Premature Ovarian Failure
Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Dec 03, 2019
What is POF (Premature Ovarian Failure) or POI (Primary Ovarian Insufficiency)?
Premature ovarian failure (POF), also known as primary ovarian insufficiency (POI), is a loss of ovarian function before the age of 40. POF can affect women at various ages, from their teenage years to their thirties. Women with POF are at a greater risk of a range of health issues, including osteoporosis, estrogen deficiency (hot flashes, vaginal dryness, etc.) and heart diseases.
These POF-related issues can usually be managed well with hormonal replacement. But for women with POF, fertility poses a challenge, as the loss of ovarian function means that the probability of pregnancy with their own eggs is greatly reduced.
What is Premature Ovarian Failure?
Dr. David H. Barad discusses the possibility of getting pregnant with premature ovarian failure. Also addressed: "What is ovarian failure?" and "What causes ovarian failure?"
Although it is sometimes called early menopause, POF is different from menopause in that POF is not a result of a woman’s natural (normal) aging process. In addition, women with POF may continue to have menstrual cycles, though their cycles are irregular and ovulation is sporadic. A small percentage of women with POF fertility issues can conceive naturally, while menopausal women will never get pregnant without medical intervention.
It is also very important that your fertility specialist is able to distinguish between POF infertility, menopause, and premature ovarian aging (POA). The distinction is important because women with POA typically have a better chance of pregnancy with their own eggs than women with POF. Yet, women with POA are frequently told that they’ll need to use an egg donor without the proper workup and diagnosis to assess their ovarian reserve status.
What Causes POF?
What causes premature ovarian failure? There are several known causes for premature ovarian failure, amongst them genetic conditions that affect the X chromosome, such as Turner Syndrome and Fragile X syndrome Autoimmunity (immunity against oneself, in this case against the ovaries) has also been implicated as one of many potential ovarian failure causes. In addition, surgical loss of excessive ovarian tissue (for example, after surgery for endometriomas , also called "chocolate cysts") can put the patient into early menopause. Chemotherapy and radiation can also wipe out the follicle pool and cause premature ovarian failure, which is why fertility preservation is recommended for cancer patients who want to preserve the ability to have children.
Premature Ovarian Failure Symptoms
POF in younger women can often present with similar symptoms as it would in older women who are going through natural menopause. Some ovarian failure symptoms in women with POF age 40 and younger are irregular or missed periods, hot flashes, vaginal dryness, bladder irritability, incontinence, dry skin, dry eyes, dry mouth, problems with sleep, decreased sexual desire, and emotional shifts such as irritability, feelings of depression, or mood swings. When experiencing these symptoms--even if they are not actively trying to conceive--women should seek medical help, as POF has a range of serious negative effects on the entire body, not just fertility.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.