Ovarian failure
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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