Premature ovarian failure (POF) is the cease of the ovarian activity at an early age, when the ovaries stop working before entering in the menopause age, approximately at age 40. Women cease ovulation and their blood estrogen levels decrease.
The different sections of this article have been assembled into the following table of contents.
There is different terminology regarding the concept of POF, and that may create some confusion, given the fact that not every term shares the same characteristics. Among them we find early menopause, premature ovarian insufficiency (POI), premature gonadal failure, gonadal dysgenesis, hypogonadal amenorrhea, etc.
During embryo development, in the eighth week of gestation, gender differentiation begins, reaching in 20th week a number close to 6-7 million ovums that will progressively decrease by atresia until the moment of birth. During puberty, there will be 300,000 eggs left to be used in every menstrual cycle during the reproductive window. Theoretically, women at birth have enough eggs for 50 years.
When menstruation is ceased by an ovarian follicle exhaustion before 40 years of age, or if there is a lack of response of ovarian follicles to the hormonal stimulus of the gonadotropins, we will be facing a premature ovarian failure.
We don't know exactly what the global incidence is, but 1-4% of the female population is estimated to have premature ovarian syndrome. In the USA, surveys show an incidence of the pathology of one in every 100 women.
POF has a wide range of causes, some of them hard to discern, but we can find these among them:
- Genetic disorders (Weak-X Syndrome, Turner Syndrome, etc.).
- Exposure to toxics, as in chemotherapy or radiotherapy.
- Enzymatic or metabolic defects (galactosemia, hemochromatosis, etc.).
- Diseases such as nervous anorexia, diabetes, pernicious anemia, lupus, etc.
- Familiar history.
- Herpes zoster or cytomegalovirus infections.
Symptoms and diagnosis
Every symptom may not be presented at the same time, perhaps only some of them, or they manifest intermittently. The only one that does occur is the difficulty to achieve pregnancy.
Some of the symptoms that may appear are:
- Irregular periods.
- Night sweats.
- Vaginal dryness.
- Lack of sex drive.
- Concentration problems.
- Sterility and/or infertility problems.
In order to determine a diagnosis of the premature ovarian failure, the woman has to be 40 or under and a missing menstruation for more than 3 months. Moreover, other factors are also taken into account, such as the presence of climacteric syndrome (partial or complete), previous sterility and a hormonal analysis showing high gonadotropins levels, FSH equal to or higher than 25mUI/ml between the third and fifth days of the menstrual cycle.
The diagnosis is performed through a previous anamnesis alongside a physical and genital exploration. To confirm the syndrome, a FSH and 17β-estradiol blood test is performed, wherein high FSH and low estradiol confirm the evidence of ovarian failure. A vaginal ultrasound can also be performed in order to confirm whether there are follicles or not.
Treatment of POF depends on the symptoms the woman has and the presence of greater health risks, such as osteoporosis or cardiac diseases provoked by low estrogens levels.
The hormone replacement therapy, using pills or estrogens and progesterone patchs, is the most used, as it reliefs the menopausal effects and helps fighting bone loss, a feature associated with osteoporosis. For those who choose not to get pregnant, the contraceptive pill can be a solution.
Besides, women whose choice is not to undergo hormone therapies can resort to natural medicine with a therapy consisting of plants that regulate hormonal imbalances.
Ovodonation is the most successful therapeutical option for women wishing to be on motherhood.
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