1 to 2% of women under the age of 40 are affected by premature ovarian failure, which is characterized by depletion of the ovarian reserve. What is ovarian failure? Ovarian failure, also called ovarian failure, is a normal physiological process in women. This period is called menopause, which occurs on average at the age of 51. Menopause is considered early when it occurs before the age of 40. In this case, it is also called premature ovarian failure. Early ovarian failure is defined clinically by amenorrhea—absence of menstruation for more than four months before age 40, associated with a high level of FSH in at least two blood samples taken several weeks apart. Early ovarian failure leads to infertility, since fertilization is not possible without ovulation. However, some women with ovarian failure may periodically produce estrogen and ovulate. Causes of the disease In the little girl, the supply of ovarian follicles accumulates during intrauterine development. Thus, at birth, each ovary contains a reserve of 1 to 2 million ovarian follicles. From puberty to menopause, with each menstrual cycle, a small portion of this supply matures during the follicular phase. The dominant follicle continues to mature while the remaining follicles degenerate. At the same time, a normal phenomenon of apoptosis is observed – the programmed death of a certain part of the follicle stock. This phenomenon accelerates after the age of 37 and menopause occurs when the number of follicles becomes less than 1000. During this physiological process, three different mechanisms can cause premature ovarian failure: An abnormality in the formation of the follicular reserve; Blocking the maturation of follicles – there is a supply of follicles, but they do not mature; Abnormally rapid depletion of the follicular reserve Various causes may underlie these mechanisms Iatrogenic causes – treatment with radiotherapy and/or chemotherapy may accelerate the process of apoptosis and lead to early depletion of the ovarian reserve; A genetic abnormality, the most common is Turner’s syndrome, which is characterized by the absence of one of the X chromosomes, but many other abnormalities located on the autosomes or on the X chromosome can lead to the disease, various genetic mutations have now been identified; Autoimmune causes – an abnormal response of the immune system that turns against the organism itself; Graves’ disease, type 1 diabetes, autoimmune polyendocrinopathy syndrome; Viral causes In more than 80% of cases, premature ovarian failure is due to unknown causes. What are the complications of ovarian failure? Complications associated with low estrogen levels: increased risk of cardiovascular disease and osteoporosis; Infertility It is also known,that young women with premature ovarian failure have an increased risk of developing autoimmune adrenal insufficiency. Symptoms of early ovarian failure Absence of puberty and primary amenorrhea – lack of menstruation, this is usually associated with a genetic abnormality secondary amenorrhea: menstrual cycle that stops suddenly; Irregular menstrual cycle, especially in case of early ovarian failure or occult ovarian failure; Various symptoms related to estrogen deficiency can accompany the cessation of menstruation: hot flashes, insomnia, fatigue, mood disorders Diagnosis Absence of menstruation for at least four months; Two FSH tests one month apart with results above 20 IU/L. Ultrasound is not a determining factor in the diagnosis of ovarian failure. An ovarian biopsy is not necessary. Sources: https://www.passeportsante.net/fr/Maux/Problemes/Fiche.aspx?doc=insuffisence-ovarienne