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Primary Ovarian Insufficiency: Overview

Primary Ovarian Insufficiency: Overview

Written By Vaishali Thapa - December 28, 2023
Read Time - 4 min read

POI, or primary ovarian insufficiency, is a disorder in which the ovaries cease to function completely. Unlike early menopause, it primarily affects women under the age of 40, and in some cases - even teenage girls1.

POI is caused by inadequate estrogen levels or when the ovaries don’t release eggs on time. Primary ovarian insufficiency, often known as premature ovarian failure, is a prevalent cause of infertility2. Women can develop POI naturally or as a result of radiation, chemotherapy, sickness, or surgery1.

Primary Ovarian Insufficiency Causes 

Did you know that the cause of around 90% of POI cases is unknown or undetectable. However, for the remaining 10%, the researchers have found issues with follicles to be responsible. A lack of or poor functioning of follicles is the primary reason in almost every case of primary ovarian insufficiency1

Follicles are tiny sac-like structures found in the ovaries where eggs grow and mature1.

The following is a list of other causes that can lead to primary ovarian insufficiency1,2:

1. Genetics

Women with genetic disorders, such as Turner Syndrome and Fragile X Syndrome have higher chances of developing POI. 

2. Toxin Exposure 

An exposure to certain toxins, such as chemical pesticides, tobacco or chemicals can cause primary ovarian insufficiency. Furthermore, if a woman is undergoing chemotherapy or radiation then her chances of developing toxin-induced ovarian failure increases.

3. Autoimmune Disorders 

In some rare cases, a certain autoimmune response causes the production of ovarian tissue antibodies. These antibodies attack the egg-containing follicles, while damaging the eggs and giving rise to primary ovarian insufficiency. Addison disease and Thyroiditis are two such autoimmune conditions leading to ovarian insufficiency3

4. Hysterectomy 

It is a surgical procedure for removal of uterus or ovaries. If a woman undergoes this surgery then she can also possibly develop POI.

Primary Ovarian Insufficiency Symptoms

The symptoms for POI are somewhat similar to estrogen deficiency and menopause, which are as follows1,2

  • Irregular, missed or skipped periods
  • Decreased libido
  • Dry eyes
  • Hot flashes
  • Dryness in vagina
  • Difficulty in conceiving 
  • Getting ill-tempered or irritability
  • Discomfort or pain while having sex

Primary Ovarian Insufficiency Risk Factors

The following factors may increase a woman's risk of having primary ovarian insufficiency2

1. Age

The risk of developing POI is most prevalent in women aged between 35-40, although it can affect any female within the reproductive age. 

2. Family Medical History

If a woman has a history of primary ovarian insufficiency in family, the risk of developing ovarian insufficiency also increases in such cases. 

3. Early Life Experiences

  • Multiple pregnancies: A study shows if a woman is a part of ‘multiple pregnancies’, meaning if she’s a twin, triplet or so on then her chances of developing primary ovarian insufficiency increases4.
  • Breastfeeding: Women who are breastfed properly as compared to women who didn’t have a lower risk of developing POI4.

4. Reproductive Factors

  • Age at menarche: Menarche is the ‘beginning of menstruation’ or the very first period you got. Research suggests that the early menarche is directly related to the high risk of developing POI4
  • Women with no children: Women who have not given birth to any children (even though at some point in their lives they did get pregnant but couldn’t deliver the baby) have a higher risk of developing POI4.

5. Lifestyle Factors

  • Cigarette smoking: Smokers have 2x higher risks of developing POI and early menopause, compared to the women who never smoked. However, if a female quits smoking, her risks become normal4
  • Body mass index: Women with lower body weight and BMI have a higher risk of early menopause. Contradictory, overweight women with fine BMI and who are not obese have found to have later age natural menopause4.

6. Environmental Factors

  • Socioecomic: A study found out that women with less levels of education and occupation had a higher risk of developing early age menopause. A different study, based in India, showed that women from rural areas have higher chances of developing POI as compared to those in urban areas4
  • Infection: Studies show that mumps oophoritis (swelling of ovaries after mumps infection) have contributed to about 3-7% POI cases. Moreover, an association between tuberculosis (TB), cytomegalovirus and POI have also been reported4,5.

Primary Ovarian Insufficiency Diagnosis

The diagnosis for primary ovarian insufficiency consists of a series of medical examinations, tests, and assessments taken by the doctor. If you or anyone close to you is experiencing symptoms similar to POI, it's advised to seek medical attention as soon as possible. 

Below mentioned are the medical procedures used for the diagnosis of primary ovarian insufficiency1,2

  • Medical questionnaire: A doctor may want to know about a patient's medical history or if they've been exposed to toxins, chemotherapy, and radiation. They may also discuss the patient’s menstrual cycle.
  • Physical examination: This includes a thorough pelvic examination, including a search for other indicators that may be causing POI like symptoms.
  • Blood test or hormone test: A blood test is required to determine the patient's hormone levels. FSH, estrogen, and prolactin are the most commonly measured hormones. Furthermore, the blood test aids in genetic testing, which indicates the probability of a chromosomal condition in the patient.  
  • Antibody test: This test is done to check out the presence of autoimmune disorders3.
  • Ultrasound of pelvis: Scans of pelvic region are done to take a closer look at the ovaries and uterus3.

Primary Ovarian Insufficiency Treatment & Management 

Unfortunately, no medication for restoring normal follicle function has been discovered as of yet. However, the silver lining is that there are several ways and therapy choices available to help control the symptoms of primary ovarian insufficiency.

Given below are the methods often used to manage the symptoms of POI1,2:

  • ART- It is an assistive reproductive method that consists of IVF (in-vitro fertilization), when egg and sperm are fused under laboratory conditions. IVF can help women with POI in conceiving.  
  • Active lifestyle- If someone has POI, they are advised to adopt a healthy lifestyle consisting of a nutrition-rich diet, maintaining balanced body weight and being physically active. Having an active lifestyle helps women with primary ovarian insufficiency avoid further health related conditions. 
  • HRT- It stands for hormone replacement therapy, under which the patient who’s going through POI (or similar disorders) is provided with female hormones like estrogen. HRT helps in improving sexual health while eliminating the risk of related heart diseases and osteoporosis (a condition in which the bones become weak and brittle).
  • Taking vitamin supplements- As women with primary ovarian insufficiency have higher risk of developing bone related health conditions, they are often prescribed vitamin D and calcium supplements. 
  • Egg freezing-  Women who are at high risk of losing their ovarian function earlier, are often advised to consider egg freezing as a way of preserving their potent ovaries for future6. This method is also called ‘oocyte cryopreservation’ wherein the eggs are harvested from the patient’s ovaries and frozen (unfertilized) for later use7

Conclusion 

Primary ovarian insufficiency can affect anyone, regardless of age or overall health, which is why it is critical to monitor your reproductive health. One can also assess their reproductive health by either consulting a doctor or by simply opting for an at-home self-collection test kit - like LifeCell’s OvaScore. 

OvaScore is a convenient at-home self-collection test kit which checks for 9 hormones linked to several reproductive health conditions in females. This test helps an individual in finding out the risk of developing primary ovarian insufficiency or any other related reproductive conditions that may affect fertility. Taking this test may also help women in understanding the possible roadblocks in achieving their fertility goals.

So ladies, take the OvaScore test today to begin the journey towards a better relationship with your body and fertility!

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