Premature Ovarian Failure or Primary Ovarian Insufficiency (POF OR POI)Dr Asha S Vijay

Premature Ovarian Failure or Primary Ovarian Insufficiency (POF OR POI) is early menopause or premature ovarian insufficiency. The period between puberty and menopause is the reproductive period in a woman. In a woman, if the ovaries stop producing eggs early before the age of 40 and there are subsequently no periods, this is known as premature ovarian failure or primary ovarian insufficiency.

Women who have POF may experience some symptoms on the brink of menopause like:

• Hot flashes

• Irregular or no periods (which might be present for years or develop after a pregnancy or after stopping birth control pills)

• Vaginal dryness

• Dry eyes

• Night sweats

• Irritability or difficulty in concentrating

• Difficulty in getting pregnant

• Decreased sexual desire.

• POF or POI may occur abruptly over 1 to 2 months or gradually repeat over several times in a year. Another sign of POF is higher levels of FSH (Follicle Stimulating Hormone) or estrogen levels.

POF or POI may be caused by:

• Chromosomal defects: Some genetic disorders are associated with POF. These include mosaic Turner syndrome — during which a lady has just one normal X chromosome and an altered second X chromosome — and fragile X syndrome — in which the X chromosomes are fragile and break.

• Toxins: Toxin-induced ovarian failure may occur due to Chemotherapy and radiation therapy. Damage to the genetic material in cells occurs due to these therapies. Other toxins like cigarette smoke, chemicals, pesticides, and viruses might fasten ovarian failure.

• Immune system response to ovarian tissue (an autoimmune disease):It is a rare form in which your system produces antibodies against your ovarian tissue, harming and damaging the eggs containing the follicles. What triggers the immune reaction is unclear, but exposure to an epidemic is possible.

• Unknown factors: The explanation for primary ovarian insufficiency is usually unknown (idiopathic). Your doctor might recommend further testing to find the reason. But in many cases, the cause remains unclear.

Certain factors increase your risk of developing primary ovarian insufficiency:

• Age Factor: The risk of POI is high in women of age between ages 35 and 40. Rarely in women before age 30, but primary ovarian insufficiency is possible in younger ladies and even in teenagers.

• Family history: Having a case history of primary ovarian insufficiency increases your risk of developing this disorder.

• Ovarian surgery: Surgeries involving the ovaries increase the danger of primary ovarian insufficiency.

Complications of Primary Ovarian Insufficiency include:

• Infertility: Inability to urge pregnant is often a complication of primary ovarian insufficiency. In rare cases, pregnancy is possible until the eggs are depleted.

• Osteoporosis: The hormone estrogen helps maintain bone strength. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to interrupt than healthy bones.

• Depression or anxiety: Some women tend to become depressed or anxious due to infertility and other complications arising due to low estrogen levels.

• Heart disease: Early loss of estrogen might increase your risk.

POF or POI diagnosis is made based on clinical assessment, blood tests; to look at hormone levels, antibodies, & genetic tests, and an ultrasound scan of the ovaries to evaluate the ovaries & uterus.

POF or POI is permanent. The treatment replaces the ovaries no longer produced, such as estrogen & progesterone. HRT-Hormone Replacement Therapy could help with menopausal symptoms.

POF or POI affects 1% of young women. It seriously interfaces with fertility and family planning. Pregnancy is, however, possible through assisted conception, with success rates up to 35%, depending on various factors such as to cause of POF or POI, treatment type & woman’s age. Egg donation & IVF offer POF or POI-affected women the best chances of conception.