Premature Ovarian Failure

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Women's Wellness
Premature Ovarian Failure

Medically Reviewed January 2024, by Dr. Susan Mayou (GMC: 2405092) - founder of the Cadogan Clinic and one of the world's leading dermatologists

What is Premature Ovarian Failure?

Premature ovarian failure (POF), also known as primary ovarian insufficiency (POI), is when a woman’s ovaries stop working as they should before the age of 40.

Women with this condition produce less oestrogen and don’t release eggs as frequently as before, causing irregular periods. The condition can lead to infertility, although women with premature ovarian failure may still be able to get pregnant if they have occasional periods. The symptoms of premature ovarian failure are similar to those experienced in premature menopause, but women with premature menopause don’t have periods and can’t get pregnant.

If left untreated, POF may lead to complications such as heart disease and osteoporosis (weak, brittle bones). The symptoms of premature ovarian failure can be treated with oestrogen, which will prevent POF-related complications from occurring.

If you have missed your period for three months or more, then you should see a doctor to find out the cause. Missing periods does not always mean that you have POF as missing or irregular periods can be due to a number of reasons, such as stress, dietary changes or pregnancy. You should also make an appointment with the doctor if you have not conceived after one year of trying.

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What are the symptoms of Premature Ovarian Failure?

There are a number of symptoms which may indicate premature ovarian failure. You may be experiencing one, some or all of these.

Irregular or missing periods. You may have been experiencing this for many months or years or they may have developed after pregnancy or after you stopped using birth control pills.
Difficulty conceiving
Decreased sexual desire
Vaginal dryness
Hot flushes
Night sweats
Frequent urinary tract infections (UTIs)
Difficulty sleeping
Headaches
Heart palpitations
Joint stiffness
Irritability
Difficulty concentrating
Dry eyes

These symptoms can also be signs of menopause or oestrogen deficiency, so it is important to see a doctor to get an accurate diagnosis.

The symptoms of premature ovarian failure can also lead to a woman developing anxiety or depression. The risk of this is higher if you are having difficulty conceiving or are concerned about the risk of complications from POF. If you are experiencing depression or anxiety, make sure to tell your doctor so you can get appropriate support.

What causes Premature Ovarian Failure?

The main causes of premature ovarian failure are:

Genetic disorders: Certain genetic disorders have been found to cause primary ovarian insufficiency. These conditions include Turner syndrome (involving one altered X chromosome) and fragile X syndrome (where X syndromes are fragile and break).
Autoimmune disease: The immune system produces antibodies which work against the ovarian tissue, harming the egg-containing follicles and damaging the egg. Autoimmune diseases that may trigger premature ovarian failure include thyroid disease or diabetes.
Cancer treatments: Radiation therapy and chemotherapy damage genetic materials (eggs and sperm) and these cancer treatments are a common cause of premature ovarian failure.
Toxins: Exposure to certain toxins, such as viruses, cigarette smoke, pesticides and chemicals, may cause POF.

However, despite numerous tests and investigations, it is not always clear what causes premature ovarian failure. This can be difficult to accept and sometimes this may trigger mental and emotional distress. If this is the case, you should consider seeking further support.

Who is at risk of Premature Ovarian Failure?

You are at an increased risk of premature ovarian failure if you fall into one or more of the following categories:

Age: Premature ovarian failure affects women under the age of 40, with women aged between 35 and 45 at the highest risk. It is rare for women under 30 to develop POF, although the condition can affect young women and even those in their teens.
Family history: A family history of premature ovarian failure is a major risk factor. If your mother, aunt, grandmother or another family member has experienced primary ovarian insufficiency, then you are at a higher risk of POI.
Ovarian surgery: If you have previously undergone any surgery which involved your ovaries, then you are at a higher risk of primary ovarian insufficiency.

How is it diagnosed?

If you are experiencing POF symptoms, you should make an appointment to see a doctor. They will ask you questions about your symptoms. Although you may find it embarrassing, it is important that you answer open and honestly. Rest assured that our expert consultants will treat you with the respect and dignity you deserve.

The doctor will carry out a physical exam, including a pelvic exam, and may recommend further tests to check for pregnancy, hormone levels, chromosome changes or the presence of certain genes. A blood sample will be taken to test for all of the above.

How is Premature Ovarian Failure treated?

Premature ovarian failure is treated with prescribed oestrogen therapy. Taking this hormone will help to relieve the symptoms of POF, such as hot flashes and night sweats, but it will also effectively reduce the risk of complications, such as osteoporosis. You may be prescribed oestrogen combined with the hormone progesterone (hormone replacement therapy, also known as HRT). If you still have your uterus, then this may make your period come back. Unfortunately the treatment will not restore ovarian function.

You will likely need to take HRT for many years, but some women may choose to stop at around the age of 50 or 51, which is the average age of when the body naturally goes into menopause. There is evidence to show that the risk of breast cancer and cardiovascular disease is increased when older women take HRT. However in young women with premature ovarian failure, the benefits of hormone therapy far outweighs any potential risks.

Women who are being treated for POF may also benefit from taking calcium and vitamin D supplements, which are important for preventing osteoporosis. This is particularly important in a country like the UK where exposure to sunlight is often limited.

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Frequently Asked Questions

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Can you cure primary ovarian insufficiency?

Unfortunately, primary ovarian insufficiency cannot be cured. While hormone replacement therapy can successfully treat the symptoms associated with POI, the treatment cannot restore ovarian function. But taking HRT can prevent you from developing potentially serious health conditions which may be triggered by primary ovarian insufficiency, such as heart disease and osteoporosis. If you are struggling to conceive with premature ovarian failure, fertility treatment, such as IVF, can help.

Can you conceive with primary ovarian insufficiency?

Yes, it is possible to conceive with primary ovarian insufficiency, as women with POF still have periods and are still capable of getting pregnant. However, because periods are often irregular or missing in women with POF, this can make trying for a baby difficult. Hormone replacement therapy cannot restore ovarian function.

Many women with premature ovarian failure opt for fertility treatment. If you are unable to get pregnant after a year of trying, then you should speak to your doctor.

Can you ovulate with POI?

Women with POI do ovulate, although they do not release an egg every month. This makes periods unpredictable and makes it more difficult to get pregnant.

Studies have shown that 5 to 10% of women with premature ovarian failure where the cause is unknown do sometimes ovulate and become pregnant.

If you have POI and are having difficulty getting pregnant, you may be able to have IVF using eggs from a donor.

Can stress cause primary ovarian insufficiency?

Stress does not cause primary ovarian insufficiency. However high stress levels can often be to blame for absent periods.

This is because the hypothalamus, the part of the brain that controls your menstrual cycle, is highly sensitive to external factors, such as stress. When working correctly, the hypothalamus releases chemicals that stimulate the pituitary gland, which then stimulate your ovary to release oestrogen and progesterone which triggers your period. When under stress, your body produces the hormone cortisol, which can disrupt the function of the hypothalamus, pituitary gland and ovaries, causing irregular or delayed periods.

What are possible complications of primary ovarian insufficiency?

Infertility is the main complication associated with primary ovarian insufficiency. POI treatments cannot restore ovarian function, so hormone replacement therapy will not increase your chances of getting pregnant.

Other possible complications include:

Osteoporosis: Oestrogen is responsible for helping to keep bones strong. Low levels of oestrogen increases the risk of the bones becoming weak and brittle, known as osteoporosis. Brittle bones are more likely to break than bones that are healthy and strong.
Heart disease: Depleted oestrogen levels earlier in life have been shown to heighten the risk of heart disease.
Depression or anxiety: The risk of infertility and other complications caused by POI can trigger feelings of depression or anxiety in some women.

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