Ovarian failure

Most women have few signs of primary ovarian insufficiency, but your health care provider may suspect the condition if you have irregular periods or are having trouble conceiving. Diagnosis usually involves a physical exam, including a pelvic exam. Your provider might ask questions about your menstrual cycle, exposure to toxins, such as chemotherapy or radiation therapy, and previous ovarian surgery.

Your provider might recommend one or more tests to check for:

Pregnancy. A pregnancy test checks for an unexpected pregnancy if you're of childbearing age and missed a period.

Hormone levels. Your provider may check the levels of a number of hormones in your blood, including follicle-stimulating hormone (FSH), a type of estrogen called estradiol, and the hormone that stimulates breast milk production (prolactin).

Chromosome changes or certain genes. You may have a blood test called a karyotype analysis to look for unusual changes in your chromosomes. Your doctor may also check to see if you have a gene associated with fragile X syndrome called FMR1.

Treatment for primary ovarian insufficiency usually focuses on the problems that arise from estrogen deficiency. Your health care provider might recommend:

Estrogen therapy. Estrogen therapy can help prevent osteoporosis as well as relieve hot flashes and other symptoms of estrogen deficiency. Your provider may prescribe estrogen with the hormone progesterone, especially if you still have your uterus. Adding progesterone protects the lining of your uterus (endometrium) from precancerous changes that may be caused by taking estrogen alone.

The combination of hormones may make your period come back, 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 primary ovarian insufficiency, however, the benefits of hormone therapy outweigh the potential risks.

Calcium and vitamin D supplements. Both nutrients are important for preventing osteoporosis, and you might not get enough in your diet or from exposure to sunlight. Your provider might suggest bone density testing before starting supplements to get a baseline measurement.

For women ages 19 through 50, experts generally recommend 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.

The optimal daily dose of vitamin D isn't yet clear. 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 provider might suggest higher doses.