Premature Ovarian Failure
One in every one hundred women suffers from premature ovarian failure, a condition in which the ovary ceases to function normally at a far earlier age than expected. It is really an onset of the menopause at an early age, usually defined as before 40 years of age. One in very thousand women has premature ovarian failure before the age of 30 years.
Because many women are now delaying pregnancy until their career is established, premature ovarian failure is becoming a steadily more significant problem in the community.
Affected women cease their periods and are unable to fall pregnant. They may start to lose some of their feminine characteristics as the breasts sag and pubic hair becomes sparse.
There are usually no warning signs of a premature menopause and the first a woman knows about it is when her periods cease. The most common time for the problem to occur is actually after a pregnancy, abortion or miscarriage when the menstrual periods fail to restart. There is a family tendency though, so it may be able to judge the risks of premature ovarian failure by the experience of older sisters or the woman’s mother.
To refer to premature ovarian failure as premature menopause is not strictly correct, as more than half of these women still have eggs (ova) in their ovaries at the time the condition is diagnosed, but the mechanism for the maturation and release of these eggs is faulty.
There is no specific cause for the condition in most cases although in some cases there is an obvious cause such as chemotherapy or irradiation for pelvic cancer, and surgery or injury to the pelvis that damages the ovaries. Rare causes of premature ovarian failure include:
- the disease galactosaemia,
- severe pelvic infections,
- some autoimmune diseases (e.g. Addison disease, myasthenia gravis),
- severe diabetes,
- thyroid disease,
- a number of other rare syndromes.
Abnormalities of the X chromosome that are passed from one generation to the next are the most likely cause of the problem in families who experience the condition across the generations. Screening techniques can now detect these abnormalities in an individual if necessary.
There is no evidence that premature ovarian failure is becoming more common, it is merely that it appears so because so many women are starting their families at an older age.
The diagnosis can be confirmed by tests on blood sex hormone levels, ultrasound scans of the ovaries and finally an ovarian biopsy using a laparoscope.
Unfortunately the treatment of premature ovarian failure is unsatisfactory as the medications used to stimulate ovulation may not work. The solution may be to use donor eggs in a GIFT procedure. Women who know that they are due to have pelvic irradiation or chemotherapy may decide to preserve some eggs in liquid nitrogen for use at a later date.
Premature ovarian failure may not be permanent, and years after the diagnosis is made the woman may suddenly start menstruating and ovulating again for no known reason. Up to one in ten women with premature ovarian failure becomes pregnant without further treatment.