Premature ovarian failure (POF) is the occurrence of hypergonadotropic
hypoestrogenic amenorrhea in women under the age of forty years. It is
idiopathic in 74-90% patients. Known cases can be divided into primary and
secondary POF. In primary POF genetic aberrations can involve the X
chromosome (monosomy, trisomy, translocations, deletions) or autosomes.
Genetic mechanisms include reduced gene dosage and non-specific chromosome
effects impairing meiosis, decreasing the pool of primordial follicles and
increasing atresia due to apoptosis or failure of follicle maturation.
Autoimmune ovarian damage is caused by alteration of T-cell subsets and
T-cell mediated injury, increase of autoantibody producing B-cells, a low
number of effector/cytotoxic lymphocyte, which decreases the number and
activity of natural killer cells. Bilateral oophorectomy, chemotherapy,
radiotherapy and infections cause the secondary POF. Symptoms of POF include
irritability, nervousness, loss of libido, depression, lack of concentration,
hot flushes, weight gaining, dry skin, vaginal dryness, frequent infections
etc. The diagnosis is confirmed by the level of FSH of over 40 IU/L and
estradiol below 50 pmol/L in women aged below 40 years. Biochemical and other
hormonal analysis (free thyroxin, TSH, prolactin, testosterone), karyotype
(<30 years of age), ultrasound of the breasts and pelvis are advisable.
Optimal therapy is combined estrogen progestagen therapy given in a
sequential rhythm, after excluding absolute contraindications. Testosterone
can be added to adnexectomized women and those with a low libido. Sequential
estrogen progestagen replacement therapy is the first line therapy for
ovulation induction in those looking for pregnancy and after that oocyte
donation will be advised. Appropriate estro-progestagen therapy improves the
quality of life and prevents complications such as cardiovascular diseases,
osteoporosis, stroke etc.
Spontaneous pregnancy in a patient with a combination of ovarian and thyroid failure