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primary ovarian failure
Etiology:
- Turner's syndrome
- fragile X syndrome
- hypothyroidism [4]
Clinical manifestations:
- apparently menarche may occur
- amenorrhea
Laboratory:
- serum FSH & serum LH high
- elevated serum FSH x 2 = primary ovarian failure [2]
- serum estradiol low [4]
- thyroid function testing*
- karyotyping if no etiology of ovarian failure is apparent
* first tests after primary ovarian failure confirmed [4]
Management:
- hormone replacement therapy (oral or transdermal) may mitigate symptoms of hypoestrogenism, reduce risks for osteoporosis, & urogenital atrophy & improve quality of life
- low bone mass should be managed first with hormone therapy, not bisphosphonates.
- contraception
- combined hormonal contraceptives are more effective than hormone therapy to prevent pregnancy
- levonorgestrel intrauterine device
- treatment should be continued until the average age of menopause, 50-51 years [3]
Related
menopause
premature ovarian failure (premenopausal anovulation)
General
ovarian failure
References
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Nelson LM.
Clinical practice. Primary ovarian insufficiency.
N Engl J Med. 2009 Feb 5;360(6):606-14
PMID: 19196677
- American Congress of Obstetricians and Gynecologists
Committe Opinion. Number 698, May 2017
Hormone Therapy in Primary Ovarian Insufficiency.
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Hormone-Therapy-in-Primary-Ovarian-Insufficiency
- NEJM Knowledge+ Endocrinology