Ovarian failure

Types

Premature ovarian failure

• Also called Primary ovarian insufficiency, premature menopause
• POF is a primary ovarian defect characterized by primary amenorrhea or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea).
• It is a heterogeneous disorder affecting approximately 1% of women <40 years
• The most severe forms present with absent pubertal development and primary amenorrhea, whereas forms with post-pubertal onset are characterized by secondary amenorrhea associated with premature follicular depletion.
• As in the case of physiological menopause, POF presents by typical manifestations of climacterium: Infertility associated with palpitations, heat intolerance, flushes, anxiety, depression, fatigue.

• Beyond infertility, hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis.
• Heterogeneity of POF is also reflected by the variety of possible causes, including autoimmunity, toxics, drugs, as well as genetic defects.

Triad of diagnosis:

• Amenorrhea,
• Hypergonadotropism: High levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea)
• Hypoestrogenism: Low levels of gonadal hormones (estrogens and inhibins)

Causes

• Idiopathic in 90%
• Auto immune:
  • Autoimmune oophoritis: MMP
  • Hashimoto thyroiditis: EBV, MMP, HCV
  • Addison disease
  • Type I diabetes mellitus
  • Pernicious anemia: Atrophic Gastritis : EBV or HCV
• Other causes include chemotherapy, being a carrier of the fragile X syndrome gene, radiotherapy, Cigarette smoking, higher body mass index, racial and ethnic factors, illnesses, and the removal of the uterus.
• Genetic disorders such as Turner syndrome and Fragile X syndrome, metabolic defects, and enzyme defects.

Secondary ovarian failure

• In secondary OF, ovaries are normal but there is a problem getting hormone signals to them from the brain.
• This is usually caused by diseases of the pituitary gland or hypothalamus. (Hypopituitarism)
• It may also caused by certain medicines, too much exercise, or certain eating disorders.
• Some women with secondary ovarian failure sometimes have menstrual periods and may be able to have children.
• Hypogonadotropic hypogonadism

Miasms

• Primary ovarian failure: Oophoritis (FSH / LH is normal) : MMP
• Secondary ovarian failure: (FSH / LH increased) Hypopituitarism (MTB), Hashimoto thyroiditis (MMP, HCV, EBV), Addison disease (MTB, HSV-1, EBV)
• Central Hypogonadism (Prolactin increasing, Genicomastia): HCV