Premature ovarian insufficiency

Question 1

What is premature ovarian insufficiency

Answer 1

Menopause before the age of 40

Question 2

Pathophysiology of premature ovarian insufficiency

Answer 2

Decline in the normal activity of the ovaries at an early age. Hypogonadism means lack of negative on pituitary gland = excess gonadotropins (hypergonadotropism).
Hormone analysis: Raised LH and FSH, low oestrogen

Question 3

Causes of premature ovarian insufficiency

Answer 3

Idiopathic (>50%), Iatrogenic (Chemotherapy, radiotherapy or surgery), Autoimmune, Genetics, Infection (mumps,TB)

Question 4

Premature ovarian insufficiency presentation

Answer 4

Irregular menstrual periods, lack of menstrual periods, symptoms of low oestrogen levels e.g. hot flushes, night sweats, vaginal dryness

Question 5

Premature ovarian insufficiency diagnosis

Answer 5

Younger than 40yrs with typical menopausal symptoms plus elevated FSH (>25 IU/l on two consecutive samples separated by more than 4 weeks)

Question 6

Premature ovarian insufficiency risks

Answer 6

Higher risk of multiple conditions relating to lack of oestrogen inc. CVD, stroke, osteoporosis, dementia, Parkinsonism, cognitive impairment

Question 7

Premature ovarian insufficiency management

Answer 7

HRT until at least age at which women normally go through menopause. Reduces risks associated with premature ovarian insufficiency.
Contraception still required, small chance of pregnancy
Can also give COCP
May be increased risk of VTE but reduced by using transdermal methods of HRT