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The natural cycle of female reproduction begins with roughly two million primordial follicles where eggs to grow and mature. Typically, these follicles last until women reach menopause around age 50. However, women with primary ovarian insufficiency (POI) have problems with their follicles and the tiny seeds that eventually turn into eggs. The ovaries stop functioning before the age of 40, causing irregular infertility. In the past, POI was known as premature ovarian failure and premature menopause, but these are inaccurate descriptions that mean the woman can no longer get pregnant and will cease having menses. POI is different: the woman may have irregular periods, but she can still get pregnant and give birth to a child. In the United States, about one percent of all women have primary ovarian insufficiency.

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The Cause of Primary Ovarian Insufficiency

Many cases of primary ovarian insufficiency (almost 90 percent) are unique. The cause may be due to other conditions, genetic disorders, or viral infections. POI develops because of follicle depletion, which means the woman runs out of healthy follicles to grow the eggs until maturity. Follicle dysfunction may also cause primary ovarian insufficiency. Sometimes physical trauma can negatively impact the ovaries and follicles and render them insufficient for healthy reproduction.

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Common Symptoms of POI

The most recognizable and common symptom of primary ovarian insufficiency is irregular periods. The woman experiences regular menses for an extended period, then will have an irregular period for four months or longer. Amenorrhea is the medical term to describe an irregular period. Women with POI, in addition to amenorrhea, may also experience trouble paying attention or keeping focused, increased irritability, hot flashes, night sweats, vaginal dryness, and a decreased appetite for sex.

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Genetic Factors

Our genes define every physical characteristic of our bodies, including fertility. Specific gene conditions such as Turner Syndrome and Fragile X Syndrome are risk factors for the onset of primary ovarian insufficiency. Almost 30 percent of women with POI have a genetic component. Fragile X syndrome is the most widespread genetic form of intellectual and developmental disability. A woman who carries the mutated gene that causes Fragile X syndrome is more likely to have POI.

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Turner Syndrome

Turner syndrome is a genetic condition that inhibits development in females. The majority of women with Turner syndrome also develop primary ovarian insufficiency. Most women have two X chromosomes, while a female with Turner syndrome may be missing part or all of the second X chromosome. Individuals with Turner syndrome may experience ovarian hypofunction as well.

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Thyroiditis

Almost a quarter of all primary ovarian insufficiency cases link to autoimmune disorders. The most common is thyroiditis, where the thyroid becomes inflamed and doesn't function properly. The thyroid gland helps to regulate metabolism and ensures the body receives all the hormones it needs to function at an optimal level. If the thyroid is inflamed and cannot produce enough estrogen, fertility may decrease, resulting in POI.

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Addison's Disease

The adrenal glands have the critical task of producing hormones that help the body deal with physical stressors such as injury and infection. Addison's disease is a condition with many related diseases that can limit physical capabilities; however, fewer than five percent of women with primary ovarian insufficiency have Addison's disease.

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Other Risk Factors

The human body requires balance to function. Fertility is particularly sensitive to any hormonal imbalance and can be affected by toxins, pollutants, chemotherapy, radiation, viral infections, and sexually transmitted infections. Metabolic illnesses like galactosemia influence how adequately the body processes galactose, a form of sugar. Over 80 percent of women with galactosemia have primary ovarian insufficiency. In addition, chemicals, pesticides, and even smoking can quicken the rate of follicle depletion which can, depending on the age of the individual, lead to POI.

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Hereditary Factor

A woman whose sister or mother has primary ovarian insufficiency is more likely to develop the disease. Experts estimate between ten and 20 percent of all women with primary ovarian insufficiency have a close blood relative with the condition. If you are seeing a physician for any reproductive reason, be sure to include such hereditary factors in your medical history.

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Process for Diagnosis

POI is like many conditions in that medical professionals must rule out other possibilities before coming to a firm diagnosis. A pregnancy test will help your doctor rule out this potential cause of your irregular or absent periods. The doctor will perform an exam looking for Addison's disease and other disorders. A blood panel will test for high levels of follicle-stimulating hormones (FSH), which aid the ovaries in the production of estrogen. The FSH test is completed twice with a four-week interval. Menopausal women and individuals with POI will have high levels of this hormone in their blood.

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Tests for POI

A physician will inquire about genetic and hereditary factors which may put you at higher risk for developing primary ovarian insufficiency. There may be an investigation to identify any developmental or intellectual disabilities. It's vital to inform your doctor of factors in your medical history such as pelvic inflammatory disease, ovarian surgery, or cancer treatment (like chemotherapy or radiation) because each of these variables impacts the likelihood of contracting POI.

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Disclaimer

This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.