Ovarian insufficiency is a dysfunction of the ovaries (ovaries) that can be attributed to various causes and manifests itself in different forms. If left untreated, an ovarian dysfunction often leads to sterility (infertility) in the affected woman and an unfulfilled desire to have children.
What is ovarian failure?
Ovarian insufficiency is a functional disorder of the ovaries as a result of hormonal dysregulation of follicle maturation or a prematurely depleted supply of follicles in the ovaries. See gradinmath for What is Hepatitis D.
In its milder form, ovarian insufficiency manifests itself in the form of corpus luteum insufficiency (weakness of the corpus luteum), in which ovulation takes place, but progesterone synthesis is limited. Premenstrual spotting, breast tenderness and/or edema (water retention) are signs of this mild form.
More severe ovarian insufficiency is characterized by anovulation (absence of ovulation) and leads to a complete failure of progesterone production. The female organism is exposed to an excess of estrogens, which in the long term can lead to changes in the endometrium (mucous membrane of the uterus), permanent bleeding and endometrial carcinoma.
The most severe variant of ovarian insufficiency is amenorrhea (absence of menstrual bleeding) with a complete lack of follicle maturation, which means that estrogen synthesis decreases so much that a deficiency of the sex hormone occurs, which can cause osteoporosis, cardiovascular diseases and menopausal symptoms (including sleep disorders, hot flashes)..
Causes
Ovarian failure is divided into different forms depending on the underlying cause. In the case of primary ovarian insufficiency, there is either a genetic functional disorder (Turner syndrome, gonadal dysgenesis, Swyer syndrome) or a prematurely exhausted supply of follicles as a result of chemotherapeutic or radiotherapeutic measures, nicotine consumption, severe infectious or autoimmune diseases in the ovaries themselves.
The secondary forms of ovarian failure are due to impairments in pituitary or hypothalamic function. Thus, in pituitary ovarian insufficiency due to a pituitary malfunction, which can be caused by prolactinoma (benign pituitary tumors), hypothyroidism (hypothyroidism) or stress, there is an increased prolactin concentration.
Hyperandrogenemic ovarian insufficiency is characterized by an increased testosterone level, which results in impaired follicle maturation and is caused by PCO (polycystic ovaries), ovarian hyperthecosis or an adrenogenital syndrome.
The hypothalamic variant is usually caused by eating disorders (bulimia, anorexia), competitive sport, mental stress or genetically by the so-called Kallmann syndrome and is accompanied by a dysregulated release of gonadoliberin from the hypothalamus, which disrupts the synthesis of gonadotropins (including FSH)..
Symptoms, Ailments & Signs
Typical symptoms of ovarian insufficiency are spotting, a feeling of tension in the breasts and water retention in the tissue (oedema). In mild forms of ovarian insufficiency, menstrual bleeding can occur despite a lack of ovulation, but the desire to have children remains unfulfilled. If the function of the ovaries is very weak, menstruation stops completely (amenorrhea).
If there is no menstrual bleeding by the age of 15, primary ovarian failure must also be considered. Affected women often suffer from the characteristic symptoms of menopause such as hot flashes, sleep disorders, night sweats and chronic exhaustion. In many cases, depressive moods, anxiety and strong mood swings occur, vaginal dryness and a decreasing libido can severely affect sex life.
Involuntary urination is common, and a decrease in bone density as a result of estrogen deficiency can manifest itself in an increased tendency to fractures. Turner syndrome is characterized by low pubic hair growth, reduced body growth, wing-shaped skin folds on the neck (pterygium colli), widely spaced nipples and a shield-shaped chest. In Swyer syndrome, secondary sexual characteristics do not develop during puberty.
Secondary ovarian insufficiency can manifest itself through increased hair growth, skin blemishes, a drop in voice frequency and increased muscle formation (hyperandrogenic ovarian insufficiency). Disturbances in the menstrual cycle occur in both hypothalamic and hyperprolactinemic ovarian insufficiency.
Diagnosis & History
In most cases, the suspicion of ovarian insufficiency is derived from an irregular menstrual cycle. To determine the specific form present, the hormone levels in the serum are determined, among other things.
In primary ovarian insufficiency, the LH and FSH values are increased, in pituitary insufficiency the prolactin concentration and in hyperandrogenemic the testosterone and DHEAS concentration in the serum. In addition, polycystic ovaries can often be detected in the latter in the sonogram (ultrasound image). In the case of hypothalamic ovarian insufficiency, on the other hand, all hormone concentrations (LH, FSH, progesterone, estradiol) are reduced or within the normal range.
Other reduced hormone levels (gonadotropins, insulin, prolactin) point to Kallmann syndrome. The prognosis and course of ovarian failure depend largely on the underlying cause. While there are currently no promising therapeutic measures for the primary form and the desire to have children often remains unfulfilled, the success of the therapy in the secondary forms of ovarian insufficiency usually depends on the cooperation of those affected and the causal therapy.
Complications
Complications from ovarian failure usually occur if the condition is left untreated. In this case, the woman can become completely infertile, so that a desire to have children can no longer be fulfilled in the conventional way. It can also lead to various psychological problems and possibly also to depression.
The quality of life of the patients is significantly restricted by the ovarian insufficiency. The affected women also suffer from spotting and menstrual disorders. As a result, mood swings or water retention often occur in different parts of the body. Infertility can also lead to complications or tensions with your partner. As a rule, ovarian insufficiency cannot be treated causally.
If the woman is already infertile, this complaint can unfortunately no longer be treated. This insufficiency can also be treated with hormones. There are no complications. The desire to have children can also be pursued with the help of appropriate treatment. The life expectancy of those affected is not affected by ovarian insufficiency. However, if ovarian insufficiency occurs due to another underlying disease or an eating disorder, this disease must first be diagnosed and treated.
When should you go to the doctor?
If sexually mature women have an unfulfilled desire to have children, they should consult a doctor together with their partner for a check-up. Although the condition cannot occur in the partner, the couple’s fertility as a whole should be evaluated and assessed to provide an overall assessment. It is advisable to consult a doctor if pregnancy has not occurred for several cycles despite sexual activity during the ovulation phase.
If a woman’s libido changes, if there are personality changes or if a woman with an unfulfilled desire to have children suffers from strong emotional problems, a doctor’s visit is advisable. Spotting, swelling of the breasts or water retention on the body should be presented to a doctor. Menstrual disorders or the absence of menstruation are signs of health problems. A doctor’s visit is necessary so that a cause analysis and subsequent treatment can be initiated. Symptoms such as vaginal dryness, involuntary urination, or night sweats should be evaluated by a doctor.
Exhaustion, general malaise, listlessness or a reduced zest for life are also symptoms that should be clarified by a doctor. A depressed appearance or mood swings are further signs of a health irregularity. If they persist for several weeks or months, a doctor is needed.
Treatment & Therapy
In the case of ovarian insufficiency, the therapeutic measures depend on the specific form present. Primary ovarian failure is usually irreversible and cannot be treated if you want to have children.
Affected women under the age of 40 are recommended hormone replacement therapy to compensate for the lack of estrogen . Therapy of pituitary ovarian insufficiency is aimed at normalizing the level of prolactin with drugs that inhibit prolactin synthesis, thus restoring the menstrual cycle. If the malfunction is based on a prolactinoma, this is treated with drugs using dopamine agonists.
A surgical intervention is only indicated if neighboring structures are affected by it. The hyperandrogenemic variant can be treated hormonally with an antiandrogenic pill. If there is a desire to have children, additional stimulation therapy of the ovaries is indicated as standard. The therapy of hypothalamic ovarian insufficiency aims at the causal treatment of the individually underlying cause.
In addition, hormone replacement therapy is recommended to avoid osteoporosis and cardiovascular diseases if women do not want to have children. If there is a desire to have children, the disrupted release of gonadoliberin can be simulated using a small micropump worn on the body, thus inducing pregnancy.
If the ovarian insufficiency is due to eating disorders or psychological stress, the affected women should also receive psychological or psychiatric care.
Outlook & Forecast
The outlook for ovarian failure varies greatly, depending on the type and cause of the disease. In most cases, primary ovarian failure cannot be treated successfully. As a rule, the patients cannot carry their own children. However, some affected women gave birth to healthy children after receiving an egg donation. However, this method is legally and morally controversial. After the surgical removal of the ovaries, pregnancy is completely impossible. In about ten percent of the women affected, however, spontaneous healing occurs without treatment. These patients can of course become pregnant.
The prognosis for the secondary form of ovarian failure is different. In most cases, this can be treated well. Once hormone levels return to normal, women often have a normal menstrual cycle again. In most cases, those affected can become pregnant naturally. In some cases, artificial insemination (IVF) or intracytoplasmic sperm injection (ICSI) is necessary. Rarely do the affected women remain infertile.
In any case, ovarian failure does not affect the course of a pregnancy. It only affects the fertility of the affected women.
Prevention
Ovarian insufficiency can only be prevented to a limited extent. Forgoing nicotine consumption, avoiding being underweight or overweight, learning stress management techniques and consistent therapy for diseases that can impair the hormonal balance minimizes the risk of ovarian dysfunction.
Aftercare
In the case of ovarian insufficiency, those affected usually have only a few and usually only limited follow-up measures available. For this reason, early diagnosis of this disease is very important to prevent the occurrence of other symptoms and complications. As a rule, ovarian insufficiency cannot heal on its own, so that those affected are always dependent on a visit to a doctor.
The disease can be treated relatively well with the help of various medications. It is always important to ensure the correct dosage and the prescribed intake of the medication. If anything is unclear or if you have any questions or side effects, you should always consult a doctor first.
Likewise, most sufferers of ovarian insufficiency are dependent on the help and support of their partner. This can also prevent depression from developing. Further follow-up measures are usually not available to the patient. The disease itself does not reduce the life expectancy of the person affected. However, no general prediction can be made about the further course.
You can do that yourself
When primary ovarian insufficiency is diagnosed, this is usually a traumatic experience for the women affected. Discussions with the partner, with other affected persons and with the gynecologist help to process the diagnosis. In addition to medical treatment, which focuses on alleviating the causes, the affected women must be given psychological care.
In the case of hypothalamic ovarian insufficiency, causal therapy is possible if the patient carries out the necessary accompanying measures. These include rest and protection, a change in diet and an observation of the symptoms. If unusual symptoms appear, the doctor must be informed. After an operation, the patient must rest for at least three to four weeks. It is also important to take advantage of the regular follow-up checks.
Pregnancy is often no longer possible after ovarian insufficiency, which is why the affected women should think about alternative options if they have a desire to have children. Especially in younger women, primary ovarian insufficiency can cause major mental problems that need to be treated with both therapy and medication. Women who are older than 40 years should take advantage of the check-ups to rule out complications.
