Premature ovarian failure (POF), also known as premature ovarian insufficiency, occurs when a woman’s ovaries stop functioning properly before the age of 40. This condition affects both the production of eggs and the synthesis of sex hormones.
Women diagnosed with POF typically experience the cessation of menstrual periods, which is often the symptom that prompts them to seek medical advice. However, it’s important to note that this condition is quite rare, affecting only 1% of women under 40 and 1 in 1,000 women under 30.
Most women discover the problem due to amenorrhoea, the absence of menstrual periods, which results from the ovaries no longer producing eggs.
Other symptoms, typically associated with menopause, may also appear. Since POF is linked to a decline in oestrogen production, some women may experience hot flushes, irritability, vaginal dryness, or a decrease in libido.
The causes of premature ovarian failure (POF) are unknown in most cases. Some possible causes include:
It is especially important to detect premature ovarian failure early when a woman intends to have children, as there are fertility preservation options such as egg freezing.
This technique allows the preservation of eggs—before the ovarian reserve significantly diminishes or even disappears—for use in future assisted reproduction processes.
Furthermore, early diagnosis allows for the management of symptoms and the prevention of potential complications, such as osteoporosis and cardiovascular diseases, associated with low oestrogen production.
Premature ovarian failure (POF) is typically not detected until a woman tries to conceive, as its symptoms are not always obvious. The following techniques are used for diagnosis:
The transvaginal ultrasound allows visualisation of the ovaries and an antral follicle count. A low count often indicates POF.
In some cases, POF may result from genetic conditions such as Turner syndrome or Fragile X syndrome. Genetic tests can identify chromosomal abnormalities or mutations.
POF can sometimes be linked to autoimmune diseases where the immune system attacks the ovaries. Specific antibody tests can help diagnose these cases.
There is no treatment to reactivate ovarian function, but there are treatments for some of the symptoms associated with premature ovarian insufficiency. The most common one is hormone replacement therapy, which usually includes a combination of oestrogen and a progestogen, and can restore the menstrual cycle regularly.
This therapy could improve pregnancy rates in women with this condition. It is a safe treatment with very few side effects. Additionally, doctors often recommend calcium and vitamin D supplements as well as regular physical activity to reduce the risk of heart disease associated with this condition.
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The chances of achieving a natural pregnancy in women diagnosed with premature ovarian failure are between 5% and 10%, according to the Spanish Society of Fertility (SEF).
Therefore, in these cases, fertility treatments such as in vitro fertilisation (IVF) with the woman's own eggs (if quality embryos can be obtained) or through egg donation are necessary.