Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Feb 23 2018

Primary Ovarian Insufficiency

  • Snapshot
    • A 37-year-old woman reports vaginal dryness and menstrual irregularities. She had an intrauterine device (IUD) placed for 5 years and now wishes to conceive with her husband. While they have only been trying for 4 months, she has not had a regular menstrual period since removing the IUD. She denies hot flashes. On physical exam, she has a normal stature and normal BMI, but has a notably atrophic vagina. Laboratory results reveal low estradiol and high follicle-stimulating hormone, suggestive of primary ovarian insufficiency.
  • Introduction
    • Hypergonadotropic hypogonadism before 40 years of age
      • also known as premature ovarian failure
    • Characterized by
      • loss of oocytes
      • ↓ estrogen production
      • infertility
    • Pathogenesis
      • accelerated follicle depletion
        • normally, follicle depletion is completed around 51 years of age (average age of menopause)
        • rate of follicle depletion may be accelerated by genetic disorders and toxins to the ovary
        • toxins
          • galactose metabolites
          • chemotherapy/radiation therapy
          • viruses (mumps and CMV) causing oophoritis
      • decreased steroid production without oocyte loss
    • Epidemiology
      • 1 in 250 by age 35 years
      • 1 in 100 by age 40 years
    • Associated conditions and risk factors
      • chromosomal defects (e.g., Turner syndrome and fragile X syndrome)
      • galactosemia
      • exposure to radiation
      • autoimmune disease
  • Presentation
    • Symptoms are similar to menopause
      • change in menstruation
        • oligomenorrhea
        • amenorrhea
        • failure to return to normal menstruation after stopping contraceptives or following a pregnancy
      • difficulty conceiving
      • estrogen deficiency
        • hot flashes
        • vaginal dryness
    • Physical exam
      • vaginal atrophy
      • features of Turner syndrome
        • short stature
        • webbed neck
        • squarely shaped chest
  • Evaluation
    • Diagnosis is made in women younger than 40 years of age with irregular menses and high follicle-stimulating hormone (FSH)
    • Labs
      • ↑ FSH and lutenizing hormone (LH)
      • ↓ estradiol
    • Transvaginal ultrasound
      • typical findings
        • enlarged cystic ovaries
      • findings in Turner syndrome
        • streak ovaries
  • Differential
    • Pregnancy
    • Hyperprolactinemia
    • Other cause of female infertility
  • Treatment
    • Estrogen-progestin replacement therapy
      • for prevention of osteoporosis
      • symptomatic control of hot flashes and vaginal dryness
      • prevention of coronary artery disease
      • recommended until after age 50
    • Assisted reproductive technologies
      • in vitro fertilization with donor oocytes or donor embryos
  • Prognosis, Prevention, and Complications
    • Complications
      • ↓ quality of life
      • earlier onset osteoporosis if primary ovarian insufficiency is not identified early
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options