Premature ovarian insufficiency

Question 1

What is premature ovarian insufficiency?

Answer 1

• menopause before the age of 40 years

- It is the result of a decline in the normal activity of the ovaries at an early age

Question 2

What is premature ovarian insufficiency characterised by?

Answer 2

-hypergonadotropic hypogonadism –> under activity of the gonads

Question 3

What will hormonal tests show in premature ovarian insufficiency?

Answer 3

• raised LH and FSH

- low oestrogen

Question 4

What are the causes of premature ovarian insufficiency?

Answer 4

• idiopathic (50%)
• Iatrogenic - due to chemo, radiotherapy or surgery
• autoimmune - associated with coeliac, diabets and thyroid
• genetic - turners syndrome
• infections - mumps, tuberculosis or CMV

Question 5

What does premature ovarian insufficiency present with?

Answer 5

• irregular menstrual peroids
• secondary amenorrhoea
• low oestrogen levels symptoms -> hot flushes, night sweats and vaginal dryness

Question 6

How is a diagnosis of premature ovarian insufficiency made?

Answer 6

• diagnosed in women < 40 years with menopausal symptoms and elevated FSH
• FSH level needs to be raised on two consecutive samples separated by more than four weeks to make a diagnosis

Question 7

What does the management for premature ovarian insufficiency involve?

Answer 7

• HRT until typical age of menopause
• HRT reduced risks associated with low oestrogen levels
• HRT options are traditional HRT or combined OCP

Question 8

what endocrine abnormalities are pts with POF more of an increased risk from?

Answer 8

-autoimmune diseases (eg hypothyroidism: TFTs should be checked yearly)
-osteoporosis

Question 9

which fertility treatment option is best for an FSH>15?

Answer 9

A FSH above 15 indicates poor ovarian reserve and all treatments apart from donor oocyte IVF are likely to be unsuccessful.

Question 10

what blood hormone can help to predict response to IVF?

Answer 10

AMH