Premature Ovarian Failure (POF)

Premature Ovarian Failure (POF) is a disease in which the ovaries lose normal function before the age of 40. Typically, women with POF exhibit a lack of periods (amenorrhea), diminished function of the ovaries to gonadotropins (hormones that regulate reproductive function), and ultimately, infertility.

POF occurrence is 1/100 before age 40 and 1/1000 before age 30. If unmanaged, POF can lead to autoimmune disorders, such as Hashimoto’s disease, or osteoporosis.[1] It is important to note that primary ovarian insufficiency (POI) and POF are used interchangeably as names for the name condition.

Symptoms of POF

Signs and symptoms of POF mimic menopause due to estrogen deficiency. These can include:

Lack of or skipped periods (amenorrhea)
Hot flashes
Night sweats
Low libido

The possible cause for POF has been linked to several genetic defects, toxins in the environment, autoimmune diseases or chemotherapy; however, a solid cause is still unknown.[2][3][4]

How to determine POF

If you have had irregular or skipped periods for more than 4 months, your doctor will do a physical and blood test to determine the cause. If the blood test comes back with higher than normal levels of follicle-stimulating hormone (FSH) and very low estradiol (natural human estrogen) levels, this is a primary sign of POF. If your luteinizing hormone (LH) is also elevated beyond normal levels, this could be yet another sign of POF.[5] For more information on FSH, LH, or any other hormones and tests, please visit the “RE Testing” page in the Menu.

Treatment for POF

While there is currently no cure for POF, treatment is available for the symptoms and risks for POF.

The most commonly used treatment for POF is hormone replacement therapy (HRT). This treatment combines estrogen and progesterone to protect the endometrium (uterine lining) from increased estrogen levels. Without progesterone, there is an increased risk of endometrial cancer.[6] HRT drugs can be taken as pills, cream, patches or as an IUD. While HRT will not return normal ovarian function, it will regulate periods, decrease risks for osteoporosis and cardiovascular disease, and increase libido. The recommended suggestion for HRT is until 50 years old when true menopause usually starts. Calcium ad Vitamin D will also need to be taken to combat bone loss.[7]

POF and Infertility

In terms of fertility, due to the loss of normal ovarian function, a woman diagnosed with POF will be unable to use her own eggs and will need donor eggs or embryos. The uterus in most POF cases is unaffected, so women with POF are still able to carry children. Women with additional issues may be suggested to use a surrogate as well.[1]

For more information on donor eggs, donor embryos, or surrogacy, please visit the Donor page located in the menu above.

[1] Jankowska, Katarzyna. 2017. “Premature Ovarian Failure.” Przeglad Menopauzalny = Menopause Review 16 (2). Termedia Publishing: 51–56. https://doi.org/10.5114/pm.2017.68592.

[2] Mayo Clinic Staff. 2018. “Premature Ovarian Failure.” 2018. https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683.

[3] Beck-Peccoz, Paolo, and Luca Persani. 2006. “Premature Ovarian Failure.” Orphanet Journal of Rare Diseases 1 (1). BioMed Central: 9. https://doi.org/10.1186/1750-1172-1-9.

[4] Shelling, Andrew N. 2010. “Premature Ovarian Failure.” Reproduction (Cambridge, England) 140 (5). Society for Reproduction and Fertility: 633–41. https://doi.org/10.1530/REP-09-0567.

[5] “Primary Ovarian Insufficiency (POF, Premature Ovarian Failure, POI).” MedicineNet.com. Accessed April 26th, 2018. https://www.medicinenet.com/premature_ovarian_failure_pof/article.htm#what_is_primary_ovarian_insufficiency_poi.

[6] “What Are the Treatments for POI?” 2016. National Institute of Child Health and Human Development. 2016. https://www.nichd.nih.gov/health/topics/poi/conditioninfo/treatments.

[7] “Premature Ovarian Failure.” 2018. Mayo Clinic. 2018. https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/diagnosis-treatment/drc-20354688.

[1] “Premature Ovarian Failure (POF).” 2017. Arizona Center for Fertility Studies (ACFS). 2017. https://www.acfs2000.com/premature-ovarian-failure-pof.html.