Premature ovarian insufficiency

Premature ovarian insufficiency is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years. It occurs in around 1 in 100 women.

Causes of premature menopause include:

idiopathic
- the most common cause
- there may be a family history
bilateral oophorectomy
- having a hysterectomy with preservation of the ovaries has also been shown to advance the age of menopause
radiotherapy
chemotherapy
infection: e.g. mumps
autoimmune disorders
resistant ovary syndrome: due to FSH receptor abnormalities

Features are similar to those of the normal climacteric but the actual presenting problem may differ

climacteric symptoms: hot flushes, night sweats
infertility
secondary amenorrhoea
raised FSH, LH levels
- e.g. FSH > 30 IU/L
- elevated FSH levels should be demonstrated on 2 blood samples taken 4-6 weeks apart
low oestradiol
- e.g. < 100 pmol/l

Management

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
- it should be noted that HRT does not provide contraception, in case spontaneous ovarian activity resumes

+PassMedicine Notes

Premature ovarian insufficiency is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years. It occurs in around 1 in 100 women.

Causes of premature menopause include: