FertilityOur Gyno Health

Causes And Associated Medical Issues With Premature Ovarian Failure

The condition of premature menopause is a potentially serious disorder with consequences on more than just the ovaries, but can affect the thyroid gland as well as the adrenal gland.

A working group from European Society of Human Reproduction and Embryology drafted the first international guidelines for managing premature ovarian insufficiency trying to address this issue. They have pointed out that some individuals who have POI may actually have chromosome disorders such as Turner’s syndrome (X0) that should be identified prior to undergoing IVF or other fertility procedures like donor eggs.

A young woman having irregular periods or occasionally hot flashes, in her 30s, may be given a diagnosis of menopause, but it’s not always true that she’s actually transitioned permanently though menopause. The normal age of menopause is menopause occurring after the age of 40. Menopause before 40 has been called premature, or premature ovarian failure (POF), or Primary ovarian insufficiency (POI).

The understanding physicians have had previously was that the ovaries have a set number of eggs, and when a woman’s eggs are all used up then we go into menopause. We have a preset number of eggs (genetically), we can lose eggs when we have disease of the ovaries or surgery of the ovary, and those things can cause individual cases of premature menopause.

But something was discovered to be off in the thinking of most cases of POF. But first there are fewer ovulations, and women with POI probably ovulate only 50% of the time, but soe will only ovulate 25% of the time even when they are having regular cycles. Thus women with POI are only fertile 5-10% of the time. As far back as 1996 we discovered that even if the whole picture appears to be premature menopause, some women with POI and POF can still be fertile.

Thus, in research settings when the patients underwent ovarian biopsies they were actually found to still have eggs and follicles left, thus some hope for pregnancy (or some risk for pregnancy if you are trying to not get pregnant). It is not just running out of eggs, something else must be occurring to put a woman into early menopause.

The newest thought is that some  with POI, do not have the full blown syndrome, but just go into a phase where their eggs won’t respond well, but they actually do exist. In some women it’s that their pituitary FSH no longer works to wake up any eggs, in others it apparently was a type of self induced (auto-immune) inflammation. Networks of white cells called lymphocytes would invade the ovary and this is perhaps why the eggs wouldn’t respond. So this is the reason some women can transiently go into menopause, but actually recover and begin to have normal cycles again.

Women who have a history of miscarriages, stillbirths and infertility are all more likely to have a risk of premature menopause and early menopause. Asian women in a recent study were most prone to these risks.

Furthermore, women with high levels of inflammation and autoantibodies are in need of treatments that will help to lower the levels of these harmful physiologies. This may mean you are a candidate for hormone optimization.

The women who have POI may or may not be able to have donor eggs to be able to have children, and the current guidelines for this condition are undergoing extensive review.


Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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