Premature Ovarian Insufficiency Flashcards
Define premature ovarian insufficiency
Clinical syndrome defined as the transient or permanent loss of ovarian function <40yo, characterised by menstrual disturbance and sporadic ovulation (menopause = no ovulation)
What are the causes of premature ovarian insufficiency
Idiopathic (most common)
Infection: mumps, TB, malaria, varicella
Autoimmune: hyperthyroidism, T1DM, Grave’s, Addison’s
Chromosomal: tuner’s syndrome, fragile X syndrome, galactosaemia
Iatrogenic: chemotherapy, radiotherapy, bilateral oophorectomy
Unknown
What are the symptoms of premature ovarian insufficiency
Amenorrhoea
Hot flushes (sudden feeling of heat in the upper body that spreads) ± palpitations, anxiety
Night sweats
Vaginal symptoms: Dryness, Itching, Dyspareunia, Burning/irritation/discomfort
Reduced libido
Mood changes: Irritability, Mood swings
Recurrent UTIs
Sleep disturbance
Poor concentration and memory
What examinations should be done for premature ovarian insufficiency
Height, weight
Blood pressure
Investigations for premature ovarian insufficiency
Bedside: Urine pregnancy test
Bloods: FSH (BMS - 2 samples 4-6 weeks apart), LH, oestradiol, androgens, AMH, TFTs, cortisol
Other: pelvic USS
When is FSH measured for menopause
> 45 with atypical symptoms
40-45 with symptoms or change in cycle
<40 years with suspected POI
50 using progesterone only contraception
What is the management for premature ovarian insufficiency
Determined by the patient’s treatment goals
Refer to the menopause clinic
Menopause treatment
Contraception advice
Fertility advice
What are the fertility options for women with premature ovarian insufficiency
5-10% of women can get pregnant without treatment
Clomiphene or FSH
IUI
Donor oocyte IVF
Surrogacy, adopation
What contraception advice should be given to women with premature ovarian insufficiency
There is still a chance of pregnancy
Required for 24 months after the last period in women < 50 years
What are the conservative measures for POI
Regular exercise, weight loss, lighter clothing, turn off heating, fans, avoid stress (hot flushes, night sweats)
Sleep hygiene + Avoid late exercise and maintain regular bedtime (sleep disturbances)
CBT
What are the medical non-hormonal measures for POI
SSRIs e.g. citalopram (Vasomotor symptoms)
Clonidine
Gabapentin
Evening primrose oil
What are the hormonal pharmacological measures for POI
Cyclical (peri-menopausal) or continuous (menopausal) HRT
Oestrogen only: for those without a uterus. Oral, gel, patch, implant
Progesterone: mirena, vaginal pessary, oral
What are the complications of premature ovarian insufficiency
Osteoporosis and fracture
CVD
Stroke
Genitourinary syndrome of menopause, due to oestrogen depletement + natural ageing process
Hypothyroidism
Sexual dysfunction
Insomnia
