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Patient education: Primary ovarian insufficiency (The Basics)

Patient education: Primary ovarian insufficiency (The Basics)

What is primary ovarian insufficiency? — This is when the ovaries stop working normally in a person younger than 40 years.

Menopause is the time when a person naturally stops having monthly periods. The ovaries stop releasing eggs and stop making the hormones estrogen and progesterone. Menopause usually happens between the ages of 45 and 55. But in some people, it happens earlier. When a person goes through menopause between age 40 and 45, doctors use the term "early menopause."

When the ovaries stop working normally before age 40, doctors use the term "primary ovarian insufficiency," or "POI." You might also hear the terms "premature ovarian insufficiency" or "premature ovarian failure."

POI can happen for different reasons. For example, certain types of cancer treatment can cause the ovaries to stop working normally and periods to stop. Genetic problems can also cause POI. But sometimes, it happens for no clear reason.

Some people who are going through POI keep having periods every once in a while. They might even be able to get pregnant during this time. But eventually, the ovaries stop working, monthly periods stop, and it is no longer possible to get pregnant naturally.

What causes POI? — POI happens when something causes the ovaries to stop working well. Normally, the ovaries release an egg about once a month. This is called "ovulation," and it makes pregnancy possible (figure 1).

In people with POI, the ovaries run out of eggs earlier than expected. As a result, they might:

Release eggs less often than normal

Stop releasing eggs completely

Why did my ovaries stop working? — Most of the time, doctors don't know what causes POI. In some people, causes include:

Problems with genes

Cancer treatments

Certain autoimmune diseases – These are conditions in which the body's infection-fighting system attacks healthy organs (such as the ovaries).

What are the symptoms of POI? — The first thing most people notice is missed periods, or periods that are lighter than normal. Other symptoms can include:

Hot flashes, which feel like a wave of heat that starts in your chest and face and then moves through your body

Extreme sweating at night

Trouble sleeping

Changes in your mood, such as feeling very irritable

Dryness in your vagina

Pain during sex

What other symptoms should I watch for? — Certain symptoms can be clues about what is causing your condition. Tell your doctor about any symptoms you have. This will help them figure out what is going on, and what treatment you might need.

Should I see a doctor or nurse? — Yes. See your doctor or nurse if you are younger than 40 and your periods have been irregular for at least 3 months.

Should I have tests? — Your doctor or nurse will decide which tests you should have based on your age, other symptoms, and individual situation. Common tests include:

A pregnancy test

Blood tests – The most common blood tests measure hormone levels. They can show why your periods are irregular. There are also other blood tests that can help doctors figure out why you have POI.

Genetic tests – If your hormone tests show that you do have POI, you will probably have other blood tests that can show if something is wrong with your chromosomes. (Chromosomes are structures in cells that contain thousands of genes.) The main test to look at chromosomes is called a "karyotype."

How is POI treated? — The most important part of treatment is getting support. Finding out that you have POI can be upsetting. You might feel anxiety, sadness, or grief. Tell your doctor if you are feeling this way. There are also doctors, nurses, and therapists who are experts in this area. It might help to find a support group so you can talk to other people who are dealing with similar things.

Depending on what is causing your condition, your doctor can also suggest specific treatment. The most common way to treat POI is with hormones, most importantly estrogen. These replace what the ovaries are not making anymore. Hormones will reduce your symptoms, especially hot flashes and night sweats. They will also help protect your bones and maybe your heart. Experts recommend that people with POI take hormones until at least age 50.

What if I want to get pregnant? — There might still be hope. About 5 to 10 percent of people with POI are able to get pregnant on their own. If this does not happen, it might be possible to get pregnant with new technologies. These methods use eggs that come from another person.

If you want to try to get pregnant, your doctor can talk to you about your options.

More on this topic

Patient education: Absent or irregular periods (The Basics)
Patient education: Female infertility (The Basics)
Patient education: Menopause (The Basics)

Patient education: Primary ovarian insufficiency (Beyond the Basics)
Patient education: Absent or irregular periods (Beyond the Basics)
Patient education: Menopause (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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