The human ovary functions as a reproductive organ and an endocrine organ. These functions are tightly coupled. Premature ovarian failure — also known as primary ovarian insufficiency — is a loss of normal function of the ovaries in its role, either as an endocrine organ or as a reproductive organ, before age 40. If the ovaries fail, they don’t produce normal amounts of the hormone estrogen or release eggs regularly. Infertility is a common result.

A woman who has primary ovarian insufficiency is very likely to have irregular or no periods, infertility problems, and menopause-like symptoms. It is difficult, though not impossible, for women who have primary ovarian insufficiency to become pregnant.

Primary ovarian insufficiency is sometimes referred to as premature menopause, but the two conditions aren’t the same. Women with POI can have irregular or occasional periods for years and might even become pregnant. Women with premature menopause stop having periods and can’t become pregnant, but about five to 10 per cent of women with primary ovarian insufficiency conceive subsequent to the diagnosis without medical intervention.

According to a study published in PubMed by Okeke et al, premature menopause affects one per cent of women under the age of 40 years in Nigeria. It is seen in 10 to 28 per cent of primary amenorrhea and four to 18 per cent of secondary amenorrhea therefore, it is not as rare as deemed.

Symptoms

As defined by the World Health Organisation, ovarian insufficiency can be caused by a primary disorder in the ovary or it can occur as a result of secondary causes. Ovarian insufficiency is considered primary if the ovary fails to function normally in response to appropriate gonadotropin stimulation provided by the hypothalamus and pituitary. Ovarian insufficiency is considered secondary if the hypothalamus and pituitary fail to provide appropriate gonadotropin stimulation.

Primary ovarian insufficiency (POI / premature ovarian failure) is a condition characterised by absent or reduced frequency of menstruation, reduced oestrogen levels and its related symptoms (hypoestrogenism) and elevated serum gonadotropin levels in women younger than 40 years. The women are at risk of premature death, neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease and infertility.

The signs and symptoms of premature ovarian failure are similar to those of women going through menopause and are typical of estrogen deficiency. They include:

Irregular or skipped periods (amenorrhoea), which might be present for years or develop after a pregnancy or after stopping birth control pills

Difficulty conceiving (infertility),hot flushes, night sweats, vaginal dryness, irritability or difficulty concentrating, decreased sexual desire.

POI is, in reality, a continuum of disorders divided into four clinical states. These states are not permanent. Patients may move from one state to another in an unpredictable manner. In some cases, normal ovarian function may even return for a period of time.

 These states range from occult primary ovarian insufficiency to the biochemical then, the overt, and lastly, premature ovarian failure, which is the irreversible extreme state of complete primordial follicle (egg) depletion. The different states are characterised by either normal or elevated levels of Follicle Stimulating Hormone.

Cause

Chromosomal defects: Certain genetic disorders are associated with premature ovarian failure. These include Mosaic Turner’s Syndrome — in which a woman has only one normal X chromosome and an altered second X chromosome — and fragile X syndrome — in which the X chromosomes are fragile and break.

Toxins: Chemotherapy and radiation therapy are the most common causes of toxin-induced ovarian failure.  Environmental, chemical and biological toxins, such as cigarette smoke, chemicals, pesticides and viruses, might hasten ovarian failure.

Autoimmune disorders: An abnormal immune system response to ovarian tissue (autoimmune disease) where antibodies are produced against 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.

Unknown factors: It’s possible to develop premature ovarian failure which, is not related to any of the aforementioned. Your doctor might recommend further testing, such as a bioenergetic body scan, to try to explain the cause, detect microorganisms like bacteria and viruses, as well as other possible toxins.

Management of primary ovarian insufficiency

This is a difficult diagnosis for any woman and traumatic for young women, hence, counselling and support is essential in the overall management and decision making, especially in the matter of family planning.

It is important to remember that the ovary is not only a reproductive organ, but it is also a source of important hormones that help maintain strong bones. Adequate replacement of these missing hormones, a healthy lifestyle, and a diet rich in calcium are essential.

A thorough way of achieving this to improve ovarian function and yield is to rid the body of all toxins through Mayr therapy. This involves total body cleansing and decongestion of toxic load, resting and supporting all related organ systems to ensure balance of normal physiologic functions and improve underlying causative conditions. This process is especially important in POI of unknown cause as it ensure to remove any hindrances to normal hormonal functions in the body.

Hormone balancing wraps and hydrotherapy treatments, as well as individualised nutrition among other interventions all go a long way in improving outcome.

Androgens

Women with ovarian failure have lower levels of free testosterone compared with normally ovulating age-matched women, but only 13 per cent have levels below the lower limit of normal.

Androgen replacement could be carefully considered for women who have persistent fatigue, low libido, and poor wellbeing despite adequate estrogen replacement and when depression has been ruled out or adequately treated.

Unproven treatments to restore fertility should be avoided because they have the potential of interfering with the development of a spontaneous pregnancy. One must be wary of herbs and concoctions which may have potent drug effects that eventually disrupt or interfere with hormonal mechanisms.

Patients with the condition  can have a successful pregnancy with the help of fertility experts, who will thoroughly evaluate and lay out best options for the individual. Options include the use of donor eggs. A decision to proceed with such a procedure should be made after a fair discussion of different options. The age of the patient is of less importance than the age of the egg donor.

Other possibilities include embryo adoption,  adoption or change of life plans.

Premature ovarian failure is indeed a saddening condition, but there is hope through proper supervised detoxification and lifestyle modification to improve hormonal balance and restore ovarian function. This should ideally precede expert medical treatment in order to improve chances of success.

If you’ve missed your period for three months or more, see your doctor to help determine the cause. You can miss your period for a number of reasons — including pregnancy, stress, or a change in diet or exercise habits — but it’s best to get evaluated whenever your menstrual cycle changes. Even if you don’t mind not having periods, it’s advisable to see your doctor to find out what’s causing the change.