What Is Primary Ovarian Insufficiency?

Primary ovarian insufficiency, also known as premature ovarian failure, occurs when an individual’s ovaries stop working before age 40.

The ovaries are a pair of female glands that are involved in the menstrual cycle, pregnancy, and menopause. The ovaries produce the hormones estrogen and progesterone and also contain an individual’s eggs. 

Primary ovarian insufficiency can lead to irregular periods and infertility. This condition is different from premature menopause.

This article describes the symptoms, risk factors, and treatment options for primary ovarian insufficiency.

Symptoms 

The first sign of primary ovarian insufficiency is usually a change in the menstrual cycle. Common symptoms include:

• Irregular periods
• Missed periods
• Difficulty getting pregnant
• Hot flashes
• Night sweats 
• Trouble concentrating
• Irritability 
• Sexual changes (decreased sex drive, painful intercourse, vaginal dryness)

Causes

The exact cause of primary ovarian insufficiency is usually unknown. In fact, the cause can only be determined in about 10% of cases.

Experts believe that the risk of primary ovarian insufficiency is linked to the health of the follicles, small sacs in the ovaries where eggs form and grow. In primary ovarian insufficiency, the follicles either do not function properly or run out earlier than expected. 

Known risk factors of primary ovarian insufficiency include:

• Family history: Having a mother or sister who has primary ovarian insufficiency raises your risk. 
• Genetic conditions: Having the genetic diseases Turner's syndrome and fragile X syndrome raises your risk of primary ovarian insufficiency. 
• Autoimmune disorders: Both thyroiditis (inflammation of the thyroid gland) and Addison's disease (an insufficient production of cortisol) have been found to raise risk. 
• Cancer treatments: Chemotherapy and radiation therapy can damage the follicles and affect fertility. 
• Environmental factors: Toxins found in cigarette smoke and pesticides may affect the number and health of the follicles. 

Diagnosis

To diagnose primary ovarian insufficiency, your healthcare provider will start with a medical history. Your provider will ask questions about your family history and if any relatives have been diagnosed with primary ovarian insufficiency. They will also ask several questions about your menstrual cycle and how long it has been irregular or absent. 

Other tests to expect include:

• Physical exam: Your healthcare provider will perform a physical exam to rule out other potential causes of irregular periods, such as Addison’s disease. 
• Pregnancy test: A pregnancy test is usually given to make sure that a new pregnancy is not the cause of changes to the menstrual cycle. 
• Follicle-stimulating hormone (FSH) blood test: FSH tells the ovaries to make estrogen. A low level indicates that the ovaries are not functioning normally.
• Estrogen blood test: A low estrogen level means that the ovaries are not functioning normally. 
• Luteinizing hormone (LH) blood test: LH tells mature follicles to release an egg. When this value is high, it usually means that the follicles are not functioning normally.
• Pelvic ultrasound: During this procedure, your healthcare provider will use a sonogram (sound waves) to visualize the ovaries and examine the follicles. 

Treatment 

There is no known cure for primary ovarian insufficiency, and no treatment option has been proven to fully restore the function of the ovaries. Treatments are usually aimed at addressing the symptoms and possible complications. 

Treatment options may include:

• Hormone therapy (HT): This is the most common treatment of primary ovarian insufficiency. HT replaces estrogen and other hormones that the ovaries normally produce. The goals of this treatment option are to improve sexual health symptoms and decrease the risk of osteoporosis. HT is usually taken until age 50 when menopause normally occurs. 
• Nutritional supplements: Your healthcare provider will likely recommend starting a daily regimen of calcium and vitamin D supplements due to the increased risk of osteoporosis. 
• In vitro fertilization (IVF): IVF may be recommended for individuals who hope to become pregnant. It’s estimated that 5%–10% of people with primary ovarian insufficiency are able to get pregnant without medical interventions. 
• Therapy: It is common for individuals diagnosed with primary ovarian insufficiency to experience a sense of loss and sadness. Meeting with a health psychologist or therapist may help.

Complications

Because primary ovarian insufficiency affects hormone levels in the body, it can raise the risk of other health conditions, including:

• Infertility: The majority of individuals with primary ovarian insufficiency experience infertility and require medical intervention to become pregnant. 
• Osteoporosis: Estrogen is a hormone that keeps bones dense and strong. Without an adequate supply, the bones weaken and are more likely to break. 
• Heart disease: When estrogen levels are low, cholesterol is more likely to build up in the arteries, leading to a hardening of the arteries known as atherosclerosis. 
• Thyroid disease: The hormonal changes caused by primary ovarian insufficiency can lead to low thyroid function (hypothyroidism). This causes a slower metabolism, low energy levels, and a feeling of mental sluggishness.
• Mental health: The hormonal changes caused by primary ovarian insufficiency can raise the risk of anxiety and depression. 
• Vision problems: Individuals with primary ovarian insufficiency are at increased risk of dry eye syndrome and damage to the eye surface.

Summary 

Primary ovarian insufficiency occurs when an individual’s ovaries stop working before age 40. It’s believed that primary ovarian insufficiency is caused by a change in the follicles. Common symptoms include irregular periods, trouble getting pregnant, hot flashes, night sweats, trouble concentrating, irritability, and changes in sexual health. Treatments are aimed at addressing the symptoms and may include hormone therapy and calcium supplements. IVF may be used to increase the chances of becoming pregnant. 

A Word From Verywell

Primary ovarian insufficiency can be a devastating diagnosis for young women and individuals who menstruate. It is normal to experience a sense of loss at the time of diagnosis. Because the cause is usually unknown, it is not possible to prevent primary ovarian insufficiency. Talk with your healthcare provider if you are struggling with this diagnosis and consider meeting with a therapist for support.