003. You can order free copies by calling 1-800-370-2943, and it’s also available for download at http://www.nichd.nih.gov/publications/pubs/pof/upload/premature_ovarian_failure.pdf

• National Institutes of Health/ Premature Ovarian Failure website http://eclipse.nichd.nih.gov/nichd/deb/geuPOF/resources.htm

• Current POF Clinical trials via the NIH recruiting patients http://www.clinicaltrials.gov and search “premature ovarian failure”

• "What's The Best Approach To Spontaneous Premature Ovarian Failure?", by Dr. Lawrence Nelson, Principal Investigator at NIH for POF research studies/clinical trials. http://pof.nichd.nih.gov/Contemp_ObGyn_2004_POF.pdf

• Women with premature menopause at increased risk for potentially fatal adrenal condition-early diagnosis can lead to effective treatment, NIH News Release. http://www.nih.gov/news/pr/aug2002/nichd-30.htm. Nelson, L., 2002.

• Irregular periods in young women could be warning sign for later osteoporosis, NIH News Release. http://www.nih.gov/news/pr/may2002/nichd-29.htm. Nelson, L., 2002.