Premature ovarian insufficiency

A condition in which the ovaries stop producing estrogen and releasing eggs periodically before a woman reaches the age of 40. Unlike early menopause, women with early ovarian failure may have occasional menstrual periods for years and may even become pregnant.

Possible causes include genetic changes, either due to a change in an X chromosome from birth, or due to toxicity from chemotherapy, radiation, or tobacco smoke. Less commonly, the change may be due to an autoimmune disease that attacks the ovarian tissue. 

It manifests as irregular menstrual periods and difficulty becoming pregnant. It may also be accompanied by menopause-like symptoms such as hot flashes, night sweats, mood swings, decreased sexual desire, and difficulty concentrating and/or remembering.

It is diagnosed by clinical history and physical examination with gynecological and pelvic examination. It is completed with a laboratory analysis that includes hormone levels such as follicle stimulating hormone, estradiol and prolactin. If a genetic cause is suspected, a karyotype study is required to identify chromosomal changes. 

Treatment is based on replacement of the deficient estrogen levels, often accompanied by progesterone supplementation to prevent uterine disorders. Because osteoporosis is a side effect of low estrogen levels, vitamin D and calcium supplements are also given.

Early ovarian failure has been linked to the onset of other diseases: infertility, osteoporosis, depression and/or anxiety, cardiovascular disease, dementia and Parkinson's disease.