Premature Ovarian Failure

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Premature Ovarian Failure

• ACOG Medical Student Teaching Module
• 2009

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What is premature ovarian failure?

• Decline in normal functioning of the ovaries in a
  woman younger than 40 years of age
• AKA Primary ovarian insufficiency,
  hypergonadotropic hypogonadism
• The term premature menopause has fallen out of
  favor

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Two Subgroups

• Total follicle depletion
• No follicles left in ovary, no ability to make
  more
• Follicle dysfunction
• Some residual follicles in ovary, but they are
  not working properly

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Prevalence

• 1/250 by age 35
• 1/100 by age 40

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Symptoms of Premature Ovarian Failure

• Most common first symptoms irregular periods,
  Infertility
• Symptoms similar to menopause
• Hot flashes, night sweats
• Irritability, poor concentration
• Decreased libido
• Vaginal dryness

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Associated health conditions

• Osteoporosis
• Hypothyroidism
• Addison's disease
• Diabetes
• Heart disease
• Fragile X carriers more likely to develop
  premature ovarian failure

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Testing

• Elevated FSH prior to age 40 is diagnostic
• Estridiol (low)
• LH (low)
• Karyotype
• Dont forget pregnancy test!

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Causes

• Unknown
• ? Genetic 10-20 percent of women with POF have
  a family history
• ? Autoimmune association with thyroid
  dysfunction and diabetes
• MUST SCREEN FOR THESE CO-MORBIDITIES!
• Chemotherapy, Radiation, Cigarette Smoke,
  Chemicals, Pesticides

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Treatment

• No proven treatment to restore ovarian function
• HRT for vasomotor symptoms, promotion of bone
  health (can use OCPs)
• Calcium, Vitamin D
• Monitor for development of hyperplasia, bleeding

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Fertility?

• 5 10 of women with premature ovarian will
  become pregnant spontaneously
• IVF with donor egg is only proven effective
  fertility treatment

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