Premature Ovarian Insufficiency:

Question 1

Premature Ovarian Insufficiency:

Definition?

Answer 1

Amenorrhoea <40yo

Question 2

Premature Ovarian Insufficiency:

Risks of POI?

Answer 2

increased risk

• CVD (40% increased risk)
• Osteoporosis (8 - 14% will develop osteoporosis)
• premature mortality
• neurocognitive disorders

Question 3

Premature Ovarian Insufficiency:

Risk factors?

Answer 3

• Family history
• smoking
• bilateral ovarian surgery
• Nulliparity
• illicit drug use

Question 4

Premature Ovarian Insufficiency:

Causes?

Answer 4

1) Idiopathic (most common)
2) Autoimmune (20%)
- hypothyroidism
- Addisons disease
- any others
3) Iatrogenic
- chemo and radiotherapy
- pelvic gynaecological surgery
4) Congenital (10%)
- Turners syndrome
- Fragile X

Question 5

Premature Ovarian Insufficiency:

Symptoms?

Answer 5

• menstrual disturbance
• menopause symptoms
• mood changes
• infertility (but they can spontaneously ovulate and conceive)
• no menarche by 15yo (98% of women will have completed menarche by this age)

Question 6

Premature Ovarian Insufficiency:

Diagnosis?

Answer 6

1) Amenorrhoea for >4 months
AND
2) FSH >40 on 2 occasions 4 weeks apart
*cease all hormonal therapy for 6 weeks prior to testing
AND 
3) Exclude secondary causes
-beta hcG
-TSH, FT4
-Prolactin
-TV USS
-oestradiol, LH, FSH
-cortisol
-DHEAS
-B12 (pernicious anaemia - autoimmune)

Specialist may consider

• karyotype exclusion (+/- FMR 1 fragile X premutation status)
• TPO Ab
• Adrenal Ab
• Coeliac serology

Question 7

Premature Ovarian Insufficiency:

Management?

Answer 7

1) Assess baseline risks
Osteoporosis = BMD, vit D, calcium requirements
CVD = ECG, BP, BMI, lipids, glucose +/- CTCA/cardiology review

2) intervene
- lifestyle adjustment
- calcium, vitamin D,
- MHT OR COCP prior to 60yo
- lipid control
- BP management
- Fertility assistance
- Sexual dysfunction assistance