TOG - Premature Ovarian Insufficiency

Question 1

At what age is Premature Ovarian Insufficiency diagnosed?

Answer 1

<40

Question 2

What is the incidence of Premature Ovarian Insufficiency?

Answer 2

1 in 100

Question 3

What are the causes of Premature Ovarian Insufficiency?

Answer 3

1. Idiopathic - 90%
2. Chromosomal
   - X-chromosome e.g. XO, FMR-1 premutation (Fragile X - Xq27.3)
   - 46XY gonadal dysgenesis
   - Autosomal (FSH receptor mutation, Blepharophimosis ptosis epicanthus inversus
   syndrome)
3. Iatrogenic e.g. chemo/radiotherapy
   (8% childhood cancer survivors)
4. Autoimmune
5. Other rare: XXX, LH recep mutations, Perrault syn, galactosaemia, surgical injury, viral infections

Question 4

In what % of cases of Premature Ovarian Insufficiency can ovarian activity resume and normal fertility occur?

Answer 4

5-10%

Question 5

How many oogonia are present at 5/12 fetal life and at birth?

Answer 5

5/12 - 7 million (peak)

birth - 0.5 million

Question 6

What are the causes of secondary amenorrhoea other than Premature Ovarian Insufficiency?

Answer 6

Pregnancy
Hypothalamic (e.g. anorexia)
Hyperprolactinaemia
PCOS
Sheehans/Ashermans syn

Question 7

What is the risk of developing osteopenia with Premature Ovarian Insufficiency?

Answer 7

50%

Question 8

By what % can androgen production decrease with loss of ovarian activity?

Answer 8

50%

Question 9

What are the recommended contraceptive options for women with Premature Ovarian Insufficiency?

Answer 9

Barrier or IUD

May still conceive on COCP - ?fails to suppress such high doses of FSH