Primary Ovarian Insufficiency

Diagnosis

Most women with primary ovarian insufficiency show few symptoms, but your healthcare provider may suspect the condition if you have irregular menstrual cycles or difficulty conceiving. Diagnosis usually begins with a physical examination, including a pelvic exam, and a discussion of your medical history, menstrual cycle, exposure to toxins such as chemotherapy or radiation, and any previous ovarian surgery.

Tests your provider may recommend include:

• Pregnancy test. This checks for an unexpected pregnancy if you are of childbearing age and have missed a period.

• Hormone level tests. Blood tests may measure levels of follicle-stimulating hormone (FSH), estradiol (a form of estrogen), and prolactin, the hormone that stimulates milk production.

• Genetic testing. A karyotype analysis can detect unusual changes in your chromosomes. Your provider may also test for the FMR1 gene associated with fragile X syndrome.

Treatment

Treatment for primary ovarian insufficiency mainly addresses problems caused by low estrogen levels. Options include:

Estrogen therapy
Estrogen therapy helps prevent osteoporosis and relieves symptoms of low estrogen, such as hot flashes. If you still have a uterus, estrogen is usually combined with progesterone to protect the uterine lining from changes that could increase cancer risk. Hormone therapy may also restore menstrual periods, but it does not restore ovarian function. Depending on your health and preferences, therapy may continue until around age 50 to 51, the average age of natural menopause. In younger women with primary ovarian insufficiency, the benefits of hormone therapy generally outweigh potential long-term risks.

Calcium and vitamin D supplements
Calcium and vitamin D are essential for maintaining bone health. Your healthcare provider may recommend a bone density test before starting supplements. For women aged 19 to 50, 1,000 mg of calcium daily is usually recommended, increasing to 1,200 mg daily for women 51 and older. A common starting dose of vitamin D is 800 to 1,000 IU daily, though higher doses may be suggested if blood levels are low.

Addressing infertility
No treatment has been proven to restore fertility. Some women with primary ovarian insufficiency and their partners consider in vitro fertilization using donor eggs. In this procedure, eggs from a donor are fertilized with sperm, and the resulting embryo is placed in the uterus.