Premature Ovarian Insufficiency

Question 1

Premature ovarian insufficiency

Answer 1

Menopause before the age of 40 years

Question 2

Pathophysiology of premature ovarian insufficiency

Answer 2

Form of hypergonadotropic hypogonadism

Complete deficiency of oocytes

Question 3

Hormone levels

Answer 3

Raised LH and FSH levels

Low oestradiol levels

Question 4

Causes of premature ovarian insufficiency

Answer 4

Idiopathic

Iatrogenic - chemotherapy, radiotherapy or surgery (i.e. oophorectomy)

Autoimmune -possibly associated with coeliac disease, adrenal insufficiency, T1DM or thyroid disease

Genetic -Turner’s syndrome

Infections - mumps, TB, CMV

Question 5

Presentation

Answer 5

Irregular menstrual periods

Secondary amenorrhoea

Menopausal symptoms like hot flushes, night sweats and mood swings

Question 6

Diagnosing premature ovarian insufficiency

Answer 6

Women younger than 40 years with typical menopausal symptoms plus elevated FSH

FSH level needs to be persistently raised on 2 consecutive samples separated by 4+ weeks

Question 7

Risks with premature ovarian insufficiency

Answer 7

Increased risk of:

• CVD
• Stroke
• Osteoporosis
• Cognitive impairment
• Dementia
• Parkinsonism

Question 8

Management of premature ovarian insufficiency

Answer 8

HRT

Question 9

Why give HRT in premature ovarian insufficiency

Answer 9

Reduces the cardiovascular, osteoporosis, cognitive and psychological risks associated with premature menopause

Question 10

HRT options for premature ovarian insufficiency

Answer 10

Hormone replacement therapy

COCP