Primary ovarian insufficiency used to be called premature ovarian failure. It’s a condition that affects a woman well before she should reach menopause.
A healthy woman’s ovaries produce estrogen. This hormone controls menstrual periods and makes you fertile (able to get pregnant). With age, your ovaries eventually stop making estrogen.
Sometimes, the ovaries stop working long before menopause is expected. (The average age for menopause is 51.) If you’re younger than 40 and your ovaries no longer make eggs and your periods have stopped, it may be primary ovarian insufficiency.
Inside the ovaries are small sacs, called follicles. They hold eggs as they grow and mature. Girls are usually born with about 2 million “seeds” that turn into these follicles, which last through menopause.
If you have primary ovarian insufficiency, your follicles either run out (your doctor may call this depletion) or don’t work properly (also called dysfunction). Doctors aren’t sure why this happens.
This condition may be more likely if your mother or sister had it. Other things that may make it more likely include:
- Autoimmune disorders
- Chemotherapy and radiation therapy
- Genetic and chromosomal disorders, including Fragile X syndrome and Turner syndrome
- Viral infections
You may not know your ovaries aren’t working normally. Some women with premature ovarian failure still have periods and may even get pregnant. But many who have this condition have trouble getting pregnant. That’s usually what prompts a visit to the doctor.
The most common symptoms of premature ovarian failure are missed or infrequent periods. Periods may start and stop again for many years. Other symptoms can seem like those of menopause and may include:
- Hot flashes
- Night sweats
- Anxiety, depression, or mood swings
- Concentration or memory problems
- Your sex drive isn’t what it used to be
- Trouble sleeping
- Vaginal dryness, which can make sex uncomfortable
If your periods have stopped or are infrequent, your doctor will do blood tests to check your hormone levels and rule out pregnancy, thyroid disease, and other health conditions.
The first blood tests you’ll likely take will measure your blood levels of:
- FSH (follicle stimulating hormone). Your pituitary gland makes this hormone, which tells the ovaries to release an egg each month.
- Estradiol. This is a type of estrogen made by your ovaries.
Results from these tests help your doctor understand what may be going on with your ovaries.
Your doctor may diagnose you with primary ovarian insufficiency if you’re under age 40 and have any of the following:
- High FSH levels (in the menopause range) on two different tests done at least 1month apart
- Low estradiol level, which means your ovaries aren’t making enough estrogen
- No periods or irregular periods (less often than every 35 days) for 3 months in a row
Your doctor might also recommend that you get a transvaginal ultrasound. This imaging test shows your ovaries. Women with primary ovarian insufficiency usually have smaller ovaries with few follicles.
If you do have this condition, you may get more tests to check on the cause.
Low levels of estrogen can affect more than just your ability to get pregnant. Estrogen is necessary for a healthy heart and bones, among other things. If your ovaries don’t make enough of this hormone, you may be more likely to have other health conditions, such as:
- Anxiety and depression
- Eye disease, including dry eye
- High cholesterol and heart disease
- Hypothyroidism (underactive thyroid)
Talk to your doctor about ways to lower your risks. A healthy lifestyle and medication may help prevent some of these conditions.
Although there’s no cure, there are treatments that can ease symptoms and potential complications related to low estrogen levels.
Hormone replacement therapy (HRT) is the most common. This treatment usually combines estrogen and progestin, although your doctor may prescribe other forms. You may take it by mouth, put it on your skin, or place it in your vagina. Make sure that you and your doctor talk about the possible side effects and risks if you’re considering this type of treatment.
Doctors usually prescribe calcium and vitamin D supplements to prevent bone loss, which can happen when estrogen levels drop. If you don’t work out, you’ll need to make fitness a habit, since weight-bearing exercises can help keep your bones strong and your heart healthy.
If you were hoping to get pregnant but find that you have primary ovarian insufficiency, you may want to talk with a counselor and also work with your doctor to understand what your options may be to start or expand your family.