Premature Ovarian Failure(POF)-Symptoms, Causes and Testing
Health care providers use the term premature ovarian failure to describe a stop in normal functioning of the ovaries in a woman under the age of 40. Many women naturally experience a decline in fertility at age 40; this age may also mark the beginning of irregularities in their menstrual cycles that signal the onset of menopause. For women with premature ovarian failure, the fertility decline and menstrual irregularities occur before age 40, sometimes even in the teens. Some health care providers also use the term primary ovarian insufficiency to describe this condition.
Causes of POF
Although researchers have a general idea of what causes premature ovarian failure, in most cases the exact cause remains unclear.
To understand what happens in premature ovarian failure, you need to understand what happens in a woman’s body when it’s functioning normally.
POF-Normal Menstrual Cycle
In general, a woman’s reproductive health involves her:
Hypothalamus (pronounced high-poe-THAL-amus)—part of the brain that functions as the main control for the body’s reproductive system. The hypothalamus works like a thermostat in a furnace, in that it controls the levels of different hormones and other chemicals in the body. If the hypothalamus detects that there is too little of a hormone in the body, it orders the body to make more.
Pituitary (pronounced pitt-OO-ih-terry) gland—the body’s master gland. The pituitary sends out hormones, or chemical signals to control the other glands in the body. The pituitary gets orders from the hypothalamus about what the body needs.
Ovaries—the source of eggs in a woman’s body. The ovaries have follicles, which are tiny, fluid-filled sacs that hold the eggs. The ovaries also make hormones that help to maintain a woman’s health, such as estrogen, progesterone, and testosterone. The ovaries receive the chemical signals from the pituitary and respond by making certain hormones. In premature ovarian failure, the ovaries stop working correctly in both their egg production role, and in their hormone production role.
Uterus—where a woman carries a baby, also called the "womb." The uterus has different layers; its innermost layer or lining is called the endometrium—endo means "inside" and metrium (pronounced MEE-tree-um) means "womb." The endometrium functions as a bed for an embryo when a woman is pregnant. If no pregnancy occurs during the cycle, then the endometrium is shed as a menstrual flow, or a period, and the cycle starts all over again.
These parts interact with one another to coordinate a woman’s monthly menstrual cycle.
An abnormal or missing X chromosome—the X chromosome stores genetic material that helps "build" a person. It also helps to determine whether a person is a male or a female. Females need two normal X chromosomes to make enough primordial follicles, and to use them properly.
If a critical part of either X chromosome is missing, or if an entire X chromosome is missing, the body may not make enough primordial follicles to begin with, or it may use them up too quickly. This problem is the cause of premature ovarian failure in 2 percent to 3 percent of women with the condition.
Even when it appears that all a woman’s follicles are depleted, it is possible that a very small number of surviving follicles can, without warning, begin to function on their own. This spontaneous function can cause ovulation or a menstrual period; if insemination occurs, this function could lead to pregnancy, although such a situation is uncommon.
The most common first symptom of premature ovarian failure is having irregular periods. Health care providers sometimes dismiss irregular or skipped periods (sometimes called amenorrhea—pronounced AY-men-or-ee-uh) as being related to stress; but a woman’s monthly cycle is actually an important sign of her health, in the same way that blood pressure or temperature are signs of health.
If you have irregular periods or skip periods, you should tell your health care provider, so that he or she can begin to determine the cause of these problems.
Some women with premature ovarian failure also experience other symptoms with premature ovarian failure. These symptoms are similar to those experienced by women who are going through natural menopause and include (but are not limited to):
- Hot flashes
- Night sweats
- Poor concentration
- Decreased interest in sex
- Pain during sex
- Drying of the vagina
One of the most common signs of premature ovarian failure is having irregular periods. Women should pay close attention to their menstrual cycles, so that they can alert their health care provider when changes occur in their periods.
If you are under age 40 and your periods are irregular, or if you miss your period altogether for three months or more, your health care provider may measure the level of FSH in your blood, to determine if you have primary ovarian insufficiency in its early stages, or possibly even fully developed premature ovarian failure. Remember that FSH signals the ovaries to make estrogen.
If the ovaries are not working properly, as is the case in premature ovarian failure, the level of FSH in the blood increases. A higher level of FSH in the blood is a strong sign of premature ovarian failure. But, irregular periods alone are not a sure sign that you have premature ovarian failure—research shows that fewer than 10 percent of women who have irregular or skipped periods have high FSH levels and premature ovarian failure.
To do an FSH test, your health care provider will collect some of your blood and send it to a laboratory. At the lab, a technician will check the level of FSH. If the level of FSH is in the menopausal range, it is likely that you have premature ovarian failure.
Reference for POF Article
National Institutes of Health