Early menopause and premature ovarian insufficiency: problems and perspectives

2020 ◽  
Vol 14 (3) ◽  
pp. 328-345
Author(s):  
D. V. Blinov ◽  
P. L. Hasan ◽  
A. N. Mnatsakanyan ◽  
D. I. Korabelnikov ◽  
A. T. Safarov ◽  
...  
Keyword(s):  
Hormone Replacement ◽  
Clinical Signs ◽  
Reproductive Function ◽  
Current Data ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Menopausal Syndrome ◽  
Natural Menopause ◽  
Threatening Condition

In this review we summarize current data on prevalence, etiology and pathogenesis resulting in premature ovarian insufficiency (POI). In particular, genetic, autoimmune, metabolic, iatrogenic disorders as well as unfavorable impact of environmental factors represent key pathogenetic mechanisms underlying POI development. Clinical picture of this disease is mainly manifested by oligo- and amenorrhea as well as genitourinary menopausal syndrome (GUMS). Special attention is paid to a link between such clinical signs and psychosocial discomfort not being a life-threatening condition but still able to markedly lower quality of woman’s life and considered as a comorbidity with type 2 diabetes mellitus, osteoporosis and cardiovascular diseases. Hormone replacement therapy (HRT) serves as the first-line therapeutic approach for treating POI, which is performed according to the principles similar to those used to perform menopausal hormone therapy (MHT) in case of natural menopause that should be continued until reaching at least the average age for the onset of menopause. Topical estriol therapy eliminates GUMS symptoms, which in turn positively affects sexual function and woman’s psychosocial status and contributes to improved quality of life. The data from recent studies examining topical estriol therapy in POI demonstrated high efficacy and safety. Finally, we also discuss diverse strategies to support reproductive function in women with POI.

scholarly journals Premature Ovarian Insufficiency: Procreative Management and Preventive Strategies

Biomedicines ◽  
2018 ◽  
Vol 7 (1) ◽  
pp. 2 ◽  
Author(s):  
Jennifer Chae-Kim ◽  
Larisa Gavrilova-Jordan
Keyword(s):  
Quality Of Life ◽  
At Risk ◽  
Fertility Preservation ◽  
Reproductive Function ◽  
Premature Ovarian Insufficiency ◽  
Preventive Strategies ◽  
Ovarian Insufficiency ◽  
Reproductive Aged Women

Premature ovarian insufficiency (POI) is the loss of normal hormonal and reproductive function of ovaries in women before age 40 as the result of premature depletion of oocytes. The incidence of POI increases with age in reproductive-aged women, and it is highest in women by the age of 40 years. Reproductive function and the ability to have children is a defining factor in quality of life for many women. There are several methods of fertility preservation available to women with POI. Procreative management and preventive strategies for women with or at risk for POI are reviewed.

Premature ovarian insufficiency: Genetic causes and treatment options. A literature review

2021 ◽  
Vol 70 (3) ◽  
pp. 75-91
Author(s):  
Valentina M. Denisova ◽  
Maria I. Yarmolinskaya ◽  
Karina A. Zakurayeva
Keyword(s):  
Literature Review ◽  
Ovarian Function ◽  
Treatment Options ◽  
Clinical Signs ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Diagnostic Features ◽  
Genetic Causes ◽  
Pubmed Database

Premature ovarian insufficiency is a syndrome characterized by hypergonadotropic ovarian insufficiency and the reduction of ovarian function before age 40. This leads to reproductive failures, metabolic changes, and a decrease in quality of life. Currently, occult and initial forms of premature ovarian insufficiency, which have their own diagnostic features and management tactics, can be figured out. The frequency of this syndrome is between 1.1 and 3.7% and the tendency for incidence to increase can be seen. This article is a literature review of the data available in the PubMed database (20052020), with international clinical guidelines taken into consideration. The genetic causes of premature ovarian insufficiency, clinical signs of this pathology and treatments options for such patients are included into the review. In addition, some features of assisted reproductive technology within this group are described.

scholarly journals Anti-Müllerian Hormone in the Diagnosis and Prediction of Premature Ovarian Insufficiency

2021 ◽  
Author(s):  
Richard A. Anderson ◽  
Scott M. Nelson
Keyword(s):  
Ovarian Function ◽  
Current Data ◽  
Premature Ovarian Insufficiency ◽  
Clinical Value ◽  
Ovarian Insufficiency ◽  
Natural Menopause ◽  
Specific Product ◽  
Estrogen Production ◽  
Increased Risk ◽  
Timing Of Onset

AbstractThe menopause and its pathological version, premature ovarian insufficiency (POI), are characterized by the cessation of follicle growth in the ovary, with consequent lack of estrogen production and amenorrhea. The measurement of a specific product of ovarian follicles would therefore be expected to be a valuable biomarker in women with POI, and to be of likely clinical value in the diagnosis and perhaps prediction of POI. Anti-Müllerian hormone (AMH) is produced by the granulosa cells of growing follicles and is therefore likely to be of value in this context. Current data indicate that measurement of AMH is an accurate indicator of POI in many situations and has diagnostic validity and may facilitate more timely diagnosis. AMH seems to be of limited value in predicting age at natural menopause, even with multiple measurements, and there are scarce data regarding prediction of POI, other than when it is imminent, and in some contexts where there is an immediate iatrogenic threat to ovarian function. AMH therefore appears to have considerable value as a diagnostic test for POI, but apart from highlighting broadly those at increased risk, it has inadequate precision to be able to predict accurately the timing of onset of impending POI.

Managing common problems in the menopause

2018 ◽  
Vol 11 (7) ◽  
pp. 378-386
Author(s):  
Louise Newson ◽  
Nick Panay
Keyword(s):  
Quality Of Life ◽  
Health Risks ◽  
Healthcare Professionals ◽  
Medical Condition ◽  
Hormone Replacement ◽  
Ovarian Insufficiency ◽  
Life Event ◽  
Common Problems

The menopause is a normal life event for women and not an illness or medical condition. Despite this, menopause can predispose vulnerable women to distressing symptoms that impact adversely on their quality of life and to long term medical conditions such as osteoporosis, cardiovascular disease and dementia. Many healthcare professionals are uncertain about the management of the menopause, and this leads to many women not receiving treatment which is often beneficial to them. This article will cover the diagnosis of the menopause including premature ovarian insufficiency. Some of the health risks of the menopause will be discussed and treatment of the menopause, with a particular focus on hormone replacement therapy, will be covered in detail.

REPRODUCTIVE POTENTIAL OF WOMEN WITH PREMATURE OVARIAN INSUFFICIENCY

2021 ◽  
pp. 41-48
Author(s):  
Spiridenko G.Yu. ◽  
Petrov Yu.A. ◽  
Palieva N.V.
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Assisted Reproductive Technologies ◽  
Hormone Replacement ◽  
Reproductive Potential ◽  
Reproductive Technologies ◽  
Pathological Process ◽  
Reproductive Age ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency

Infertility is currently a priority problem for women of reproductive age. One of the reasons for this condition may be premature ovarian insufficiency. This is a pathological process causes by primary hypogonadism that occurs in women under 40 years of age. Its prevalence varies from 1:10,000 at the age of 20 to 1:100 at an older age. The absence of specific clinical manifestations of the disease complicates its early diagnosis and timely treatment. This pathological process manifests itself as secondary oligo-or amenorrhea, infertility. Less often, before the onset of reproductive disorders, there are manifestations of estrogenic insufficiency - vasomotor disorders - hot flashes, hyperhidrosis, cephalgia, tachycardia, arterial hypertension, emotional and vegetative disorders-irritability, asthenic manifestations, anxiety, depression, hypo - thymia, decreased libido. The lack of accurate data on etiological factors makes it harder to find methods for preventing this disease. The main direction of treatment is hormone replacement therapy, aimed at eliminating the insufficiency of natural estrogens in the woman's body. The chances of successful realization of the reproductive potential depend on the value of the follicle-stimulating hormone, since its high concentration affects the mitotic activity of granulosa cells of the follicle, which confirms the validity of hormone replacement therapy. The non-occurrence of pregnancy after therapy forces the patient to use assisted reproductive technologies using donor embryos and oocytes, while the effectiveness of in vitro fertilization does not exceed 58%. To prevent this outcome, if a woman has risk factors for developing premature ovarian insufficiency, it is necessary to timely assess the ovarian reserve with the preservation of her own oocytes for subsequent assisted reproductive technologies.

scholarly journals Efficacy of Traditional Chinese Medicine Tonifying Kidney (Bushen) and Activating Blood (Huoxue) Prescription for Premature Ovarian Insufficiency: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Hui-Fang Li ◽  
Qi-Hong Shen ◽  
Wen-Jun Chen ◽  
Wei-Min Chen ◽  
Zhang-Feng Feng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Meta Analysis ◽  
Scientific Journal ◽  
Peak Systolic Velocity ◽  
Premature Ovarian Insufficiency ◽  
Cochrane Library ◽  
Ovarian Insufficiency

Context. Premature ovarian insufficiency (POI) is one of the difficult gynecological diseases with complex etiologies. Tonifying kidney (bushen) and activating blood (huoxue) prescription (TKABP) is a popular traditional Chinese medicine (TCM) therapy which is commonly applied for POI. However, its efficacy and safety are still controversial. Objective. We carried out this systematic review and meta-analysis to evaluate the effectiveness of TKABP on POI. Methods. The following eight databases were searched from the establishment to September 30, 2019, for randomized controlled trials (RCTs): PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese BioMedical database (CBM), Chinese Scientific Journal Database (VIP), and the Wanfang database. The quality of evidence was estimated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results. Twenty-three RCTs involving 1712 patients with POI were included. Compared to hormone therapy (HT) groups, TKABP groups showed a significantly higher total effective rate (RR: 1.10; 95% CI: 1.04–1.17; P<0.01, I2 = 32%). In addition, TKABP groups revealed a better improvement in terms of serum follicle-stimulating hormone (FSH) levels, serum estradiol (E2) levels, peak systolic velocity (PSV) of ovarian stromal blood, and Kupperman index (KI) score. However, serum luteinizing hormone (LH) levels and ovarian volume (OV) showed no significant statistical difference. Subgroup analyses showed that herbal paste and 3 months of treatment duration had a greater effect on the improvement of hormone levels. Besides, the occurrence of related adverse events in TKABP groups was lower than that in HT groups. Conclusions. Our review suggests that TKABP appears to be an effective and safe measure for patients with POI, and the herbal paste may be superior. However, the methodological quality of included RCTs was unsatisfactory, and it is necessary to verify its effectiveness with furthermore standardized researches of rigorous design.

scholarly journals Spontaneous pregnancy in a patient with premature ovarian insufficiency after a failed attempt of ovulation induction

2021 ◽  
Vol 10 (9) ◽  
pp. 3584
Author(s):  
Nasuha Yaacob ◽  
Fadzlin M. Adzlan ◽  
Siti Nabillah Ab Rahman
Keyword(s):  
Hormone Replacement Therapy ◽  
Menstrual Cycle ◽  
Caesarean Section ◽  
Ovulation Induction ◽  
Hormone Replacement ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Healthy Baby ◽  
Spontaneous Pregnancy ◽  
Failed Attempt

Premature ovarian insufficiency (POI) is defined as intermittent or permanent gonadal insufficiency before age of 40 years. POI causes female infertility hence pregnancies are uncommon but not impossible. Ovarian failure is not permanent, unlike menopause. There could be intermittent ovulation and spontaneous pregnancy. Many protocols aimed to restore ovarian functions have been described in the recent years. This is a case of POI women who conceived spontaneously in the immediate menstrual cycle after a failed attempt at ovarian stimulation following many years on hormone replacement therapy (HRT). She had an unremarkable pregnancy and delivered a healthy baby via caesarean section.

scholarly journals Hormone Replacement Therapy Reverses Gut Microbiome and Serum Metabolome Alterations in Premature Ovarian Insufficiency

2021 ◽  
Vol 12 ◽  
Author(s):  
Lingling Jiang ◽  
Haiyi Fei ◽  
Jinfei Tong ◽  
Jiena Zhou ◽  
Jiajuan Zhu ◽  
...  
Keyword(s):  
Hormone Replacement Therapy ◽  
Gut Microbiota ◽  
Replacement Therapy ◽  
Gut Microbiome ◽  
Hormone Replacement ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Serum Metabolites ◽  
Tgf Β1 ◽  
Metabolic Signatures

ObjectiveWe explored the gut microbiome and serum metabolome alterations in patients with premature ovarian insufficiency (POI) and the effects of hormone replacement therapy (HRT) with the aim to unravel the pathological mechanism underlying POI.MethodsFecal and serum samples obtained from healthy females (HC, n = 10) and patients with POI treated with (n = 10) or without (n = 10) HRT were analyzed using 16S rRNA gene sequencing and untargeted metabolomics analysis, respectively. Peripheral blood samples were collected to detect serum hormone and cytokine levels. Spearman’s rank correlation was used to evaluate correlations between sex hormones and cytokines and between the gut microbiota and serum metabolites. To further confirm the correlation between Eggerthella and ovarian fibrosis, the mice were inoculated with Eggerthella lenta (E. lenta) through oral gavage.ResultsThe abundance of genus Eggerthella significantly increased in the fecal samples of patients with POI compared to that observed in the samples of HCs. This increase was reversed in patients with POI treated with HRT. Patients with POI showed significantly altered serum metabolic signatures and increased serum TGF-β1 levels; this increase was reversed by HRT. The abundance of Eggerthella was positively correlated with altered metabolic signatures, which were, in turn, positively correlated with serum TGF-β1 levels in all subjects. Estrogen ameliorated ovarian fibrosis induced by E. lenta in mice.ConclusionsThe interactions between the gut microbiota, serum metabolites, and serum TGF-β1 in patients with POI may play a critical role in the development of POI. HRT not only closely mimicked normal ovarian hormone production in patients with POI but also attenuated gut microbiota dysbiosis and imbalance in the levels of serum metabolites and TGF-β1, which are reportedly associated with fibrosis. The findings of this study may pave the way for the development of preventive and curative therapies for patients with POI.

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