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Primary Ovarian Insufficiency

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Introduction

Primary Ovarian Insufficiency is a condition where the ovaries of a woman stop functioning normally before she reaches 40 years’ of age. This condition leads to the ovaries not producing the normal amounts of oestrogen or not releasing eggs regularly.

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What is Primary Ovarian Insufficiency?

Primary Ovarian Insufficiency is also termed as premature menopause or premature ovarian failure. However, these terms can often mislead, since women having this condition do not always stop menstruating nor their ovaries completely stop functioning. This condition just means that the ovaries stop functioning normally.

In Primary Ovarian Insufficiency, the ovaries either stop producing hormones like oestrogen, progesterone or testosterone or produce them intermittently and/or the ovaries stop releasing eggs or release them intermittently. The hormone oestrogen controls the menstrual periods and maintaining fertility.

What are the Causes of Primary Ovarian Insufficiency?

In most cases, the exact cause of Primary Ovarian Insufficiency is unknown. There might be various causes that result in this condition. Potential causes include:

  • A reduced number of follicles: These are small sacs inside the ovaries which hold the eggs as they mature. In this condition, the follicles can either be depleted or not work properly. Insufficient number of follicles at birth can also be a cause for this condition.
  • Autoimmune disorders: The immune system produces antibodies against its own ovarian tissue causing harm to the follicles and damaging the egg.
  • Genetic disorders: Certain women have chromosomal defects which result in genetic disorders like the Turner syndrome wherein the second X chromosome is altered or the Fragile X syndrome in which the X chromosomes are delicate. Women with these disorders are at a higher risk of developing this condition.
  • ● Toxins induced ovarian failure can be a potential cause resulting from chemotherapy and radiation therapy. Other toxins include smoke from cigarettes, pesticides, and certain chemicals.

What are the Symptoms of Primary Ovarian Insufficiency?

Signs and symptoms of Primary Ovarian Insufficiency are like that experienced by women during their natural menopause. The initial and most common sign overlooked is of irregular periods. Other symptoms include:

  1. Vaginal dryness
  2. Hot flashes
  3. Night sweats
  4. Difficulty in getting pregnant
  5. Decreased sexual desire
  6. Difficulty in concentrating
  7. Irritability
  8. Pain during sexual intercourse
  9. Anxiety, depression or mood swings

How is Primary Ovarian Insufficiency Diagnosed?

Diagnosis starts with a physical exam, which is a pelvic exam. This is to look for the signs of other disorders which could be causing the symptoms. The doctor asks for the medical history of the patient and about her menstrual cycle and if she has had any previous exposure to chemotherapy and radiation therapy.

The doctor may then ask for certain tests to be carried out. These include:

  • ● Pregnancy test to ensure that the patient is not pregnant.
  • ● Blood tests in order to check for hormone levels in the blood. These include the follicle-stimulating hormone (FSH), oestradiol which is a type of oestrogen made by the ovaries and prolactin which stimulates the production of breast milk.
  • ● Pelvic ultrasound is done to check for multiple follicles or to check if there is an enlarged ovary.
  • ● Transvaginal ultrasound might be carried out too.

How is Primary Ovarian Insufficiency Treated?

Presently there is no cure for Primary Ovarian Insufficiency, but there are certain measures that can be taken to manage the symptoms and provide relief to the patient.

  • Hormone Replacement  Therapy (HRT): This is the main common treatment for primary ovarian insufficiency. It gives the body the much-needed oestrogen and the other hormones that the ovaries cannot make. This also improves sexual health and decreases the risk of osteoporosis and heart diseases.
  • Calcium and Vitamin D supplements: Taking calcium and vitamin D supplements regularly can help reduce the risk of osteoporosis.
  • In Vitro Fertilisation: This technique can help women having primary ovarian insufficiency become pregnant.
  • ● Maintaining a healthy body weight.
  • ● Ensuring regular physical activity.
  • ● Treating associated conditions that are related to primary ovarian insufficiency.
  • ● Keeping track of the menstrual cycle and other signs and symptoms.

What is the Results of Primary Ovarian Insufficiency Treatment?

Wishing to become pregnant even after diagnosis may be difficult and hence it is important to be open to the partner, seek support through counselling and take good care of the body by eating well and doing proper exercises.

What are the Risks Associated with Primary Ovarian Insufficiency treatments?

Complications from this condition include:

  • Infertility: The patient might develop infertility and lose her ability to get pregnant
  • ● Heart diseases
  • Osteoporosis: Oestrogen helps maintain strong bones and lower levels will result in weak and delicate bones
  • ● Depression and anxiety resulting from the risk of infertility.

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FAQ's

Can Ovaries Work Normally Again?

There is no treatment available currently, which may cause the ovaries to work again normally. It is very rare that the ovaries work again, and even if they do, the reason remains unknown.

How is Primary Ovarian Insufficiency Different from Premature Menopause?

Primary Ovarian insufficiency does not stop the menstrual cycle and the patient will still experience her periods whereas, in premature menopause, the menstrual cycle comes to a halt.

What Other Problems can Primary Ovarian Insufficiency Cause?

Patients having this condition are at a higher risk of developing heart diseases, depression and anxiety, osteoporosis, infertility, dry eye syndrome and hypothyroidism.

Who is at Risk of Developing Primary Ovarian Insufficiency?

Following factors increase the risk of developing this condition. These include genetic factors (chromosomal defects), autoimmune diseases and viral infections, cancer treatments like chemotherapy and radiation therapy, and previous family history. Even age is a factor, as women between the age of 35-40 are at a higher risk.

What Exactly is Hormone Replacement Therapy?

Hormone replacement therapy is a therapy which gives the body oestrogen and other hormones which are at low levels as the ovaries do not function normally.

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