Ovarian failure

A Ovarian failure is a functional disorder of the ovaries (ovaries) that can be traced back to various causes and manifests itself in different forms. If left untreated, ovarian dysfunction often results in sterility (infertility) for the woman concerned and an unfulfilled desire to have children.

What is Ovarian Failure?

Typical symptoms of ovarian insufficiency are spotting, a feeling of tightness in the breasts and water retention in the tissue (edema). In mild forms of ovarian insufficiency, menstrual bleeding can occur despite the lack of ovulation, but the desire to have children remains unfulfilled.
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As Ovarian failure is a functional disorder of the ovaries as a result of a hormone-related dysregulation of follicle maturation or a prematurely depleted follicle supply in the ovaries.

In its milder form, ovarian insufficiency manifests itself on the basis of corpus luteum insufficiency (luteal body weakness), in which ovulation takes place but there is limited progesterone synthesis. Premenstrual spotting, breast tenderness and / or edema (water retention) are signs of this mild form.

A more pronounced ovarian failure is characterized by anovulation (lack of ovulation) and leads to a complete absence 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 (uterine lining), permanent bleeding and endometrial cancer.

The most severe variant of ovarian insufficiency is amenorrhea (lack of menstrual bleeding) with a complete lack of follicle maturation, which means that estrogen synthesis declines so much that a deficiency of the sex hormone arises, which can cause osteoporosis, cardiovascular diseases and climacteric symptoms (including sleep disorders, hot flashes) .

causes

A Ovarian failure is divided into different forms depending on the underlying cause. Primary ovarian insufficiency is either a genetic dysfunction (Turner syndrome, gonadal dysgenesis, Swyer syndrome) or a prematurely exhausted follicle supply as a result of chemotherapy or radiation therapy, nicotine consumption, severe infectious or autoimmune diseases in the ovaries themselves.

The secondary forms of ovarian failure are due to impaired pituitary or hypothalamic function. In the case of pituitary ovarian failure due to a pituitary dysfunction which, among other things, prolactinomas (benign pituitary tumors), an underactive thyroid gland (hypothyroidism) or stress, an increased prolactin concentration.

Hyperandrogenemic ovarian insufficiency is characterized by an increased testosterone level, which leads to impaired follicular maturation and is caused by PCO (polycystic ovaries), hyperthecosis ovaries or an adrenogenital syndrome.

The hypothalamic variant is usually caused by eating disorders (bulimia, anorexia), competitive sports, psychological stress or genetically by the so-called Kallmann syndrome and is associated with 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 tightness in the breasts and water retention in the tissue (edema). In mild forms of ovarian insufficiency, menstrual bleeding can occur despite the lack of ovulation, but the desire to have children remains unfulfilled. If the function of the ovaries is severely weakened, menstruation stops completely (amenorrhea).

If there is no menstrual period up to the age of 15, primary ovarian failure should also be considered. Affected women often suffer from the characteristic symptoms of menopause such as hot flashes, insomnia, night sweats and chronic fatigue. In many cases, depressive moods, anxiety and severe mood swings occur, vaginal dryness and a declining libido can severely impair sex life.

Frequently there is involuntary leakage of urine, a decrease in bone density as a result of the lack of estrogen can manifest itself as an increased tendency to fracture bones. Turner syndrome is characterized by poor 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, the 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), disorders in the menstrual cycle occur in both hypothalamic and hyperprolactinemic ovarian insufficiency.

Diagnosis & course

The suspicion of one Ovarian failure derives in most cases from an irregular menstrual cycle. To determine the specific form present, i.a. determines the hormone levels in the serum.

In the case of primary ovarian insufficiency, the LH and FSH levels are increased, in the hypophysial the prolactin and in the hyperandrogenemic the testosterone and DHEAS concentration in the serum. In the latter, polycystic ovaries can often be detected in the sonogram (ultrasound image). In hypothalamic ovarian insufficiency, on the other hand, all hormone concentrations (LH, FSH, progesterone, estradiol) are reduced or within the normal range.

Further decreased hormone levels (gonadotropins, insulin, prolactin) indicate a 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 mostly depends on the involvement of those affected and the causal therapy.

Complications

Ovarian failure complications usually arise if the condition is left untreated. In this case, the woman can become completely sterile, so that a desire for children can no longer be fulfilled in the conventional way. This can also lead to various psychological complaints and possibly also to depression.

The quality of life of the patient is significantly reduced by ovarian insufficiency. The women affected also suffer from spotting and also from 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 tension with your partner. As a rule, ovarian failure cannot be treated causally.

If the woman is already sterile, this complaint can unfortunately no longer be dealt with. Furthermore, this insufficiency can be treated with hormones. There are no complications. The desire to have children can also be pursued with the help of suitable treatment. The life expectancy of those affected is not influenced by ovarian failure. 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 and their partner should consult a doctor for a check-up. Although the partner may not experience the disease, the couple's overall fertility should be examined and assessed so that an overall assessment can be made. It is advisable to consult a doctor if pregnancy has not occurred for several cycles, although sexual activity occurred during the ovulation phase.

If there are changes in the woman's libido, if there is a change in personality or if a woman with an unfulfilled desire to have children suffers from severe emotional problems, a visit to the doctor is advisable. See a doctor for spotting, swelling of the breasts or water retention on the body. Menstrual disorders or a lack of menstruation are signs of a health problem. A doctor's visit is necessary so that research into the cause and subsequent treatment can be initiated. Symptoms such as vaginal dryness, involuntary urination, or night sweats should be examined by a doctor.

Exhaustion, general malaise, listlessness or a reduced zest for life are also symptoms that should be clarified by a doctor. Depression or mood swings are further signs of a health irregularity. If they last 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. A primary Ovarian failure is usually irreversible and cannot be treated if you want to have children.

Affected women under 40 years of age are recommended to use hormonal replacement therapy to compensate for the lack of estrogen. The therapy of pituitary ovarian failure aims to normalize the prolactin level by means of drugs that inhibit prolactin synthesis and thus restore the menstrual cycle. If the malfunction is based on a prolactinoma, this is treated with dopamine agonists.

A surgical intervention is only indicated if it affects neighboring structures. The hyperandrogenemic variant can be treated hormonally with an antiandrogen pill. If there is a desire to have children, additional ovarian stimulation therapy is indicated as standard. The therapy of hypothalamic ovarian insufficiency aims at the causal treatment of the individual underlying cause.

In addition, if women do not want to have children, hormone replacement therapy is recommended to avoid osteoporosis and cardiovascular diseases. If you want to have children, the disturbed release of gonadoliberin can be simulated by a small micropump that is worn on the body, thus inducing the onset of pregnancy.

If ovarian failure is due to eating disorders or psychological stress, the women affected should receive additional psychological or psychiatric care.

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Outlook & forecast

The outlook for ovarian failure varies widely and depends on the form and cause of the disease. Primary ovarian failure cannot be treated successfully in most cases. As a rule, the patients cannot bear their own children. However, some affected women gave birth to healthy children after receiving egg donation. However, this method is legally and morally controversial. After the ovaries have been surgically removed, pregnancy is completely ruled out. However, around ten percent of affected women heal spontaneously without treatment. These patients can of course become pregnant.

The prognosis is different for the secondary form of ovarian failure. In most cases, this can be treated well. Once hormone levels return to normal, women often return to normal menstrual cycles. In most cases, those affected can get pregnant naturally. In some cases, an artificial fear (IVF) or an intracytoplasmic sperm injection (ICSI) is necessary. The affected women rarely remain sterile.

In any case, ovarian failure does not affect the course of pregnancy. It only affects the fertility of the affected women.

prevention

One Ovarian failure can only be prevented to a limited extent. Refraining from nicotine consumption, avoiding being underweight or overweight, learning stress management techniques and consistently treating diseases that can affect the hormonal balance minimizes the risk of ovarian dysfunction.

Aftercare

In the case of ovarian insufficiency, the affected person usually has only a few and usually only limited follow-up measures available. For this reason, early diagnosis of this condition is very important in order to prevent other symptoms and complications from occurring. With ovarian insufficiency, there is usually no independent healing, 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 drugs. 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 people with ovarian failure depend on the help and support of their partner. This can also prevent the development of depression. 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

If primary ovarian failure is diagnosed, it is usually a traumatic experience for the women concerned. In order to process the diagnosis, discussions with the partner, with other affected persons and with the gynecologist help. In addition to medical treatment, which focuses on alleviating the causes, the women affected must receive psychological care.

In the case of hypothalamic ovarian insufficiency, causal therapy is possible, provided the patient takes the necessary accompanying measures. This includes rest and rest, a change in diet and observation of the symptoms. The doctor must be informed if unusual symptoms arise. After an operation, the patient must rest for at least three to four weeks. It is also important to make use of the regular follow-up checks.

Pregnancy is often no longer possible after ovarian failure, which is why the sick women should think about alternative options if they want to have children. Primarily in younger women, primary ovarian insufficiency can cause major psychological problems that must be treated therapeutically as well as medication.Women over the age of 40 should take preventive medical checkups to rule out complications.