What is decreasing ovarian reserve?

When a woman’s ovaries stop working before age 40, she is said to have decreasing ovarian reserve, previously referred to as premature ovarian failure [POF]. It affects approximately 1% of women but the incidence is on the rise. When this happens, a woman’s menstrual cycles become irregular and stop. Her ovaries stop making hormones such as estrogen and progesterone and she stops releasing eggs (ovulating) regularly or at all.

When should one suspect that she may have DOR?

DOR may occur suddenly with an abrupt stoppage of menstrual periods, or, it can come on gradually with months of menstrual irregularity before periods stop. Most women with DOR have symptoms that are commonly experienced by women approaching and entering menopause. These symptoms include hot flashes, vaginal dryness, irritability, night sweats, and difficulty sleeping. Young women with DOR may never begin having menstrual periods and may not go through the normal stages of puberty. For others, difficulty getting pregnant may be the earliest and only sign of premature ovarian aging.

What might be potential causes of DOR?

In almost half of women affected by DOR, the exact cause is never known. Some known reasons may include familial causes, autoimmune disorders like those affecting thyroid or adrenal glands, genetic causes such as Turner and Fragile X syndrome, or certain medications such as chemotherapy or radiation.

Are there risks associated with DOR that one should be aware of?

In addition to the symptoms listed above, low estrogen levels also can make one more likely to develop osteoporosis and early heart disease. If DOR is caused by a genetic condition, there may be potential long-term risks to the next generation, therefore, having a genetic consultation is advisable. Although approximately 10% of women with DOR may be able to get pregnant using their own eggs, fertility rates are difficult to predict in this group. For women with DOR who attempt pregnancy, success rates may be improved through the use of donor eggs.

Can DOR be treated?

For medically induced causes of DOR such as radiation and chemotherapy, some ovarian function may return naturally over time. The younger a woman is at the time she is exposed to the damaging treatments, the more likely it is for her ovaries to keep some function. It is common to have no identifiable cause of DOR. There are no existing treatments that reverse this type of ovarian failure. Hormonal therapy (consisting of estrogen and progesterone) and a number of non-hormonal therapies can be used to treat symptoms, but do not help with fertility. For women with DOR who are seeking pregnancy, the use of donor eggs can be suggested. Women with ovarian insufficiency often carry healthy pregnancies successfully through the use of donor eggs.