What is the best management strategy for a 20-year-old woman with premature ovarian failure?

Reproductive Medicine Unit, University College London Hospitals, London, UK.
Clinical Endocrinology (Impact Factor: 3.46). 05/2012; 77(2):182-6. DOI: 10.1111/j.1365-2265.2012.04408.x
Source: PubMed


The diagnosis of premature ovarian failure (POF) for a 20-year-old woman is devastating and will impact on many areas of her life. She deserves prompt confirmation of the diagnosis and accurate, honest information about the condition including the chances of conception and long-term health issues. She should be offered investigation of aetiology, although this may be hard to establish, and assessment of associated medical conditions. Oestrogen replacement should be advised for long-term use until the normal age of menopause, and she should be fully counselled on the benefits and risks of hormone replacement and her options of which preparation to take. Long-term follow-up is needed, and this is likely to require multidisciplinary input, including that from a gynaecologist, clinical psychologist and fertility team. POF may not be the appropriate terminology for this condition. Ovarian function often fluctuates in young women with POF, who may continue to menstruate occasionally and even conceive spontaneously. In view of this unpredictability, 'premature ovarian insufficiency' is a better description of the condition and carries a less negative connotation than 'ovarian failure' which can cause great distress. We recommend that the condition is termed 'premature ovarian insufficiency' (Clinical Endocrinology 2008;68:499).

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    ABSTRACT: Premature ovarian failure (POF) in a healthy adolescent is a rare event. It is diagnosed by the presence of amenorrhea, hypoestrogenism, and elevated follicle-stimulating hormone (FSH) levels before the age of 40. The patient presented with amenorrhoea at 17 years after identifying a change from her regular to irregular and metrorrhagic cycles. No positive medical history was noted regarding smoking, chemotherapy, radiation or autoimmune diseases and the physical examination was normal. Her family history revealed that both her maternal aunt and grandmother were affected by POF, but the karyotype test was normal and the FMR1 screening premutation test was negative. The patient underwent an ovarian biopsy which revealed the absence of functional follicles. She began a replacement therapy with estroprogestogens and she was informed about the most successful means to start a family, including adoption and oocyte donation. POF is a heterogeneous, multifactorial, and poorly understood condition that involves medical concerns, psychological sphere, and sexuality of the affected patients. Management should be directed at symptoms resolution, bone protection, and psychosocial support for women facing this unexpected and devastating diagnosis.
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