Premature Ovarian Failure

Question 1

Definition of POF

Answer 1

Cessation of ovarian function below 40 years of age

Question 2

Incidence POF

Answer 2

1%

30% Amenorrhoeic women

Question 3

FSH consistent with POF

Answer 3

> 20 on two or more occasions

The longer the period of amenorrhoea and the higher the FSH, the more likely POF to be permanent

Question 4

Investigations for POF

Answer 4

FSH
Karyotype
Ovarian autoantibody screen
Screen for other autoimmune disease or infection (HIV)
Baseline bone densitometry scan

Question 5

Genetic gonadal dysgenesis

Answer 5

Turner syndrome
Turner mosaics

Only 10% progress through puberty

Question 6

What symptoms to ask for in a woman with oligomenorrhoea or amenorrhoea

Answer 6

Symptoms of oestrogen deficiency

Question 7

Diagnostic criteria POI

Answer 7

Oligo/amenorrhea for at least 4 months

Elevated FSH >25IU/l o two occasions 4 weeks apart

Question 8

Treatment if tests positive for Y chromosomal material

Answer 8

Gonadectomy

Question 9

Info to give relatives

Answer 9

No proven predictive test to identify women that will develop POI
No established POI preventing measures
Fertility preservation is promising
Potential risk of earlier menopause - take into account when planning family

Question 10

Consequences of POI

Answer 10

Reduced life expectancy - CVD
Small chance of spontaneous pregnancy, otherwise oocyte donation
Obstetric risks low (higher with oocyte donation)
Higher Obs risk if have had RT to uterus

Question 11

POI fitness for pregnancy

Answer 11

Thyroid and adrenal function
ECHO - turners or cyclophosphamide
BP, renal function and thyroid

Question 12

Bone health monitoring in POI

Answer 12

BMD at initial diagnosis
If BMD normal and adequate systemic oestrogen, no need for repeated DEXA scan
If osteoporosis —>repeat scan in 5 years