Primary Ovarian Insufficiency

Conditions Basics

What is primary ovarian insufficiency?

Primary ovarian insufficiency (sometimes called premature ovarian failure) occurs when your ovaries-which store and release eggs-stop working before age 40. You may have no or few eggs. Depending on the cause, primary ovarian insufficiency may develop as early as the teen years, or the problem may have been present from birth.

What causes it?

Although the exact cause of primary ovarian insufficiency may be unknown, a genetic factor or a problem with the body's immune system may play a role. In an immune system disorder, the body may attack its own tissues-in this case, the ovaries.

Primary ovarian insufficiency may develop after a hysterectomy or other pelvic surgery or from radiation or chemotherapy treatment for cancer. In some of these cases, the condition may be temporary, with the ovaries starting to work again some years later.

What are the symptoms?

The symptoms of primary ovarian insufficiency are similar to those of menopause. Your menstrual periods may become irregular—you have a period one month but not the next—or they may stop. You also may have some or all of the symptoms of menopause, such as hot flashes, night sweats, irritability, vaginal dryness, low sex drive, or trouble sleeping.

Symptoms can also include fertility problems. It may be more difficult, though not impossible, to become pregnant.

How is it diagnosed?

If your periods become irregular or stop, your doctor will give you a physical exam and ask you questions about your general health and whether you have other symptoms of primary ovarian insufficiency. You will also have a pregnancy test and blood tests.

To check for possible ovarian insufficiency, your blood level of follicle-stimulating hormone (FSH) will be checked. FSH signals your body to release an egg every month. If the amount of FSH in your blood is higher than normal on more than one day, you may have primary ovarian insufficiency. Another blood test also may be done to measure the amount of estradiol (or estrogen) in your blood. Very low estrogen with a high FSH is a sign of primary ovarian insufficiency. Your blood may also be tested for other possible causes of irregular periods. This includes blood tests that check prolactin levels and thyroid function.

Some people find out they have primary ovarian insufficiency when they see a doctor because they are having trouble getting pregnant.

How is primary ovarian insufficiency treated?

Treatment for primary ovarian insufficiency will help you manage your symptoms. But there is currently no treatment that will make the ovaries start to work properly again. Your doctor may prescribe hormone therapy or other medicines to help with hot flashes. Hormone therapy can also help prevent early bone loss. Talk to your doctor about which treatments may be right for you.

Some people with primary ovarian insufficiency may choose to try to become pregnant using donor eggs and in vitro fertilization.

Finding out you have primary ovarian insufficiency can be upsetting. You may want to get support through counselling. You can also find information and support at https://fertilitymatters.ca from Fertility Matters Canada.

Can you prevent it?

At this time, there is no way to prevent primary ovarian insufficiency. But you can take steps to protect your overall health. This condition can increase your risk of bone thinning and fractures (osteoporosis) and heart disease. A balanced and low-fat diet, regular exercise, and not smoking can help protect your bones and heart. Getting enough calcium and vitamin D may help slow bone loss. Talk to your doctor about other steps you can take.