Premature ovarian failure
Summary
Definition
History and exam
Key diagnostic factors
- age <40 years
- family history of primary ovarian failure
- menstrual irregularities
- toxic exposures
Other diagnostic factors
- 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
Risk factors
- 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
Diagnostic tests
1st tests to order
- 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
Tests to consider
- 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
Treatment algorithm
all patients
Contributors
Authors
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
Disclosures
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
Disclosures
RR declares that she has no competing interests.
Acknowledgements
Dr William Ledger would like to gratefully acknowledge Dr William Hurd, Dr Rebecca Flyckt, and Dr Nichole Giannios, the previous contributors to this topic.
Disclosures
WH, RF, and NG declare that they have no competing interests.
Peer reviewers
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
Declarações
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
Declarações
EM declares that he has no competing interests.
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Referências
Principais artigos
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.Texto completo Resumo
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. Resumo
Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009 Jan;6(1):8-18. Resumo
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. Resumo
Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14. Resumo
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. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Pregnancy
- Polycystic ovary syndrome
- Anorexia nervosa
Mais Diagnósticos diferenciaisDiretrizes
- Guideline on premature ovarian insufficiency
- The 2022 hormone therapy position statement of the North American Menopause Society
Mais DiretrizesFolhetos informativos para os pacientes
Menopause: should I take HRT?
Menopause: what is it?
Mais Folhetos informativos para os pacientes
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