Premature Ovarian Insufficiency

Question 1

What is premature ovarian insufficiency?

Answer 1

Menopause before the age of 40.

Question 2

What are the hormonal levels in premature ovarian insufficiency?

Answer 2

Hypergonadotropic hypogonadism:

1. Raised LH and FSH
2. Low oestradiol levels

Question 3

What are 5 causes of premature ovarian insufficiency?

Answer 3

1. Idiopathic
2. Iatrogenic (chemo, radiotherapy, oophorectomy)
3. Autoimmune
4. Genetic
5. Infections

Question 4

What proportions of cases of premature ovarian insufficiency are idiopathic?

Answer 4

50%

Question 5

What 4 autoimmune conditions are associated with premature ovarian insufficiency?

Answer 5

1. Coeliac disease
2. Adrenal insufficiency
3. Type 1 diabetes
4. Thyroid

Question 6

Name a genetic condition linked to primary ovarian insufficiency?

Answer 6

Turner’s syndrome

Question 7

Name 3 infections linked to premature ovarian insufficiency?

Answer 7

1. Mumps
2. Tuberculosis
3. Cytomegalovirus

Question 8

How can premature ovarian insufficiency be diagnosed?

Answer 8

In women younger than 40 with typical menopausal symptoms plus raised FSH.

The FSH level needs to be persistently raised (more than 25 IU/l) on two consecutive samples separated by more than four weeks to make a diagnosis. The results are difficult to interpret in women taking hormonal contraception.

Question 9

What are women with premature ovarian failure at higher risk of developing?

Answer 9

1. Cardiovascular disease
2. Stroke
3. Osteoporosis
4. Cognitive impairment
5. Dementia
6. Parkinsonism

Question 10

How is premature ovarian failure managed?

Answer 10

Management involves hormone replacement therapy (HRT) until at least the age at which women typically go through menopause.

Question 11

Is it possible for women with premature ovarian failure to get pregnant?

Answer 11

Yes there is a small risk so contraception is still required.

Question 12

What are two options for HRT in women with premature ovarian insufficiency?

Answer 12

1. Traditional hormonal replacement therapy

2. Combined oral contraceptive pill

Question 13

What is traditional hormone replacement therapy associated with compared with the combined oral contraceptive pill?

Answer 13

Lower blood pressure.

The combined pill may be more socially acceptable (less stigma for younger women) and additionally acts as contraception.

Question 14

Is HRT before the age of 50 considered to increase the risk of breast cancer?

Answer 14

No - since women would ordinarily produce the same hormones at this age.

Question 15

What are women under 50 on HRT at increased risk of? How can this risk be reduced?

Answer 15

Increased risk of venous thromboembolism.

Risk can be reduced by using transdermal patches.