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