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Dr. Angelo Smith M.D WHPL


Definition Premature ovarian failure is also known as primary ovarian insufficiency It refers to a loss of normal function of ovaries before age 40 Affects 1% of women Depending on the cause, premature ovarian failure may develop as early as the teen years, or the problem may have been present from birth.

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Primary ovarian insufficiency (POI) is characterized by amenorrhea, hypoestrogenism, and elevated serum gonadotropin levels in women younger than 40 years.


Anatomy The ovary is a ductless reproductive gland in which the female reproductive cells are produced. Although about 1 million oocytes are present at birth in the human ovary, only about 500 of these ovulate, and the rest are wasted. If the ovaries fail, they won’t produce normal amounts of the hormone estrogen or release eggs regularly which will result into Infertility.


Causes Genetic disorders Autoimmune diseases Tuberculosis of the genital tract Smoking Radiation and/or chemotherapy Ovarian failure following hysterectomy Prolonged GnRH ( Gonadatrophin Releasing Hormone) therapy Enzyme defects Resistant ovary Induction of multiple ovulation in infertility

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Chromosomal defects.   Certain genetic disorders are associated which include Turner's syndrome, a condition in which a woman has only one X chromosome instead of the usual two, and fragile X syndrome. Toxins.   Chemotherapy and radiation therapy are the most common causes of toxin-induced ovarian failure. These therapies may damage the genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses may hasten ovarian failure.

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Autoimmune: Immune system may produce antibodies against own ovarian tissue, harming the egg-containing follicles and damaging the egg. What triggers the immune response is unclear, but exposure to a virus is one possibility.  

Risk Factors:

Risk Factors Age : The risk of ovarian failure rises sharply between age 35 and age 40. Family history : Having a family history of premature ovarian failure increases your risk of developing this disorder.


Symptoms Irregular or skipped periods (amenorrhea) Hot flashes Night sweats Vaginal dryness Irritability Poor concentration Decreased sexual desir e


Complications Infertility.  Inability to get pregnant may be the most troubling complication of premature ovarian failure, although in rare cases, pregnancy is possible. Osteoporosis.   The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones. Depression or anxiety.  The risk of infertility and other complications arising from low estrogen levels may cause some women to become depressed or anxious.

Tests & Diagnosis:

Tests & Diagnosis Follicle-stimulating hormone (FSH) test.   FSH is a hormone released by the pituitary gland that stimulates the growth of follicles in the ovaries. Women with premature ovarian failure often have abnormally high levels of FSH in the blood. POF patients is over 40 mlU/ml (post-menopausal range). Estradiol test.  The blood level of estradiol, a type of estrogen, is usually low in women with premature ovarian failure. Prolactin test High levels of prolactin the hormone that stimulates breast milk production in the blood can lead to problems with ovulation.

Tests & Diagnosis:

Tests & Diagnosis Karyotype. This is a test that examines all 46 of your chromosomes for abnormalities. Some women with premature ovarian failure may have only one X chromosome instead of two or may have other chromosomal defects. FMR1 gene testing.   The FMR1 gene is the gene associated with fragile X syndrome an inherited disorder that causes intellectual problems. The FMR1 test looks at both of your X chromosomes to make sure they appear to be normal


Treatment en therapy.   To help prevent osteoporosis and relieve hot flashes and other symptoms of estrogen deficiency, Estrogen is typically prescribed with another hormone called progesterone. Adding progesterone protects the lining of your uterus (endometrium) from precancerous changes caused by taking estrogen alone. In older women, long-term estrogen plus progestin therapy has been linked to an increased risk of heart and blood vessel (cardiovascular) disease and breast cancer. In young women with premature ovarian failure, however, the benefits of hormone replacement therapy for heart health may outweigh the potential risks.


Treatment Calcium and vitamin D supplements.   Both calcium and vitamin D are important for preventing osteoporosis. A bone density test shall be suggested before starting supplements to get a baseline bone density measurement. For women ages 19 through 50, the Institute of Medicine recommends 1,000 milligrams (mg) of calcium a day through food or supplements, increasing to 1,200 mg a day for women age 51 or older.

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