Premature_Ovarian_Insufficiency_Flashcards

Question 1

What is premature ovarian insufficiency?

Answer 1

Premature ovarian insufficiency is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years.

Question 2

How common is premature ovarian insufficiency among women?

Answer 2

Premature ovarian insufficiency occurs in around 1 in 100 women.

Question 3

What are the causes of premature menopause?

Answer 3

Causes of premature menopause include idiopathic, bilateral oophorectomy, radiotherapy, chemotherapy, infection (e.g., mumps), autoimmune disorders, and resistant ovary syndrome.

Question 4

What is the most common cause of premature menopause?

Answer 4

The most common cause of premature menopause is idiopathic, and there may be a family history.

Question 5

How does bilateral oophorectomy relate to premature ovarian insufficiency?

Answer 5

Bilateral oophorectomy is a cause of premature ovarian insufficiency.

Question 6

How does hysterectomy with preservation of the ovaries affect menopause?

Answer 6

Having a hysterectomy with preservation of the ovaries has been shown to advance the age of menopause.

Question 7

What are some medical treatments that can cause premature ovarian insufficiency?

Answer 7

Medical treatments that can cause premature ovarian insufficiency include radiotherapy and chemotherapy.

Question 8

What infections can cause premature ovarian insufficiency?

Answer 8

Infections such as mumps can cause premature ovarian insufficiency.

Question 9

How do autoimmune disorders relate to premature ovarian insufficiency?

Answer 9

Autoimmune disorders can lead to premature ovarian insufficiency.

Question 10

What is resistant ovary syndrome?

Answer 10

Resistant ovary syndrome is due to FSH receptor abnormalities.

Question 11

What are the features of premature ovarian insufficiency?

Answer 11

Features of premature ovarian insufficiency are similar to those of the normal climacteric but may present differently, including climacteric symptoms (hot flushes, night sweats), infertility, secondary amenorrhoea, raised FSH and LH levels, and low oestradiol.

Question 12

What are climacteric symptoms associated with premature ovarian insufficiency?

Answer 12

Climacteric symptoms associated with premature ovarian insufficiency include hot flushes and night sweats.

Question 13

What laboratory findings are indicative of premature ovarian insufficiency?

Answer 13

Laboratory findings indicative of premature ovarian insufficiency include raised FSH and LH levels (e.g., FSH > 30 IU/L) and low oestradiol (e.g., < 100 pmol/l).

Question 14

What levels of FSH are considered elevated in premature ovarian insufficiency?

Answer 14

FSH levels > 30 IU/L are considered elevated in premature ovarian insufficiency.

Question 15

How should elevated FSH levels be confirmed?

Answer 15

Elevated FSH levels should be demonstrated on 2 blood samples taken 4-6 weeks apart.

Question 16

What is the recommended management for premature ovarian insufficiency?

Answer 16

The recommended management for premature ovarian insufficiency is hormone replacement therapy (HRT) or a combined oral contraceptive pill until the age of the average menopause (51 years).

Question 17

Why does hormone replacement therapy (HRT) not provide contraception?

Answer 17

HRT does not provide contraception in case spontaneous ovarian activity resumes.

Question 18

summarise Premature ovarian insufficiency

Answer 18

Premature ovarian insufficiency

Premature ovarian insufficiency is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years. It occurs in around 1 in 100 women.

Causes of premature menopause include:
idiopathic
the most common cause
there may be a family history
bilateral oophorectomy
having a hysterectomy with preservation of the ovaries has also been shown to advance the age of menopause
radiotherapy
chemotherapy
infection: e.g. mumps
autoimmune disorders
resistant ovary syndrome: due to FSH receptor abnormalities

Features are similar to those of the normal climacteric but the actual presenting problem may differ
climacteric symptoms: hot flushes, night sweats
infertility
secondary amenorrhoea
raised FSH, LH levels
e.g. FSH > 30 IU/L
elevated FSH levels should be demonstrated on 2 blood samples taken 4-6 weeks apart
low oestradiol
e.g. < 100 pmol/l

Management
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
it should be noted that HRT does not provide contraception, in case spontaneous ovarian activity resumes

Question 19

A 33-year-old woman presents to the GP as she has not had a period for 6 months. She has also noticed that she is sweating more at night and has had started to have the occasional hot flush, although she thinks this may just be due to the weather. She does not want children and has only come today to check there is no sinister cause for her lack of periods. She has no past medical history and no family history.

Blood tests are as follows:

TSH 2 mU/L (0.5 - 5.5)
T4 10 pmol/L (9 - 18)
Prolactin 15 µg/L (<25)
FSH 75 iu/L (<40)
Oestradiol 45 pmol/L (>100)

Bloods repeated 6 weeks later show no change.

What is the most appropriate management?

Combined hormone replacement therapy for 5 years
Combined hormone replacement therapy until the age of 51
No management is required
Oestrogen-only hormone replacement therapy until the age of 51
Progestogen-only pill until the age of 51

Answer 19

Combined hormone replacement therapy until the age of 51

Premature ovarian insufficiency: hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years

Amenorrhea, climacteric symptoms (hot flushes and night sweats), lost oestradiol and raised gonadotrophins are all consistent with ovarian failure. As this patient is under 40, this is premature ovarian failure. The mainstay of treatment is hormone replacement therapy (which can also be given as the combined oral contraceptive pill) which is given until the age of natural menopause (around 51 years) to prevent osteoporosis, as well as to protect against symptoms of oestrogen deficiency and possible cardiovascular complications. As this patient has a uterus, she must not have unopposed oestrogen (due to the risk of endometrial cancer), so combined replacement should be given. Of the above options, the most appropriate answer is combined hormone replacement therapy until the age of 51.

Combined hormone replacement therapy for 5 years is incorrect; although it is the correct treatment, it is needed until the age of natural menopause (i.e. longer than 5 years) to protect against osteoporosis.

No management is required is incorrect. Hormone replacement therapy should be offered to all women with premature ovarian failure, not only to treat symptoms of low oestrogen but also to protect bone mineral density.

This patient has a uterus. She, therefore, must not receive oestrogen-only hormone replacement therapy. Unopposed oestrogen will lead the uterine lining to proliferate, increasing the risk of endometrial cancer.

The progestogen-only pill alone is inadequate treatment. Oestrogen is needed to treat symptoms of low oestrogen (such as hot flushes) and to promote bone mineral density. Progesterone is added to oppose oestrogen and reduce the risk of endometrial cancer.

Question 20

A 38-year-old woman complains that she is experiencing hot flushes and has not had a period for the past five months. She is worried that she going through an ‘early menopause’.

What is the most appropriate investigation to diagnose premature ovarian failure?

Progesterone level
Ovarian ultrasound
Follicle stimulating hormone level
Serial measurement of basal body temperature
Oestrogen level

Answer 20

Follicle stimulating hormone level

Follicle stimulating hormone (FSH) level is raised significantly in menopausal patients. Test FSH to confirm menopause

Follicle stimulating hormone (FSH) and luteinising hormone (LH) are gonadotropins released from the anterior pituitary into the blood. Gonadotropins act on the ovaries to stimulate the growth and maturation of the follicle. The levels of circulating FSH and LH are regulated through negative feedback to the hypothalamus by steroid hormones produced by the ovaries. At menopause (and in premature ovarian failure), ovarian function ceases, leading to high levels of FSH due to the removal of the negative feedback mechanisms.