Premature ovarian failure (POF) is a condition in which your ovaries stop functioning properly before the age of 40. POF affects about 1% of females, and is also known as premature ovarian insufficiency (POI) or premature menopause. In this article, we'll discuss the causes, symptoms, diagnosis, treatment options for POF, and how it can affect your mental and emotional well-being.
What causes premature ovarian failure?
POF is a complex and multifactorial condition, with the exact cause remaining unknown in the vast majority (90%) of cases. However, research suggests that the problem is often related to issues with the follicles (the small sacs in the ovaries where the eggs mature). Some people with POF may run out of functional follicles earlier than expected, while others may have follicles that are not functioning properly.
While the cause is often unknown, there are several factors that have been linked to POF. These include genetic disorders such as Fragile X syndrome and Turner syndrome, autoimmune diseases such as thyroiditis and Addison disease, exposure to toxins like cigarette smoke, chemicals, and pesticides, as well as certain metabolic disorders. Additionally, treatments such as chemotherapy or radiation therapy can also increase the risk of developing POF.
Symptoms of premature ovarian failure
The symptoms of POF are similar to those of menopause, and include irregular periods, hot flashes, vaginal dryness, and mood changes. Those with POF may also experience infertility or difficulty getting pregnant. In addition, POF can increase the risk of osteoporosis and heart disease. POF can also lead to a decrease in libido and sexual function, as well as depression and anxiety.
How do I know if I have premature ovarian failure?
POF is diagnosed based on symptoms, medical history, and blood tests that measure levels of certain hormones. Females with POF typically have low levels of estrogen and high levels of follicle-stimulating hormone (FSH), which stimulates the ovaries to produce eggs. A pelvic exam and ultrasound may also be performed to evaluate the ovaries and determine if there are any structural abnormalities.
Premature ovarian failure and estrogen levels
POF can lead to low estrogen levels, which can cause a range of symptoms. Estrogen plays a vital role in the reproductive system and overall health. It helps regulate the menstrual cycle, maintains bone density, and supports vaginal and urinary health. When estrogen levels drop, you may experience symptoms like hot flashes, night sweats, vaginal dryness, mood changes, and difficulty sleeping. All of these are generally a result of lower estrogen levels.
Premature ovarian failure and FSH levels
Follicle-stimulating hormone (FSH) is a hormone that stimulates the growth of ovarian follicles and the production of estrogen. In those with premature ovarian failure, FSH levels are typically high due to the lack of viable follicles in the ovaries. High levels of FSH can be a useful tool in diagnosing POF.
Premature ovarian failure and AMH levels
Anti-Mullerian hormone (AMH) is a hormone that is produced by the ovarian follicles. Low levels of AMH can be a sign of a low ovarian reserve, which is a common characteristic of premature ovarian failure. While AMH levels can be useful in diagnosing POF, they are not always a reliable indicator of fertility potential.
Do you still have eggs with premature ovarian failure?
Premature ovarian failure is usually characterized by a decline in the number of eggs you have. However, some individuals with premature ovarian failure may still have a small number of eggs in their ovaries, especially early in the diagnosis.
This can be determined through an ovarian reserve test, which measures the number of follicles (fluid-filled sacs that contain immature eggs) present in the ovaries.
However, for most individuals with premature ovarian failure, the number of eggs left may be too low for successful fertility treatment using their own eggs. In these cases, donor eggs may be a viable option for achieving a healthy pregnancy.
Can premature ovarian failure be cured?
There is no cure for POF, but there are several treatment options available. Hormone replacement therapy (HRT) can help alleviate symptoms of menopause and reduce the risk of osteoporosis and heart disease. Those with POF who wish to conceive can also explore fertility treatments like in vitro fertilization (IVF) with donor eggs. This can be a successful option for those with POF since the donor eggs come from women who are more likely to produce healthy embryos.
Can someone with premature ovarian failure get pregnant?
While premature ovarian failure can make it difficult to conceive unassisted, it is still possible for some people to get pregnant with the help of assisted reproductive technologies, like donor egg IVF. In some cases, patients with POF may even be able to use their own eggs if they have enough viable follicles remaining. However, the success rates of these treatments are generally lower than for people without POF.
The good news, though, is that people with POF are generally able to carry a healthy pregnancy!
Can you do IVF with premature ovarian failure?
Yes! IVF may be an option for those with premature ovarian failure who still have a small number of eggs in their ovaries. In some cases, these eggs can be retrieved and used for IVF. But it may take higher doses of medications, and more cycles to achieve success.
However, if you have very few or no eggs remaining, IVF with donor eggs may be recommended instead.
Mental and emotional well-being, and coping strategies
POF can have a significant impact on your mental and emotional well-being. The diagnosis of POF can be devastating, and you may experience a range of emotions, including grief, anger, and depression. It is so important to seek support from a mental health professional and to connect with others who have experienced POF.
There are several coping strategies to manage your symptoms and improve your quality of life. Focus on maintaining a healthy lifestyle by eating a balanced diet, getting regular exercise, and reducing stress. Those with POF can also explore alternative therapies such as yoga, meditation, or massage to help manage symptoms and gain a sense of inner peace. Those with POF should also be proactive about their healthcare by staying up to date on their medical appointments and advocating for themselves.
Premature ovarian failure can be a challenging condition to manage, but there are options available to help alleviate symptoms and increase the chances of starting a family. If you suspect you may have POF, it's important to speak with your doctor to start an evaluation.
Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account today!
Mare Mbaye, MD is a board certified OBGYN based in New York City, in addition to being a Cofertility Founding Medical Advisor. She has worked in the private practice setting caring for pregnant and non-pregnant people with a variety of medical concerns. Dr. Mbaye also boasts several years of experience as a medical advisor, digital health startup consultant, and content creator. Previously, Dr. Mbaye has served as the Medical Director for Noula Health and advised, consulted, and created original content for other startups including Delfina Care, Mina Health, and Pollie. Today, she is also a Medical Advisor for Frame Fertility. Dr. Mbaye is on a mission to bring empathetic, holistic, and affirming reproductive healthcare to all, with a particular focus on historically marginalized groups. With Cofertility, Dr. Mbaye hopes to bridge accessibility gaps in egg freezing to provide people with more freedom and options when it comes to how they build their families. She loves supporting work in the fertility space that thinks outside the conventional bounds of traditional healthcare in the US.
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