Premature ovarian loss, POF, is understood as the loss of the primary role of the ovary by the age of 40. POF is associated with the depletion of the ovarian follicle before the time of natural menopause comes. What are the symptoms of premature ovarian failure and how is the treatment going?
Contents:
- Premature loss of ovarian function - symptoms
- Premature loss of ovarian function - causes
- Premature loss of ovarian function - effects
- Premature loss of ovarian function - diagnosis
- Premature loss of ovarian function - AMH study
- Premature loss of ovarian function - treatment
- Premature ovarian failure and pregnancy
Premature ovarian declineis a condition associated with the decline of the basic function of the ovaries and the onset of an earlier menopause. It occurs in about 1 percent. women in the population. Its incidence is estimated at 1/100 women before 40 years of age and 1/1000 women before 30 years of age.
Premature ovarian decline is diagnosed in about 10 percent of women in fertility clinics. It most often affects women aged 25-40.
Premature loss of ovarian function - symptoms
The symptoms of premature ovarian failure are:
- irregular, too long menstrual cycles,
- secondary amenorrhea,
- decreased libido,
- hot flashes,
- sweating, most commonly night sweats,
- problems with concentration,
- low number of ovarian follicles and reduced volume of ovaries in ultrasound examination,
- hormone tests show hypergonadotropic hypogonadism: low estradiol concentration (E2 20 IU / l), low concentration of AMH-anti-Mullerian hormone ( <1 ng/ml).
Premature loss of ovarian function - causes
Premature ovarian decline has various causes.
- Genetic
Genetic diseases that cause premature ovarian failure include: Turner syndrome, fragile X chromosome syndrome and pseudo-hypoparathyroidismtype 1a.
- Autoimmune
Diseases associated with the secretion of anti-ovarian antibodies are often associated with POF. Other autoimmune conditions, such as Hashimoto's disease, Addison's disease, type 1 diabetes, vitiligo, celiac disease, rheumatoid arthritis, and pernicious anemia, may also coexist with premature ovarian decline.
- Oncological treatment - chemotherapy, radiotherapy
The ovaries are damaged during radiotherapy. Chemotherapy drugs also have a negative effect on the functioning of the gonads. A high risk of fertility problems may be caused by cyclophosphamide, melphalan, and dacarbazine.
- Enzymatic
POF can also be caused by inherited enzyme deficiencies, such as galactosemia.
- Environmental
Viral infections and smoking can lead to premature ovarian failure.
Premature loss of ovarian function - effects
When the level of estrogen in a woman's body is too low, it manifests itself in a decrease in bone mineral density, a higher risk of fractures. It is recommended to regularly perform a bone density test - densitometry.
However, one of the most important effects of POF on women is decreased fertility.
Premature loss of ovarian function - diagnosis
To identify premature ovarian decline, obtain FSH>40IU / L at least two weeks apart. However, the diagnosis of premature ovarian failure should be made very carefully, as it is a diagnosis that many women find difficult to come to terms with. It should not be judged on the basis of a one-time FSH test. The patient should also be made aware of the possibility of a temporary recovery of ovarian function. However, this situation happens very rarely. Anti-Müllerian Hormone, i.e. AMH (Anti-Müllerian Hormone), is secreted by granular cells of preantral vesicles. Its task, along with follicle stimulating hormone (FSH), regulates the maturation of the follicles in which the egg develops. In order to assess the ovarian reserve, and thus the number of ovarian follicles, the AMH test should be performed. The AMH standard is an age-dependent value. Values between 1 ng / ml and 3.0 ng / ml are assumed to be correct for women of childbearing age. AMH testing does not require patient preparation. They are performed regardless of the day of the cycle or taking hormonal contraception. In substitution treatment, hormone replacement therapy is used, i.e. the administration of missing hormones. Estrogen taken by patients prevents increased bone fragility and osteoporosis. Please note that causal treatment is indicated. There have been reports of recovery of ovarian function after adherence to a gluten-free diet in the case of celiac disease. It is also recommended to use over-the-counter preparations, e.g. melatonin. It is believed to have a positive effect on fertility, menstrual cycle and mood. In younger patients, with even minimal ovarian response to stimulation, there is a chance of becoming pregnant naturally. The absence of pregnancy after several stimulated cycles may be an indication for in vitro fertilization. Read also: Read more from this authorPremature loss of ovarian function - AMH study
Premature loss of ovarian function - treatment
Premature ovarian failure and pregnancy
About the author
Natalia MłyńskaStudent of medicine at the Medical University of Lodz. Medicine is her greatest passion. He also loves sports, mainly running and dancing. She would like to treat her future patients in such a way as to see them as a human being, not only a disease.