Premature ovarian insufficiency

Question 1

What is premature ovarian insufficiency?

Answer 1

• menopause before the age of 40 years

- It is the result of a decline in the normal activity of the ovaries at an early age

Question 2

What is premature ovarian insufficiency characterised by?

Answer 2

-hypergonadotropic hypogonadism –> under activity of the gonads

Question 3

What will hormonal tests show in premature ovarian insufficiency?

Answer 3

• raised LH and FSH

- low oestrogen

Question 4

What are the causes of premature ovarian insufficiency?

Answer 4

• idiopathic (50%)
• Iatrogenic - due to chemo, radiotherapy or surgery
• autoimmune - associated with coeliac, diabets and thyroid
• genetic - turners syndrome
• infections - mumps, tuberculosis or CMV

Question 5

What does premature ovarian insufficiency present with?

Answer 5

• irregular menstrual peroids
• secondary amenorrhoea
• low oestrogen levels symptoms -> hot flushes, night sweats and vaginal dryness

Question 6

How is a diagnosis of premature ovarian insufficiency made?

Answer 6

• diagnosed in women < 40 years with menopausal symptoms and elevated FSH
• FSH level needs to be raised on two consecutive samples separated by more than four weeks to make a diagnosis

Question 7

What does the management for premature ovarian insufficiency involve?

Answer 7

• HRT until typical age of menopause
• HRT reduced risks associated with low oestrogen levels
• HRT options are traditional HRT or combined OCP