Premature Ovarian Failure (POF)
Premature ovarian failure (POF), also known as primary ovarian insufficiency, is a condition where the ovaries stop functioning normally before age 40. This results in diminished ovarian reserve and reduced fertility.
Some key points about POF:
- It impacts ~1% of women under age 40. The cause is often unknown.
- Main symptoms are irregular periods or amenorrhea (lack of periods) and infertility. Some women have menopause-like symptoms like hot flashes.
- There is no cure, but hormones like estrogen and progesterone can help manage symptoms. Egg donation may be an option for pregnancy.
- Even with POF, some women conceive spontaneously, but the chance is low at <10% on average.
Why does POF happen?
There are a few known causes:
- Genetic factors - chromosomal or single-gene mutations that affect ovarian function
- Autoimmune disease damaging the ovaries
- Cancer treatment like chemotherapy/radiation
- Surgery removing ovaries
However, in ~90% of cases no specific cause is found. Research suggests combinations of genetic and environmental factors disrupt normal ovarian function.
What is the impact of POF?
Beyond fertility challenges, POF has significant health and psychological impacts:
- Infertility - With loss of normal ovarian function, conceiving is difficult. Egg donation improves success.
- Menopause symptoms - Lack of estrogen leads to symptoms like hot flashes, vaginal dryness, mood changes, etc. Often more severe than natural menopause.
- Bone loss/osteoporosis - Estrogen helps maintain bone density, so lack of estrogen increases future fracture risk.
- Cardiovascular risk - Heart disease risk rises without estrogen. Careful monitoring is required.
- Psychological effects - Depression, anxiety, lowered self-esteem are common reactions. Counseling and support groups can help.
What is the treatment for POF?
While there is no cure, the goals of treatment are relieving symptoms and preventing long-term issues:
- Hormone therapy - Estrogen/progesterone supplements to replace ovarian hormones. Dosage is titrated based on age and symptoms.
- Osteoporosis prevention - Medications (bisphosphonates), calcium, vitamin D and weight-bearing exercise.
- Egg donation - For women desiring pregnancy, in vitro fertilization with a donor egg can be very successful.
- Supportive care - Counseling and support groups to help cope with the psychological effects of early menopause and infertility.
The key with POF is early detection and multidisciplinary care - endocrinologists, gynecologists, mental health professionals all play a role in guiding treatment, fertility options, and promoting long-term health.