Premature ovarian failure - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Cessation of menses for more than 1 year before 40 years of age secondary to loss of ovarian function.
Symptoms include amenorrhea and symptoms of hypoestrogenism such as hot flashes, sleep disturbance, irritability, and vaginal dryness.
Usually results in infertility, although spontaneous ovulation and pregnancy can occur rarely after its diagnosis.
Differential diagnosis includes genetic/chromosomal abnormalities, autoimmune disorders, infections, and toxic and idiopathic causes.
Screening for underlying medical conditions is recommended (as is karyotyping), especially in women younger than 30 years of age.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

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.[Abstract][Full Text]
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.[Abstract]
Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009 Jan;6(1):8-18.[Abstract]
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.[Abstract]
Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14.[Abstract]
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.[Abstract]

Other Online Resources

ClinicalTrials.gov
NICHD: primary ovarian insufficiency
Jean Hailes for Women's Health: premature and early menopause

Referenced Articles

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30. Tosh D, Rao KL, Rani HS, et al. Association between fragile X premutation and premature ovarian failure: a case-control study and meta-analysis. Arch Gynecol Obstet. 2014 Jun;289(6):1255-62.[Abstract]
31. Perry JR, Corre T, Esko T, et al. A genome-wide association study of early menopause and the combined impact of identified variants. Hum Mol Genet. 2013 Apr 1;22(7):1465-72.[Abstract][Full Text]
32. Ledger WL. Clinical utility of measurement of anti-mullerian hormone in reproductive endocrinology. J Clin Endocrinol Metab. 2010 Dec;95(12):5144-54.[Abstract]
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34. Kalu E, Panay N. Spontaneous premature ovarian failure: management challenges. Gynecol Endocrinol. 2008 May;24(5):273-9.[Abstract]
35. Bakalov VK, Vanderhoof VH, Bondy CA, et al. Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiency in young women with spontaneous premature ovarian failure. Hum Reprod. 2002 Aug;17(8):2096-100.[Abstract][Full Text]
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38. Committee on Gynecologic Practice. Committee Opinion No. 698: hormone therapy in primary ovarian insufficiency. Obstet Gynecol. 2017 May;129(5):e134-41.[Abstract]
39. European Medicines Agency. Four-week limit for use of high-strength estradiol creams. 4 October 2019 [internet publication].[Full Text]
40. National Institute for Health and Care Excellence. Menopause: diagnosis and management. 5 December 2019 [internet publication].[Full Text]
41. de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric. 2013 Apr;16(2):203-4.[Abstract][Full Text]
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43. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019 Sep 28;394(10204):1159-68.[Abstract][Full Text]
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45. Medicines and Healthcare products Regulatory Agency. Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping. 30 August 2019 [internet publication].[Full Text]
46. European Medicines Agency. Guideline on clinical investigation of medicinal products for hormone replacement therapy of oestrogen deficiency symptoms in postmenopausal women. May 2006 [internet publication].[Full Text]
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49. Kalantaridou SN, Calis KA, Vanderhoof VH, et al. Testosterone deficiency in young women with 46,XX spontaneous premature ovarian failure. Fertil Steril. 2006 Nov;86(5):1475-82.[Abstract]
50. Janse F, Tanahatoe SJ, Eijkemans MJ, et al. Testosterone concentrations, using different assays, in different types of ovarian insufficiency: a systematic review and meta-analysis. Hum Reprod Update. 2012 Jul;18(4):405-19.[Abstract]
51. Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009 Jan;6(1):8-18.[Abstract]
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57. 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.[Abstract]
58. Gallagher JC. Effect of early menopause on bone mineral density and fractures. Menopause. 2007 May-Jun;14(3 Pt 2):567-71.[Abstract]
59. Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14.[Abstract]
60. 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.[Abstract]
61. O'Donnell RL, Warner P, Lee RJ, et al. Physiological sex steroid replacement in premature ovarian failure: randomized crossover trial of effect on uterine volume, endometrial thickness and blood flow, compared with a standard regimen. Hum Reprod. 2012 Apr;27(4):1130-8.[Abstract][Full Text]
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