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Saturday, 6 December 2014

Premature Ovarian Failure

Ovarian failure is considered premature when it occurs in women < 40 yrs of age and accounts for 10 % of secondary amenorrhoea which means failure of occurrence of menstruation in women for 6 months or longer in women who have previously menstruated. 

The term used is Primary Ovarian Insufficiency and has replaced premature ovarian failure and premature menopause in recognition that this disorder represents a continuum of decreased ovarian function.

 

Menstruation is an end point in the cascade of events starting in the cerebral cortex and hypothalamus and through pituitary gland and ovaries ending with uterine bleeding with a patent lower genital tract. A disturbance at any level can cause amenorrhoea

Primary ovarian insufficiency results from a loss of negative feedback restraint on the hypothalamus and pituitary, resulting in increased FSH and LH levels which are the Follicle Stimulating Hormone and Luteinizing Hormone respectively. FSH is a better marker as its levels are less variable than LH.

Levels may wax and wane and hence serial measurements are necessary for the diagnosis.

Causes of Premature Ovarian Failure
 Chromosomal abnormalities including Turner Syndrome
 Autoimmune diseases are reported in 30-60% of patients. Mumps, thyroid dysfunction, hypoparathyroidism, and Addison s disease can be responsible in some cases.
 Tuberculosis of the genital tract.
 Smoking
 Radiotherapy and Chemotherapy are causes but the effect can be reversible and the ovaries can start functioning after a year or two of stopping the treatment.


 Can follow hysterectomy or tubectomy. 
 Galactosemia
 Premutation carriers of Fragile X syndrome- Risk of severe mental retardation in male children with FMR1 mutations.
 Idiopathic or unknown cause.
 Rarely in mutations of FSH and LH receptors
 Aromatase deficiency 
 17-hydroxylase deficiency
 Prolonged GnRH therapy 
 Induction of multiple ovulation in infertility can cause premature menopause when the follicles get exhausted.

Clinical Features In Premature Ovarian Failure
 Amenorrhoea
 Hot flushes
 Sweating
 Headache
 Irritability
 Depression
 Lack of concentration
 Insomnia
 Diminished libido
 

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