Pre-mature Ovarian Insufficiency/Failure

Question 1

Define Pre-mature Ovarian Insufficiency.

Answer 1

Secondary amenorrhoea before the age of 40 years

• POI = ovulate sporadically
• Menopause = stopped entirely

Question 2

What are the causes of POI?

Answer 2

• Unknown (Addison’s – steroid cell autoantibodies cross-react with granulosa cells and theca interna)
• Iatrogenic (i.e. oophorectomy)

Question 3

What are the signs and symptoms of POI?

Answer 3

Those of the menopause

Question 4

What are the appropriate investigations for suspected POI?

Answer 4

• 2 x FSH results >30 (4-6 weeks apart) + menopause symptoms
• Low oestrogen
• High FSH/LH
• Antral follicle count
• AMH levels (test ovarian reserve) – helpful, but don’t base diagnosis off of this

Question 5

What is the management of POI?

Answer 5

• Fertility management
  
  • Donor oocyte IVF
  • Surrogacy and adoption are other options
  • 5-10% POI women can get pregnant without fertility treatment
• Menopause management - HRT and non-HRT options

Question 6

What are the complications of POI?

Answer 6

• Osteoporosis - regular DEXA scans, all of them should get HRT
• Hypothyroid
• Sexual dysfunction
• Insomnia (vasomotor symptoms)
• Stroke
• Heart disease