Most women reach menarche in their early teens if not before and continue menstruating throughout their adult years until their 50’s. While some girls do mature faster than others, and some women reach menopause earlier, failing to menstruate during your reproductive years indicates something is awry. One cause of amenorrhea, or the absence of menstruation, is primary ovarian insufficiency.
This condition can impact a woman’s fertility; however, with proper treatment, some do go on to have children. What is primary ovarian insufficiency, what causes it and how do doctors treat it?
Primary ovarian insufficiency refers to a condition where your ovaries stop functioning normally before you reach age 40. Sometimes, this results from injury or surgery; other times, there is no known cause.
Often, primary ovarian insufficiency occurs due to hormonal imbalances. When the body fails to produce sufficient estrogen or follicle-stimulating hormone (FSH), the ovary does not release an egg. The effect is the opposite of what happens in polycystic ovarian syndrome. In that disorder, the ovary releases too many eggs, leading to weight gain, hair loss and mood disorders.
Sometimes, certain autoimmune disorders such as lupus cause a woman’s body to stop ovulation. This occurs because the body begins attacking the ovarian tissue. Other times, genetic disorders such as Turner’s syndrome play a role.
While primary ovarian insufficiency sometimes occurs for no known reason, certain factors do put a woman at a higher risk of developing the condition. One factor women cannot control is their age. Women 35 and older are more likely to develop the condition, meaning women who put off starting their family may wish to bank their eggs if they hope to conceive later in life.
Researchers suspect genetics play a role in the disorder, as women with a family history of the disease are more likely to develop it themselves. Finally, if a woman undergoes multiple surgeries on her reproductive organs, especially her ovaries, she is more likely to develop primary ovarian insufficiency.
One factor a woman can control is whether or not she smokes. Researchers discovered when women smoke, polycyclic aromatic hydrocarbons (PAHs) bind to a receptor called the AHR inside her egg cells. This can lead to premature ovarian failure.
For women who have gone through puberty, the complications of the disorder grow less severe. Symptoms often mimic those associated with menopause, and the treatment protocol follows along those lines. Nearly a quarter of women experience mood changes, as well as drying skin and hair, lowered sexual desire and vaginal dryness. Many women 35 and older remain unaware they have the disorder unless they try to conceive. Hormone-replacement therapy can ease symptoms and increase fertility chances if she still wants children.
When a woman develops the disorder before she completes puberty, the consequences can prove more severe. The most troubling symptom remains lack of fertility, although women can become pregnant until they deplete their egg supply fully. For this reason, girls wishing to prevent pregnancy do well to discuss birth control with their physician.
Osteoporosis is one troubling consequence of the disorder, especially when contracted young. The disorder can stunt growth potentially due to insufficient hormone levels, and decreased estrogen levels make bones more porous and prone to breakage. This can result in dental problems, such as lost teeth, as well.
Finally, women with primary ovarian insufficiency face a higher risk of developing heart disease. When estrogen levels drop in menopause or due to the disorder, blood pressure often rises. Making lifestyle changes such as exercising 30 minutes most days per week and switching to a more plant-based diet helps stave off this complication.
The primary treatment for primary ovarian insufficiency is hormone-replacement therapy. By replacing estrogen levels, doctors can stimulate the ovaries to release eggs. This may or may not restore fertility, but it can reduce other symptoms like bone loss and mood changes.
Additionally, doctors recommend women with primary ovarian insufficiency take supplemental calcium and vitamin D. They recommend this due to the increased risk of osteoporosis and broken bones. The University of Medicine recommends women over 50 as well as those with the disorder consume 800-1200 mg of calcium per day through food or supplements.
Women who hope to reproduce but find their own egg supply lacking have options. They can utilize donor eggs and carry the fetus to term. They can also use a surrogate to carry a child, especially if other health factors make carrying to term themselves inadvisable.
Regardless of whether a woman hopes to conceive, primary ovarian insufficiency requires careful monitoring. Patients with the disorder must return to their physician regularly for hormone testing to ensure their estrogen levels remain in balance. Expanding access to health care in the U.S. by implementing a form of universal care or creating a public option can help more women maintain their fertility and protect their health.
While primary ovarian insufficiency proves a difficult diagnosis for many women to stomach, treatment options exist. If you suspect you suffer from the condition, make an appointment with your OB/GYN today. Even if you never procreate, knowledge allows you to protect your overall health from any adverse effects stemming from the condition.