premature ovarian failure

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PREMATURE OVARIAN FAILURE

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  • 1. Dr. Angelo Smith M.DWHPL

2. DefinitionPremature ovarian failure is alsoknown as primary ovarian insufficiencyIt refers to a loss of normal functionof ovaries before age 40Affects 1% of womenDepending on the cause, prematureovarian failure may develop as early asthe teen years, or the problem mayhave been present from birth. 3. Primary ovarian insufficiency(POI) is characterized byamenorrhea,hypoestrogenism, andelevated serum gonadotropinlevels inwomen younger than 40 years. 4. AnatomyThe ovary is a ductless reproductive gland inwhich the female reproductive cells areproduced.Although about 1 million oocytes are presentat birth in the human ovary, only about 500 ofthese ovulate, and the rest are wasted.If the ovaries fail, they wont produce normalamounts of the hormone estrogen or releaseeggs regularly which will result into Infertility. 5. CausesGenetic disordersAutoimmune diseasesTuberculosis of the genital tractSmokingRadiation and/or chemotherapyOvarian failure following hysterectomyProlonged GnRH (Gonadatrophin Releasing Hormone)therapyEnzyme defectsResistant ovaryInduction of multiple ovulation in infertility 6. Chromosomal defects. Certain genetic disorders are associated whichinclude Turner's syndrome, a condition in which awoman has only one X chromosome instead of theusual two, and fragile X syndrome.Toxins. Chemotherapy and radiation therapy are the mostcommon causes of toxin-induced ovarian failure. These therapies may damage the genetic materialin cells. Other toxins such as cigarette smoke,chemicals, pesticides and viruses may hastenovarian failure. 7. Autoimmune:Immune system may produceantibodies against own ovariantissue, harming the egg-containingfollicles and damaging the egg. Whattriggers the immune response isunclear, but exposure to a virus isone possibility. 8. Risk FactorsAge : The risk of ovarian failure risessharply between age 35 and age 40.Family history : Having a familyhistory of premature ovarian failureincreases your risk of developing thisdisorder. 9. SymptomsIrregular or skipped periods (amenorrhea)Hot flashesNight sweatsVaginal drynessIrritabilityPoor concentrationDecreased sexual desire 10. ComplicationsInfertility. Inability to get pregnant may be the mosttroubling complication of premature ovarian failure,although in rare cases, pregnancy is possible.Osteoporosis. The hormone estrogen helpsmaintain strong bones. Women with low levels ofestrogen have an increased risk of developing weak andbrittle bones (osteoporosis), which are more likely tobreak than healthy bones.Depression or anxiety. The risk of infertility andother complications arising from low estrogen levelsmay cause some women to become depressed oranxious. 11. Tests & DiagnosisFollicle-stimulating hormone (FSH) test.FSH is a hormone released by the pituitary gland thatstimulates the growth of follicles in the ovaries.Women with premature ovarian failure often haveabnormally high levels of FSH in the blood.POF patients is over 40 mlU/ml (post-menopausalrange).Estradiol test.The blood level of estradiol, a type of estrogen, isusually low in women with premature ovarian failure.Prolactin testHigh levels of prolactin the hormone that stimulatesbreast milk production in the blood can lead toproblems with ovulation. 12. Tests & DiagnosisKaryotype.This is a test that examines all 46 of yourchromosomes for abnormalities. Some women withpremature ovarian failure may have only one Xchromosome instead of two or may have otherchromosomal defects.FMR1 gene testing.The FMR1 gene is the gene associated with fragile Xsyndrome an inherited disorder that causesintellectual problems. The FMR1 test looks at bothof your X chromosomes to make sure they appearto be normal 13. Treatmenten therapy.To help prevent osteoporosis and relieve hot flashesand other symptoms of estrogen deficiency, Estrogen istypically prescribed with another hormone calledprogesterone.Adding progesterone protects the lining of your uterus(endometrium) from precancerous changes caused bytaking estrogen alone.In older women, long-term estrogen plus progestintherapy has been linked to an increased risk of heart andblood vessel (cardiovascular) disease and breast cancer.In young women with premature ovarian failure,however, the benefits of hormone replacement therapyfor heart health may outweigh the potential risks. 14. TreatmentCalcium and vitamin D supplements.Both calcium and vitamin D are important forpreventing osteoporosis.A bone density test shall be suggested beforestarting supplements to get a baseline bonedensity measurement.For women ages 19 through 50, the Institute ofMedicine recommends 1,000 milligrams (mg) ofcalcium a day through food or supplements,increasing to 1,200 mg a day for women age 51or older.

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