Premature ovarian failure

Abstract

Premature ovarian failure (POF) is the occurrence of hypergonadotropic hypoestrogenic amenorrhea in women under the age of forty years. It is idiopathic in 74-90% patients. Known cases can be divided into primary and secondary POF. In primary POF genetic aberrations can involve the X chromosome (monosomy, trisomy, translocations, deletions) or autosomes. Genetic mechanisms include reduced gene dosage and non-specific chromosome effects impairing meiosis, decreasing the pool of primordial follicles and increasing atresia due to apoptosis or failure of follicle maturation. Autoimmune ovarian damage is caused by alteration of T-cell subsets and T-cell mediated injury, increase of autoantibody producing B-cells, a low number of effector/cytotoxic lymphocyte, which decreases the number and activity of natural killer cells. Bilateral oophorectomy, chemotherapy, radiotherapy and infections cause the secondary POF. Symptoms of POF include irritability, nervousness, loss of libido, depression, lack of concentration, hot flushes, weight gaining, dry skin, vaginal dryness, frequent infections etc.The diagnosis is confirmed by the level of FSH of over 40 IU/L and estradiol below 50 pmol/L in women aged below 40 years. Biochemical and other hormonal analysis (free thyroxin, TSH, prolactin, testosterone), karyotype (<30 years of age), ultrasound of the breasts and pelvis are advisable. Optimal therapy is combined estrogen progestagen therapy given in a sequential rhythm, after excluding absolute contraindications. Testosterone can be added to adnexectomized women and those with a low libido. Sequential estrogen progestagen replacement therapy is the first line therapy for ovulation induction in those looking for pregnancy and after that oocyte donation will be advised. Appropriate estro-progestagen therapy improves the quality of life and prevents complications such as cardiovascular diseases, osteoporosis, stroke etc.

Rationale of Incorporating Serum Anti-Mullerian Hormone Estimations in Diagnosing Premature Ovarian Failure

“…26,27,28 Svetlana et al 29 and Bachelot et al 30 observed 74.90% and 88.2% respectively for unidentified causes. In this study, 12% of the patients were associated with hypothyroidism.…”

X Chromosome Deletion in an Iranian Woman with Premature Ovarian Failure and a Mini Review

“…To confirm the disease status, further biochemical analysis of other hormones like free thyroxin, prolactin, TSH, testosterone, Karyotyping (under 30 years), breast and pelvic ultrasound are recommended [3]. The measurement of other ovarian peptides that cause POF, such as Inhibin-B and anti mullerian hormone (AMH) is important for the diagnosis of the disease.…”

“…Premature ovarian failure is presently one of the clinical conflicts of our century, a common disease that affects approximately 1% of under 40 year old women. It is believed that 10-28 percent of them prove primary amenorrhea [2] while 74-90% suffers of unknown etiology [3]. The importance of the study of the genetic factors is undoubtedly a royal key for opening the minds to the blind section of the disease etiology.…”

Falência ovariana precoce

“…Os danos nos ová-rios por autoimunidade, também como causa primária de FOP, são provocados por alteração de subconjuntos de células T e lesão mediada por células T, aumento da produção de autoanticorpos de células B, um menor número de linfócitos efetor/citotóxico, diminuindo, assim, o número e a atividade das células Killer. A FOP secundária seria por infecções, ooforectomia bilateral, quimioterapia e radioterapia (2,5) Sob a visão folicular, a FOP pode ocorrer por dois mecanismos principais: disfunção e depleção do folículo. A disfunção do folículo indica que, apesar de permanecerem nos ovários, um processo patológico impede sua formação normal (2,10).…”

“…É idiopática em 74% a 90% das pacientes. Algumas pacientes com FOP podem produzir estrogênio, ovular, e, em 5% a 10% dos casos, conceber e ter uma gravidez e parto sem alterações, assim como ter a função ovariana intermitente (sem amenorreia associada) e menstruação espontânea (embora anormalidades da função menstrual estejam presentes) (3)(4)(5)(6)(7)(8)(9).…”