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Premature ovarian failure

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 16 Aug 2025
最后更新： 09 Jan 2025

小结

定义

病史和体格检查

关键诊断因素

  • age <40 years
  • family history of primary ovarian failure
  • menstrual irregularities
  • toxic exposures
完整详情

其他诊断因素

  • hot flashes
  • sleep disturbance
  • irritability
  • vaginal dryness
  • infertility
  • vaginal atrophy
  • small uterus with nonpalpable ovaries
  • cognitive abnormalities
  • signs of thyroid dysfunction
  • signs of adrenal dysfunction
  • signs of hyperprolactinemia
  • signs of genetic syndromes
完整详情

危险因素

  • family history of POF
  • exposure to chemotherapy or radiation
  • autoimmune disease
  • family history of fragile X syndrome
  • galactosemia
  • hysterectomy
  • uterine artery embolization
  • smoking
  • lower socioeconomic status, higher education level, nulliparity
  • presence of specific genetic variants
  • ovarian surgery
完整详情

诊断性检查

首要检查

  • pregnancy test
  • serum follicle-stimulating hormone (FSH) level
  • serum luteinizing hormone (LH) level
  • serum estradiol level
  • anti-Müllerian hormone (AMH) level
  • thyroid function tests
  • serum prolactin level
  • transvaginal ultrasound
完整详情

需考虑的检查

  • thyroid peroxidase antibody
  • serum fasting glucose level
  • electrolytes, BUN, creatinine
  • karyotype
  • fragile X premutation
  • adrenocorticotropic hormone (ACTH) stimulation test
  • serum adrenal antibodies
  • baseline dual-energy x-ray absorptiometry scan
完整详情

治疗流程

急症处理

all patients

撰稿人

作者

William Ledger, MA, DPhil (Oxon), MB, ChB, FRCOG, FRANZCOG, CREI

Professor of Obstetrics and Gynaecology

Academic Unit of Reproductive & Developmental Medicine

The University of New South Wales

Sydney

Australia

利益声明

WL is the author of one reference cited in this topic.

Rachael Rodgers, BA, BSc, MBBS, MScMed (RHHG)

Fellow in Reproductive Endocrinology

Reproductive Medicine

Royal Hospital for Women

Sydney

Australia

利益声明

RR declares that she has no competing interests.

鸣谢

Dr William Ledger would like to gratefully acknowledge Dr William Hurd, Dr Rebecca Flyckt, and Dr Nichole Giannios, the previous contributors to this topic.

利益声明

WH, RF, and NG declare that they have no competing interests.

同行评议者

John F. Randolph Jr., MD

Professor and Director

Division of Reproductive Endocrinology and Infertility

Department of Obstetrics and Gynecology

University of Michigan Health System

Ann Arbor

MI

利益声明

JFR declares that he has no competing interests.

Edward Morris, MD

Consultant

Honorary Senior Lecturer and Clinical Director

Department of Obstetrics and Gynaecology

Norfolk and Norwich University Hospital

Norwich

UK

利益声明

EM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

North American Menopause Society. Early menopause guidebook. 6th edition. Cleveland, OH: North American Menopause Society; 2006.

Chen H, Li J, Cui T, Hu L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women. Cochrane Database Syst Rev. 2011;(11):CD008018.全文  摘要

The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-94. 摘要

Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009 Jan;6(1):8-18. 摘要

van Kasteren YM, Schoemaker J. Premature ovarian failure: a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy. Hum Reprod Update. 1999 Sep-Oct;5(5):483-92. 摘要

Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14. 摘要

Toulis KA, Tzellos T, Kouvelas D, et al. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin Ther. 2009 Feb;31(2):221-35. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • 鉴别诊断

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    • The 2022 hormone therapy position statement of the North American Menopause Society
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