B8.027 Prework 2: Primary Ovarian Insufficiency

Question 1

what is primary ovarian insufficiency

Answer 1

POI
continuum of impaired ovarian function (intermittent to permanent) usually with extended periods of amenorrhea in women < 40
type of premature menopause NOT caused by med/surg treatments

Question 2

why is term insufficiency preferred over failure?

Answer 2

5-25% may experience at least 1 spontaneous return of ovarian function
5-10% may conceive spontaneously

Question 3

causes of POI

Answer 3

genetic disorders
-familial (4-33%)
autoimmune disorders
-thyroid, andrenals, parathyroid, diabetes
misc
-metabolic syndrome
-infection
-idiopathic (74-90%)

Question 4

presentation of a patient with POI

Answer 4

AUB, oligomenorrhea, or amenorrhea
elevated FSH, but may fluctuate
low or undetectable AMH
low ovarian AFC (usually not obtained clinically)
some intermittently have symptoms of menopause

Question 5

assessment of patient with suspected POI

Answer 5

history for bleeding pattern and symptoms of menopause
physical to assess vaginal changes
FSH and estradiol levels
TSH, PL, AMH possible
karyotype

Question 6

what causes of secondary amenorrhea should be ruled out in suspected POI

Answer 6

pregnancy
hypothalamic amenorrhea
PCOS
hypothyroidism, hyperthyroidism, hyperprolactinemia

Question 7

specific testing for suspected POI

Answer 7

FMR1 gene premutation
adrenal Abs
thyroid peroxidase Abs
fasting glucose
pelvic US

Question 8

criteria for POI

Answer 8

differ from normal menopause
min 4 months of bleeding abnormality
at least 2 elevated FSH levels at least a month apart

Question 9

management of POI

Answer 9

consider HT
discuss fertility options
discuss contraception
psych support (high risk of depression/anxiety)
address sexual concerns