Premature ovarian failure — also known as primary ovarian insufficiency — is a loss of normal function of your ovaries before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone oestrogen or release eggs regularly. Infertility is a common result.
Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions aren’t the same. Women with premature ovarian failure 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.
Restoring oestrogen levels in women with premature ovarian failure helps prevent some complications, such as osteoporosis, that occur as a result of low oestrogen.
Signs and symptoms of premature ovarian failure are similar to those of going through menopause and are typical of oestrogen deficiency. They include:
• Irregular or skipped periods (amenorrhea), which might be present for years or develop after a pregnancy or after stopping birth control pills
• Difficulty conceiving
• Hot flashes
• Night sweats
• Vaginal dryness
• Irritability or difficulty concentrating
• Decreased sexual desire
In women with normal ovarian function, the pituitary gland releases certain hormones during the menstrual cycle, which causes a small number of egg-containing follicles in the ovaries to begin maturing. Usually one or two follicles — tiny sacs filled with fluid — reach maturity each month.
When the follicle matures, it opens, releasing an egg. The egg enters the fallopian tube where a sperm cell might fertilize it, resulting in pregnancy.
Premature ovarian failure results from the loss of eggs (oocytes). This might happen because of:
• 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. These therapies can damage the genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses might hasten ovarian failure.
• An immune system response to ovarian tissue (autoimmune disease). In this rare form, your immune system produces antibodies against your 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, but have no known chromosomal defects, toxin exposure or autoimmune disease. Your doctor might recommend further testing to find the cause, but in most cases, the cause remains unknown (idiopathic).
Factors that increase your risk of developing premature ovarian failure include:
• Age. Risk rises between the ages of 35 and 40, although younger women and adolescents can develop the condition.
• Family history. Having a family history of premature ovarian failure increases your risk of developing this disorder.
• Multiple ovarian surgeries. Ovarian endometriosis or other conditions requiring repeated surgeries on the ovaries increases the risk of premature ovarian failure.
Complications of premature ovarian failure include:
• Infertility. Inability to get pregnant may be the most troubling complication of premature ovarian failure, although in rare cases, pregnancy is possible until the eggs are depleted.
• Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.
• Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels causes some women to become depressed or anxious.
• Heart disease. Early loss of estrogen might increase your risk.
• Dementia. Lack of estrogen can contribute to this in some people.
Most women have few signs of premature ovarian failure. Diagnosis usually involves a physical exam, including a pelvic exam. Your doctor might ask questions about your menstrual cycle, exposure to toxins, such as chemotherapy or radiation therapy, and previous ovarian surgery.
Your doctor might recommend one or more of these tests:
• Pregnancy test. This checks for an unexpected pregnancy in a woman of childbearing age who has missed a period.
• Follicle-stimulating hormone (FSH) test. FSH is a hormone released by the pituitary gland that stimulates the growth of follicles in your ovaries. Women with premature ovarian failure often have abnormally high levels of FSH in the blood.
• Estradiol test. The blood level of estradiol, a type of estrogen that comes from the ovaries, is usually low in women with premature ovarian failure.
• Prolactin test. High blood levels of prolactin — the hormone that stimulates breast milk production — can lead to problems with ovulation, including irregular or absent menstrual periods.
• Karyotype. This test examines your 46 chromosomes for abnormalities. You could have only one X chromosome instead of two or other chromosomal defects.
• FMR1 gene testing. The FMR1 gene is the gene associated with fragile X syndrome — an inherited disorder that can cause intellectual problems. The FMR1 test looks at both of your X chromosomes to make sure they appear normal.
Treatment for premature ovarian failure usually focuses on the problems that arise from estrogen deficiency. Your doctor might recommend:
• Estrogen therapy. Estrogen therapy can help prevent osteoporosis and relieve hot flashes and other symptoms of estrogen deficiency. Your doctor typically prescribes estrogen with the hormone progesterone, especially if you still have your uterus. Adding progesterone protects the lining of your uterus (endometrium) from precancerous changes caused by taking estrogen alone.
The combination of hormones can cause vaginal bleeding again, but it won’t restore ovarian function. Depending on your health and preference, you might take hormone therapy until around age 50 or 51 — the average age of natural menopause.
In older women, long-term estrogen plus progestin therapy has been linked to an increased risk of heart and blood vessel (cardiovascular) disease and breast cancer. In young women with premature ovarian failure, however, the benefits of hormone therapy outweigh the potential risks.
• Calcium and vitamin D supplements. Both are important for preventing osteoporosis, and you might not get enough in your diet or from exposure to sunlight. Your doctor might suggest bone density testing before starting supplements to get a baseline bone density measurement.
For women ages 19 through 50, the Institute of Medicine recommends 1,000 milligrams (mg) of calcium a day through food or supplements, increasing to 1,200 mg a day for women age 51 and older.
Scientists don’t yet know the optimal daily dose of vitamin D. A good starting point for adults is 600 to 800 international units (IU) a day, through food or supplements. If your blood levels of vitamin D are low, your doctor might suggest higher doses.
What is ovarian insufficiency?
Human female is born with the fixed number of eggs at the time of birth. From the time of puberty, she constantly loses eggs to produce hormones for development of reproductive organs and initiate cyclicity of uterine and ovarian tissues. She constantly loses eggs to produce hormones to mature and release one egg in each cycle. The number of eggs decreases significantly by the age of 35 years and goes down rapidly by the age of forty.
For long we have been led to believe that once the eggs in ovaries are exhausted due to any reason then there is no alternative but the egg donation to have babies. The disadvantage is that in egg donation the mother is not the biological mother of the baby. It is for this reason that parents have to think hard and long before taking a decision. In some religions, it is not even permitted.
But in the light of recent researches in stem cell and PRP technology, it seems possible to offer these advanced therapies to menopausal women and females with premature ovarian failure, a chance to have a baby of their own eggs.
Adipose-derived stem cells or PRP or both injected directly into the ovary can stimulate the endogenous stem cells (pericytes) in the damaged area to regenerate ovarian tissue-specific cells to regenerate and rejuvenate the ovary.
PRP injected directly into the ovary releases it cytokines and growth factors to heal and revive the local tissues in the ovaries to produce eggs again. In the case of women with premature ovarian insufficiency and menopause, it gives them the opportunity to have a baby with their own eggs.
The Role of Growth Factors in Rejuvenation
Body cells normally release growth factors for multiplication and differentiation of cells. These factors are important for cell renewal, the growth of tissues like muscle, bone, organs and wound healing. The plasma platelets also release several growth factors to repair injured tissues. PRP has been in use for long in treating sports injuries, in surgery for wound healing. The same property has been used for regeneration off eggs in the ovary and endometrium of the uterus in cases of the thin endometrium.
Platelets in the PRP have several growth factors that help ovarian regeneration in cases of premature ovarian failure and menopausal patients.
Following are Some of The Growth Factors:
• Platelet-derived growth factor (PDGF)
• Transforming growth factor (TGF), platelet factor interleukin (IL)
• Platelet-derived angiogenesis factor (PDAF)
• Vascular endothelial growth factor (VEGF), epidermal growth factor (EGF)
• Insulin-like growth factor IGF and Fibronectin.
With this procedure new wave of egg production starts, normal menstrual cycles are established and the couple can have their own biological child.