Premature Ovarian Insufficiency and Long-Term Health Consequences

2019 ◽  
Vol 17 (6) ◽  
pp. 604-609 ◽  
Author(s):  
Sophia Tsiligiannis ◽  
Nick Panay ◽  
John C. Stevenson
Keyword(s):  
Ovarian Function ◽  
Management Strategies ◽  
Premature Ovarian Insufficiency ◽  
Health Consequences ◽  
Mineral Density ◽  
Ovarian Insufficiency ◽  
Oestrogen Deficiency ◽  
The Subject ◽  
Neurological Effects

Premature ovarian insufficiency (POI) is defined as the cessation of ovarian function before the age of 40 years. The trio of amenorrhea, elevated gonadotropins and oestrogen deficiency is associated with long-term health consequences including increased cardiovascular disease (CVD), decreased bone mineral density (BMD), significantly reduced fertility, psychological distress, vulvovaginal atrophy, neurological effects and overall reduced life expectancy. There are deficits in our understanding of this condition and subsequently the long-term health consequences. The underlying aetiology of POI and the optimal management strategies are also poorly understood. Our knowledge of long-term cardiovascular consequences specifically relating to women with POI is limited as most data on the subject are derived from studies involving women who experienced menopause at the natural age (after 40 years with an average age of 51).

scholarly journals The Role of Noncoding RNA in the Pathophysiology and Treatment of Premature Ovarian Insufficiency

2021 ◽  
Vol 22 (17) ◽  
pp. 9336
Author(s):  
Katarzyna Pankiewicz ◽  
Piotr Laudański ◽  
Tadeusz Issat
Keyword(s):  
Neurological Disorders ◽  
Noncoding Rna ◽  
Ovarian Function ◽  
Hormone Replacement ◽  
Premature Ovarian Insufficiency ◽  
Mineral Density ◽  
Ovarian Insufficiency ◽  
Exosomal Mirnas

Premature ovarian insufficiency (POI) is defined as a loss of ovarian function before the age of 40 years, with a prevalence rate estimated at approximately 1%. It causes infertility and is related to serious long-term health consequences, including reduced life expectancy, increased cardiovascular risk, decreased bone mineral density and neurological disorders. There is currently no effective therapy for POI that is widely available in clinical practice; therefore, the treatment of patients with POI is based on hormone replacement therapy. One of the recent advances in the understanding of the pathophysiology of POI has been the role of microRNAs (miRNAs) and other noncoding RNAs (ncRNAs) in the disease. Moreover, intensive research on human folliculogenesis and reproductive biology has led to the development of novel promising therapeutic strategies with the use of exosomal miRNAs derived from mesenchymal stem cells to restore ovarian function in POI patients. This narrative review focuses on the new studies concerning the role of ncRNAs in the pathogenesis of POI, together with their potential as biomarkers of the disease and targets for therapy.

scholarly journals Long-term outcome of ovarian function in women with intermittent premature ovarian insufficiency

2016 ◽  
Vol 86 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Anne Bachelot ◽  
Carole Nicolas ◽  
Maud Bidet ◽  
Jérôme Dulon ◽  
Monique Leban ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Premature Ovarian Insufficiency - an update on recent advances in understanding and management

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2069 ◽  
Author(s):  
Saioa Torrealday ◽  
Pinar Kodaman ◽  
Lubna Pal
Keyword(s):  
Ovarian Function ◽  
Clinical Medicine ◽  
Premature Ovarian Insufficiency ◽  
Clear Understanding ◽  
Timely Manner ◽  
Ovarian Insufficiency ◽  
Ongoing Research ◽  
Health Complications

Premature ovarian insufficiency is a complex and relatively poorly understood entity with a myriad of etiologies and multisystem sequelae that stem from premature deprivation of ovarian sex hormones. Timely diagnosis with a clear understanding of the various comorbidities that can arise from estrogen deficiency is vital to appropriately counsel and treat these patients. Prompt initiation of hormone therapy is critical to control the unsolicited menopausal symptoms that many women experience and to prevent long-term health complications. Despite ongoing efforts at improving our understanding of the mechanisms involved, any advancement in the field in recent decades has been modest at best and researchers remain thwarted by the complexity and heterogeneity of the underpinnings of this entity. In contrast, the practice of clinical medicine has made meaningful strides in providing assurance to the women with premature ovarian insufficiency that their quality of life as well as long-term health can be optimized through timely intervention. Ongoing research is clearly needed to allow pre-emptive identification of the at-risk population and to identify mechanisms that if addressed in a timely manner, can prolong ovarian function and physiology.

scholarly journals How to Protect Ovarian Function before and during Chemotherapy?

2021 ◽  
Vol 10 (18) ◽  
pp. 4192
Author(s):  
Luca Arecco ◽  
Tommaso Ruelle ◽  
Valentino Martelli ◽  
Andrea Boutros ◽  
Maria Maddalena Latocca ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Premenopausal Women ◽  
Protective Role ◽  
Premature Ovarian Insufficiency ◽  
Negative Consequences ◽  
Key Factors ◽  
Ovarian Insufficiency ◽  
Natural Menopause ◽  
Premenopausal Patients

A significant number of women receive a cancer diagnosis before their age of natural menopause. Among these patients, the most frequent neoplasms are breast cancer, gynecological, and hematological malignancies. Premature ovarian insufficiency and infertility are among the most feared short- to long-term consequences of anticancer treatments in premenopausal patients. Both patient- and treatment-related characteristics are key factors in influencing the risk of gonadotoxicity with the use of chemotherapy. The cryopreservation of oocytes/embryos is a standard strategy for fertility preservations offered to young women interested in future family planning, but it does not allow gonadal function protection during chemotherapy. Ovarian suppression with gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy is now recommended as an option to reduce the risk of gonadotoxicity in order to avoid the negative consequences of premature ovarian insufficiency in premenopausal women receiving cytotoxic therapy, including those not interested in fertility preservation. This review summarizes the risk of treatment-induced gonadotoxicity in premenopausal patients and the evidence available on the protective role of administering GnRHa during chemotherapy to preserve ovarian function.

scholarly journals Premature Ovarian Insufficiency: A Review

2019 ◽  
Author(s):  
Avantika Gupta ◽  
Purnima Tiwari
Keyword(s):  
Ovarian Function ◽  
Well Being ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Catastrophic Event ◽  
Timely Initiation ◽  
Population Subgroup ◽  
Short And Long Term

Premature ovarian insufficiency is waning of ovarian function before the age of 40 years. This hypoestrogenic state is characterised by menstrual irregularities and loss of fertility in the patient. This review narrates evaluation, consequences, and management of this complex entity. Truncation in ovarian physiology at such an early age renders the patient prone for various short- and long-term health consequences which negatively affect physical and psychological well-being of the patients. Therefore, this review emphasises that timely initiation of hormonal therapy is mandatory to mitigate the distressing menopausal and/or other hypoestrogenic symptoms to improve the quality of life of such patients. Although much has been said about premature ovarian insufficiency, many aspects of this condition still need to be explored in order to identify this population subgroup before happening of the catastrophic event and to formulate strategies and interventions to delay the premature cessation of ovarian functions.

scholarly journals Rationale and design of a cohort study on primary ovarian insufficiency in female survivors of Hodgkin’s lymphoma: influence on long-term adverse effects (SOPHIA)

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e018120
Author(s):  
Inge M Krul ◽  
Annemieke W J Opstal-van Winden ◽  
Josée M Zijlstra ◽  
Yolande Appelman ◽  
Sanne B Schagen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Hodgkin’S Lymphoma ◽  
Primary Ovarian Insufficiency ◽  
Hodgkin's Lymphoma ◽  
Reverse Causality ◽  
Mineral Density ◽  
Cvd Risk ◽  
Ovarian Insufficiency

IntroductionHodgkin’s lymphoma (HL) has become the prototype of a curable disease. However, many young survivors suffer from late adverse effects of treatment. Both chemotherapy (CT) and radiotherapy (RT) may induce primary ovarian insufficiency (POI), which has been associated with reduced bone mineral density (BMD), neurocognitive dysfunction and possibly cardiovascular disease (CVD). While the general assumption is that POI increases CVD risk, other hypotheses postulate reverse causality, suggesting that cardiovascular risk factors determine menopausal age or that biological ageing underlies both POI and CVD risk. None of these hypotheses are supported by convincing evidence. Furthermore, most studies on POI-associated conditions have been conducted in women with early natural or surgery-induced menopause with short follow-up times. In this study, we will examine the long-term effects of CT-induced and/or RT-induced POI on BMD, cardiovascular status, neurocognitive function and quality of life in female HL survivors.Methods and analysisThis study will be performed within an existing Dutch cohort of HL survivors. Eligible women were treated for HL at ages 15–39 years in three large hospitals since 1965 and survived for ≥8 years after their diagnosis. Women visiting a survivorship care outpatient clinic will be invited for a neurocognitive, cardiovascular and BMD assessment, and asked to complete several questionnaires and to provide a blood sample. Using multivariable regression analyses, we will compare the outcomes of HL survivors who developed POI with those who did not. Cardiovascular status will also be compared with women with natural POI.Ethics and disseminationThis study has been approved by the Institutional Review Board of the Netherlands Cancer Institute and has been registered at ‘Toetsingonline’ from the Dutch Central Committee on Research involving Human Subjects (file no. NL44714.031.13). Results will be disseminated through peer-reviewed publications and will be incorporated in follow-up guidelines for HL survivors.

Investigation and treatment of premature ovarian insufficiency: A multi-disciplinary review of practice

2018 ◽  
Vol 24 (4) ◽  
pp. 155-162 ◽  
Author(s):  
A Richardson ◽  
SA Haridass ◽  
E Ward ◽  
J Ayres ◽  
NE Baskind
Keyword(s):  
Significant Variation ◽  
Fragile X ◽  
Treatment Options ◽  
Human Reproduction ◽  
Premature Ovarian Insufficiency ◽  
Teaching Hospitals ◽  
Thyroid Peroxidase ◽  
Mineral Density ◽  
Ovarian Insufficiency ◽  
Long Term Follow Up

Objectives To assess compliance with the European Society for Human Reproduction and Embryology (ESHRE) guidelines on the investigation and management of women with premature ovarian insufficiency at the Leeds Teaching Hospitals NHS Trust (LTHT) and to determine whether this varies depending on the clinical setting in which the women present. Study design A retrospective review of all females diagnosed with premature ovarian insufficiency between 1 July 2016 and 30 June 2017, presenting to one of the following clinics: reproductive medicine, specialist menopause, general gynaecology, oncology long-term follow-up, general endocrinology or paediatric endocrinology. Main outcome measures Proportion of patients who had the necessary investigations performed and relevant treatment options discussed. Results 103 women were included in the study. Overall, 40.6% had a karyotype. Screening for the Fragile-X pre-mutation, thyroid peroxidase and 21-hydroxylase antibodies occurred in 7.4%, 11.1% and 13.6% of women, respectively. Only 35.9% had their bone mineral density measured. There was significant variation in the performance of a karyotype (p < 0.001) and thyroid peroxidase antibodies (p < 0.01) between the different clinical settings. Overall, lifestyle advice was offered to 30.1%. Estrogen replacement, contraception, fertility options and bone protection were discussed with 76.0%, 38.4%, 59.0% and 75.0%, respectively. Psychological support was offered to 25.2%. There was significant variation for all apart from contraception. Conclusion The investigation and treatment of women with premature ovarian insufficiency at the LTHT is not consistent with the ESHRE guidelines and requires improvement. Furthermore, there is significant variation in management depending on the department to which the patient initially presents.

Drought relief schemes for the 'Pastoral Zone'.

1982 ◽  
Vol 4 (2) ◽  
pp. 67 ◽  
Author(s):  
IB Robinson
Keyword(s):  
Land Tenure ◽  
Management Strategies ◽  
Government Policies ◽  
Primary Industry ◽  
The Subject ◽  
Consensus View ◽  
Spatial Diversification ◽  
The Individual ◽  
The Impact

In this article I have attempted to firstly provide a consensus view of graziers to sound drought strategies; secondly, outline Government policies or action directed towards assisting graziers affected by drought; and finally, address the subject of drought policy as it relates to conservation of the rangeland resource. Drought strategies discussed include pre-drought (e.g. fodder reserves, conservative stocking), longer term (e.g. increasing property size, spatial diversification of grazing blocks) and in-drought (e.g. reduce stock numbers early in drought). Grounds for Government intervention and aid for drought affected producers are analysed with regard to both the individual farmer's needs and the impact nationally of low return from a drought-affected primary industry. Aspects discussed include provision of better infrastructure (e.g, new roads), taxation concessions, a National Drought Fodder Reserve, land tenure policy, the Rural Adjust- ment Scheme and credit and freight concessions. From the conservation viewpoint, it is pointed out that officially declared 'droughts' occur too frequently and there are no incentives for graziers to either act early before a drought becomes firmly established or to delay re-stocking after the drought has broken. It is concluded that a balance between in-drought assistance and long term assistance needs to be struck, and that drought policies should be directed towards 'good' management strategies. If this can be achieved then primary producers should be less dependent on relief schemes.

scholarly journals An Overview of International Guidelines Focusing on the Long-Term Management of Coeliac Disease

2020 ◽  
Vol 2 (2) ◽  
pp. 152-163
Author(s):  
Sophie W. Hall ◽  
Andrew S. Day
Keyword(s):  
Coeliac Disease ◽  
Best Practice ◽  
Management Strategies ◽  
Autoimmune Disorder ◽  
Risk Groups ◽  
Annual Review ◽  
Mineral Density ◽  
Strict Adherence ◽  
Micronutrient Status

Coeliac disease (CD) is an autoimmune disorder characterised by, but not isolated to, intestinal enteropathy in response to exposure to gluten in predisposed individuals. The mainstay of the management of CD is a strict, lifelong gluten free diet (GFD). Although numerous publications have focused on pathways to guide the diagnosis of CD, recommendations for the care of patients after diagnosis are less well established. This manuscript aimed to review the available published guidelines focusing on the ongoing management and follow-up of patients after diagnosis with CD and commencement of a GFD. All available guidelines recommend strict adherence to a GFD with most recommending an annual review by a specialist clinician, focusing on symptoms, adherence and growth. In addition to monitoring micronutrient status, some guidelines suggest monitoring bone mineral density in at-risk groups and screening for other autoimmune disorders. The benefit of multi-disciplinary input was outlined in many guidelines, in particular, the involvement of a specialist dietitian to provide nutritional counselling and support. While the available guidelines provide key messages, they highlight a lack of strong evidence and some inconsistences. Further evidence is required to support high quality, best-practice management strategies that will optimise the outcomes of patients with CD.

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