Premature Ovarian Failure (Premature Menopause)

Disorders in which women < 40 yr present with symptoms and signs due to estrogen deficiency and have high levels of circulating gonadotropins (especially FSH) and low levels of estradiol.

Various disorders can cause premature ovarian failure.

Diagnosis

Gonadotropin levels are high in all patients. Karyotype should be determined in patients < 30 yr who are diagnosed with ovarian failure on the basis of high gonadotropin levels.

The presence of a Y chromosome requires laparotomy or laparoscopy and excision of all gonadal tissue to prevent malignant tumor formation, which occurs in 25% of such women. Genetic evaluation is unnecessary in women > 35 yr with high gonadotropin levels because gonadal neoplasms have not been reported in them; these women are presumed to have premature menopause.

Blood tests to check for autoimmune disorders include sedimentation rate, rheumatoid factor, and antinuclear antibodies. Other tests include serum calcium and phosphorus to rule out hypoparathyroidism, thyroid function and antibodies to rule out thyroiditis, and an AM cortisol to rule out hypoadrenalism, as well as CBC, total protein, and albumin/globulin ratio. Serum gonadotropin and estradiol levels are determined weekly for 2 to 4 wk; if LH levels are ever greater than FSH levels or if estradiol is ever > 50 pg/mL, ovarian follicles should be present.

Treatment

Women who have premature ovarian failure and do not desire pregnancy should be given estrogen replacement therapy (as for women who have chronic anovulation and do not desire pregnancy). They should be cautioned that failure to bleed in response to progestin may indicate pregnancy (in about 5 to 10%). For those who desire pregnancy, an option is oocyte donation, with artificial cycles stimulated by exogenous estrogen and progesterone, so that the oocytes fertilized in vitro can be transferred to appropriately stimulated endometrium.