Climacteric and Menopause - Premature Ovarian Insufficiency

Question 1

What is Premature Ovarian Insufficiency?

Answer 1

Menopause before the age of 40.

Question 2

Aetiology of Premature Ovarian Insufficiency (5).

Answer 2

Decline of normal activity of ovaries at an early age.

1. Idiopathic (50%).
2. Iatrogenic : Chemotherapy, Radiotherapy, Surgery (Bilateral Oophorectomy).
3. Autoimmune (e.g. Coeliac Disease, Adrenal Insufficiency, Type I Diabetes, Thyroid Disease).
4. Genetic : Positive Family History or Turner’s.
5. Infection : Mumps, Tuberculosis, CMV.

Question 3

Hormones in Premature Ovarian Insufficiency (2).

Answer 3

Hypergonadotrophic Hypogonadism :

1. Raised LH and FSH (negative feedback).
2. Low estradiol (under-activity of gonads).

Question 4

Clinical Presentation of Premature Ovarian Insufficiency.

Answer 4

Typical symptoms of Menopause before the age of 40.

Question 5

Diagnosis of Menopause.

Answer 5

Women Below 40 + Typical Menopausal Symptoms + Elevated FSH (on 2 consecutive samples separated by 4_ weeks).

Question 6

Management of Premature Ovarian Insufficiency.

Answer 6

1. HRT until usual age of menopause.

2. Traditional HRT or COCP.

Question 7

Complications of Premature Ovarian Insufficiency (3).

Answer 7

Lack of Oestrogen :

1. Cardiovascular Disease and Stroke.
2. Osteoporosis.
3. Cognitive Impairment, Dementia and Parkinsonism.