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2.1
Acquired Premature Ovarian Failure
Other Ovarian Dysfunction

Presentation

Weight loss will also occur with hypopituitarism which also presents with secondary amenorrhoea. [endobible.com]

Presentation The most common presentations are primary or secondary amenorrhoea [ 2 ]. However, abnormal bleeding patterns also include oligomenorrhoea. [patient.info]

Antenatal diagnosis Not relevant at present. Management Patients with POF have infertility and hormone deficits. At present, fertility cannot be restored if the diagnosis is made after complete follicular depletion. [ojrd.biomedcentral.com]

The last two markers tested, DXS1073 and DXS1108 were both present in heterozygote state in the three women. The deletion is therefore interstitial and the last 3 Mb of Xq28 are present in the three patients. [nature.com]

The clinical presentation of POI can be variable, but the most common presenting symptom is menstrual disturbance, particularly oligomenorrhoea or amenorrhoea. [racgp.org.au]

Entire Body System

  • Pain

     In primary hypogonadism, oestrogen withdrawel symptoms occur – hot flushes, sweats, mood changes, vaginal dryness, pain on intercourse.  Signs of established hypogonadism include facial wrinkling, breast involution, general reduction in body hair. [mymedicalstudentnotes.com]

    Other symptoms may include mood swings, energy loss, low sex drive, painful sex, and bladder control problems. [ivf1.com]

    […] antivaccine underground, this report is being used to resurrect even wilder speculation about L-histidine somehow invoking autoimmune disease (which, by the way, this girl appears not to have had), all because girls not infrequently complain of joint pain [scienceblogs.com]

    The symptoms are cyclic lower abdominal pain and bladder irritability. Examination shows a firm pelvic mass that varies in size and is not always symmetrical in outline. Vaginal inspection reveals a short vagina and no cervix. [glowm.com]

  • Asymptomatic

    The patient is actually asymptomatic premature menopause(E28.319) or asymptomatic post-procedural ovarian failure (E89.40) I'm not sure which and probably Hormone Replacement Therapy (Z79.890). [aapc.com]

    E27.9 Disorder of adrenal gland, unspecified E28 Ovarian dysfunction E28.0 Estrogen excess E28.1 Androgen excess E28.2 Polycystic ovarian syndrome E28.3 Primary ovarian failure E28.31 Premature menopause E28.310 Symptomatic premature menopause E28.319 Asymptomatic [icd10data.com]

    Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiency in young women with spontaneous premature ovarian failure. Human Reproduction, 17 (8), 2096–2100. [womenshealthnetwork.com]

    Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiency in young women with spontaneous premature ovarian failure. Hum Reprod. 2002 Aug. 17(8):2096-100. [Medline]. Bannatyne P, Russell P, Shearman RP. [emedicine.medscape.com]

  • Weakness

    Once the diagnosis of Premature Ovarian Failure (POF) is made, additional diagnostic testing is important to evaluate for genetickaryotyping, assessment of other endocrine systems such as thyroid and parathyroid, myasthenia gravis (a muscle weakness disorder [acfs2000.com]

    Symptoms of adrenal insufficiency include abdominal pain, anorexia, unexplained weakness, darkening of the skin, salt craving, and orthostatic hypotension-dizzy spell occurring when standing after being at rest for some time due to low blood pressure. [ivf1.com]

    Yes, the argument is just that vacuous and weak. Let's go back to the report itself, and then let's go to how antivaccinationists are spinning it. [scienceblogs.com]

  • Fatigue

     p/c: fatigue, amenorrhoea, infertility, male pattern baldness, acne, hirsuitism, anosmia (in Kallman’s syndrome), signs of oestrogen withdrawel (menopausal symptoms), obesity (PCOS), galactorrhoea (increased PRL), Hx of excessive exercise/stress, [mymedicalstudentnotes.com]

    […] menopause, POF is clinically characterized by typical manifestations of climacterium such as palpitations, heat intolerance, flushes, night sweats, irritability, anxiety, depression, sleep disturbance, decreased libido, hair coarseness, vaginal dryness, fatigue [ojrd.biomedcentral.com]

  • Underweight

    Gold P, Gwirtsman H, Avgerinos P et al: Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa: Pathophysiologic mechanisms in underweight and weight-corrected patients. N Engl J Med 314: 1335, 1986 73. [glowm.com]

Gastrointestinal

  • Vomiting

    The main symptoms of autoimmune oophorotis are irregular or absent menstrual period ( amenorrhea ) and symptoms related to ovarian cysts such as abdominal cramping, bloating, nausea and vomiting. [monarchinitiative.org]

    The main side effects may be nausea or vomiting and occasional gastric problems. Sometimes, it can induce heavy menstrual bleeding and rarely drowsiness, which are not major side effects. [fertilityscienceresearch.org]

  • Nausea

    The main symptoms of autoimmune oophorotis are irregular or absent menstrual period ( amenorrhea ) and symptoms related to ovarian cysts such as abdominal cramping, bloating, nausea and vomiting. [monarchinitiative.org]

    The main side effects may be nausea or vomiting and occasional gastric problems. Sometimes, it can induce heavy menstrual bleeding and rarely drowsiness, which are not major side effects. [fertilityscienceresearch.org]

Cardiovascular

  • Hypotension

    Women may also have symptoms and signs of the causative disorder (eg, dysmorphic features due to Turner syndrome; intellectual disability, dysmorphic features, and autism due to Fragile X syndrome; rarely, orthostatic hypotension, hyperpigmentation, and [merckmanuals.com]

    Symptoms of adrenal insufficiency include abdominal pain, anorexia, unexplained weakness, darkening of the skin, salt craving, and orthostatic hypotension-dizzy spell occurring when standing after being at rest for some time due to low blood pressure. [ivf1.com]

Skin

  • Flushing

     In primary hypogonadism, oestrogen withdrawel symptoms occur – hot flushes, sweats, mood changes, vaginal dryness, pain on intercourse.  Signs of established hypogonadism include facial wrinkling, breast involution, general reduction in body hair. [mymedicalstudentnotes.com]

    Typical symptoms found when the menopause occurs later, such as hot flushes and night sweats, may not be present. POI is not an early menopause. [patient.info]

    Some women may also get other typical menopausal symptoms, including: hot flushes night sweats vaginal dryness and discomfort during sex difficulty sleeping low mood or anxiety reduced sex drive (libido) problems with memory and concentration Read more [nhs.uk]

    The symptoms are the same as those experienced by women going through natural menopause Irregular or missed periods Periods that are heavier, lighter, longer, shorter Hot flushes Vaginal Dryness Bladder issues For a comprehensive list and information [menopausehealthmatters.com]

Musculoskeletal

  • Osteoporosis

    ( M81.0- ) postmenopausal osteoporosis with current pathological fracture ( M80.0- ) postmenopausal urethritis ( N34.2 ) ICD-10-CM Codes Adjacent To E28.31 E27.40 Unspecified adrenocortical insufficiency E27.49 Other adrenocortical insufficiency E27.5 [icd10data.com]

    This can lead to reduced quality of life and an increased risk of developing osteoporosis and cardiovascular disease, which can lead to early mortality. [nice.org.uk]

    Complications Women with POI have a significantly increased risk of osteoporosis, cardiovascular disease and possibly Alzheimer's disease. [patient.info]

    The authors report a case of ovarian failure in a 16 year old girl, most likely due to Savage Syndrome, who started hormonal replacement for normal development of sexual characteres and for osteoporosis prevention. [ispub.com]

    Observational studies suggest that there is an increased risk of diabetes following surgical menopause. 19 Osteoporosis is considered one of the most feared consequences by patients with POI. 13 The prevalence of osteoporosis is estimated to be 8–14% [racgp.org.au]

  • Fracture

    Obstetrical & gynecological survey Volume 66 Issue number 6 DOIs 10.1097/OGX.0b013e31821a4aaa State Published - Jun 2011 It is well-recognized that young women with untreated premature ovarian failure (POF) are at increased risk of osteoporosis and bone fracture [research.ed.ac.uk]

    N92.4 ) menopausal and perimenopausal disorders due to artificial or premature menopause ( E89.4-, E28.31 - ) premature menopause ( E28.31 - ) Type 2 Excludes postmenopausal osteoporosis ( M81.0- ) postmenopausal osteoporosis with current pathological fracture [icd10data.com]

    Women with POI have significantly lower bone mineral density and increased fracture risk. The period of accelerated bone loss occurs during the initial 4-5 years after the menopause. [patient.info]

    Chronic low levels of estrogen, needed for bone health, increase the risks of osteoporosis, leading to an increased risk of bone fractures and resulting complications. [acfs2000.com]

    Women with low estrogen levels from POF appear also to be at an increased risk for developing osteoporosis (bone thinning which can lead to fracture) and heart disease. [ivf1.com]

Psychiatrical

  • Fussiness

    Barad et al. showed that DHEA supplementation in women with DOR significantly improved the overall clinical pregnancy of 10.9-28.1%, and half of the pregnancy in treatment group occurred spontaneously. [4] Fussi et al. had corroborated the above finding [fertilityscienceresearch.org]

Neurologic

  • Irritability

    Symptoms and causes of premature ovarian insufficiency Premature ovarian insufficiency has symptoms similar to menopause: hot flashes, vaginal dryness, irritability, night sweats and difficulty sleeping. [fertility-texas.com]

    Douglas suspects ovulatory dysfunction, he may first ask about any symptoms you may have been experiencing, such as hot flashes, irregular or absent cycles, irritability, vaginal dryness and decreased sex drive. [ivfplano.com]

    Women may experience infertility, hot flashes, irregular or even the absence of menses for one to two months at a time, night sweats, irritability, moodiness, sleep disturbance, decreased libido, hair coarseness, and vaginal dryness. [acfs2000.com]

    This leaves women with two equally disturbing concerns: the possibility of infertility, and plenty ofcomplicated symptoms, such as hot flashes, night sweats, mood swings, irritability, vaginal dryness and a lowered sex drive. [womenshealthnetwork.com]

    As in the case of physiological menopause, POF is clinically characterized by typical manifestations of climacterium such as palpitations, heat intolerance, flushes, night sweats, irritability, anxiety, depression, sleep disturbance, decreased libido, [ojrd.biomedcentral.com]

Urogenital

  • Amenorrhea

    Clinical Differential Diagnosis of Primary Amenorrhea Presence of Uterus Breast Development No Breast Development Present Similar to secondary amenorrhea Hypothalamic amenorrhea Pituitary amenorrhea Gonadal dysgenesis 17α-hydroxylase deficiency (46,XX [glowm.com]

    […] before the age of 40 years (secondary amenorrhea) [ 1, 2 ]. [ojrd.biomedcentral.com]

    cancer, autoimmune disease, infertility, and/or amenorrhea. [clinicaladvisor.com]

    Some definitions of POF are inclusive of patients with ovarian failure and primary amenorrhea, thus including patients with gonadal dysgenesis, while other definitions are limited to patients with secondary amenorrhea. [fcionline.com]

    M Sobral, J Dias, O Viseu Keywords hormonal replacement, hypergonadotropic hypogonadism, premature ovarian failure, primary amenorrhea, savage syndrome Citation M Sobral, J Dias, O Viseu. Premature Ovarian Failure in a 16 year old girl. [ispub.com]

  • Vaginal Dryness

    Symptoms and causes of premature ovarian insufficiency Premature ovarian insufficiency has symptoms similar to menopause: hot flashes, vaginal dryness, irritability, night sweats and difficulty sleeping. [fertility-texas.com]

     In primary hypogonadism, oestrogen withdrawel symptoms occur – hot flushes, sweats, mood changes, vaginal dryness, pain on intercourse.  Signs of established hypogonadism include facial wrinkling, breast involution, general reduction in body hair. [mymedicalstudentnotes.com]

    Women who have premature ovarian failure (POF) may experience some symptoms close to that of menopause such as hot flashes, no period, and vaginal dryness. [resolve.org]

    Douglas suspects ovulatory dysfunction, he may first ask about any symptoms you may have been experiencing, such as hot flashes, irregular or absent cycles, irritability, vaginal dryness and decreased sex drive. [ivfplano.com]

    Other women with this condition experience vaginal dryness, night sweats, hot flashes or cessation of menses — symptoms normally associated with menopause. [ovationfertility.com]

  • Hot Flushes

     In primary hypogonadism, oestrogen withdrawel symptoms occur – hot flushes, sweats, mood changes, vaginal dryness, pain on intercourse.  Signs of established hypogonadism include facial wrinkling, breast involution, general reduction in body hair. [mymedicalstudentnotes.com]

    Typical symptoms found when the menopause occurs later, such as hot flushes and night sweats, may not be present. POI is not an early menopause. [patient.info]

    Some women may also get other typical menopausal symptoms, including: hot flushes night sweats vaginal dryness and discomfort during sex difficulty sleeping low mood or anxiety reduced sex drive (libido) problems with memory and concentration Read more [nhs.uk]

    The symptoms are the same as those experienced by women going through natural menopause Irregular or missed periods Periods that are heavier, lighter, longer, shorter Hot flushes Vaginal Dryness Bladder issues For a comprehensive list and information [menopausehealthmatters.com]

Workup

S. married, but after a complicated and frustrating infertility workup and treatment regimen, including fertility drugs and varying procedures without a successful pregnancy, she now age 32 divorced her husband. [fertilitysolution.com]

A review of the literature of 33 cytogenetic studies composed of 1,757 phenotypic females with primary amenorrhea revealed a 32% incidence of chromosome abnormalities. 22 Figure 1 gives a schematic outline of the laboratory workup. Fig. 1. [glowm.com]

Treatment

Treatments for early menopause The main treatment for early menopause is either the combined contraceptive pill or HRT to make up for your missing hormones. [nhs.uk]

Treatment of Premature Ovarian Failure Treatment addresses the issues that premature ovarian failure caused. Treatment is to replace the hormone estrogen, restore fertility and to take care of the psychological well-being of the patient. [medthical.com]

Regardless of the etiology, there currently is no effective treatment that will be likely to result in a pregnancy (with her own eggs) for premature ovarian failure. Egg donation is a highly successful treatment (see below). [advancedfertility.com]

Currently there is no treatment for premature ovarian insufficiency. [fertility-texas.com]

[…] reach the average age of menopause (about age 51), when treatment may be reassessed. [merckmanuals.com]

Prognosis

Ovarian function following abdominal irradiation in childhood: natural history and prognosis. Clin Oncol (R Coll Radiol) 1: 75, 1989. Article CAS Google Scholar Gulati SC, Van Poznak C. Pregnancy after bone marrow transplantation. [link.springer.com]

Prognosis Sex steroid replacement for women with POI up to the normal age of natural menopause will not only improve symptoms but also reduce the risk of osteoporosis and cardiovascular disease. [patient.info]

However, it has some practical clinical value in that it may give a clue to etiology and prognosis. [glowm.com]

Etiology

We present a case of premature ovarian failure in a 16 year-old girl and discuss the possible etiology, treatment and follow-up in these cases. [ispub.com]

These patients exhibit amenorrhoea, elevated gonadotropin levels and subnormal estrogen levels with or without typical menopausal symptoms. 1 Etiology The exact etiology of this disease entity is unknown, but it is suggested that some patients might be [fertilitysolution.com]

Regardless of the etiology, patients with primary ovarian insufficiency are estrogen deficient. [acog.org]

Etiology Because multiple factors may play a role in the development of secondary amenorrhea, it is difficult to construct a complete etiologic classification. [glowm.com]

Epidemiology

Relevant External Links for POF1B Genetic Association Database (GAD) POF1B Human Genome Epidemiology (HuGE) Navigator POF1B Atlas of Genetics and Cytogenetics in Oncology and Haematology: POF1B No data available for Genatlas for POF1B Gene Mutation analysis [genecards.org]

Epidemiology At least 1% of women under the age of 40 are affected. [patient.info]

Little and Ward even suggest an epidemiological study of young women vaccinated with quadrivalent HPV vaccine versus those not vaccinated against HPV with long term followup of ovarian function. This is a ridiculous suggestion. [scienceblogs.com]

Epidemiology POF affects approximately: one in 10,000 women by age 20; one in 1,000 women by age 30; one in 100 women by age 40 [ 3 ]. The familial form of POF is rare, representing 4 to 31% of all cases of POF [ 4 – 6 ]. [ojrd.biomedcentral.com]

It also avoids the first-pass effect in the liver. [34] Epidemiology [ edit ] It has been estimated that POF affects 1% of the female population. [35] History [ edit ] Fuller Albright et al. in 1942 first reported a syndrome in young women characterized [en.wikipedia.org]

Pathophysiology

This distinction is descriptive and artificial, because the underlying pathophysiologic conditions responsible for primary or secondary amenorrhea may be similar. [glowm.com]

Pathophysiology POI is, in reality, a continuum of disorders. Dividing the continuum of ovarian insufficiency into 4 clinical states is the authors' preferred method to facilitate explanation. These states are not permanent. [emedicine.medscape.com]

Prevention

Estrogen can be given orally or transdermally either continuously or cyclically (21 days on then 7 days off).Estrogen therapy does not prevent pregnancy and ovulation. [medthical.com]

The authors report a case of ovarian failure in a 16 year old girl, most likely due to Savage Syndrome, who started hormonal replacement for normal development of sexual characteres and for osteoporosis prevention. [ispub.com]

Doctors usually prescribe calcium and vitamin D supplements to prevent bone loss, which can happen when estrogen levels drop. [webmd.com]

To help prevent osteoporosis, women with primary ovarian insufficiency should consume an adequate amount of calcium and vitamin D (in the diet and/or as supplements). [merckmanuals.com]

 Mx of female hypogonadism: o In ovarian failure = oestrogens (alleviate deficiency syndromes and prevent long-term complications), such as osteoporosis o Progesterones are added for women with an intact uterus to avoid endometrial hyperplasia and [mymedicalstudentnotes.com]

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2.1
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