What is the Best Management Strategy for a 20-year-old Woman With Premature Ovarian Failure?

Melanie C. Davies; Beth Cartwright

Disclosures

Clin Endocrinol. 2012;77(2):182-186. 

In This Article

Abstract and Introduction

Abstract

The diagnosis of premature ovarian failure (POF) for a 20-year-old woman is devastating and will impact on many areas of her life. She deserves prompt confirmation of the diagnosis and accurate, honest information about the condition including the chances of conception and long-term health issues. She should be offered investigation of aetiology, although this may be hard to establish, and assessment of associated medical conditions. Oestrogen replacement should be advised for long-term use until the normal age of menopause, and she should be fully counselled on the benefits and risks of hormone replacement and her options of which preparation to take. Long-term follow-up is needed, and this is likely to require multidisciplinary input, including that from a gynaecologist, clinical psychologist and fertility team. POF may not be the appropriate terminology for this condition. Ovarian function often fluctuates in young women with POF, who may continue to menstruate occasionally and even conceive spontaneously. In view of this unpredictability, 'premature ovarian insufficiency' is a better description of the condition and carries a less negative connotation than 'ovarian failure' which can cause great distress. We recommend that the condition is termed 'premature ovarian insufficiency' (Clinical Endocrinology 2008;68:499).

Introduction

Spontaneous premature ovarian failure or ovarian insufficiency[1] (POF) occurs in about one in 1000 women before the age of 30, and one in 100 before the age of 40.[2] It can be a devastating diagnosis; affected women may have to contend with menopausal symptoms, long-term health sequelae and subfertility. It is not suprising that adverse effects on psychological well-being are reported.[3]

It is disappointing that, on average, patients see three or more health professionals before diagnosis.[4] Secondary amenorrhoea is common,[5] and although POF is not the most frequent cause, it should always be considered. Women may experience symptoms which they are unaware are related to menstrual disturbance and may not mention them unless directly questioned. Menopausal symptoms include hot flushes and night sweats, vaginal dryness, low libido, low energy levels, sleep disturbance, lack of concentration, stiffness, skin/hair changes and mood swings. Symptoms may be intermittent, reflecting the fluctuations in spontaneous ovarian function. Women with primary amenorrhoea very rarely experience symptoms, implying that these are provoked by oestrogen withdrawal.

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