Premature Ovarian Failure

Management

Investigations and Diagnosis

Serum FSH levels ( >20IU/L) : as FSH levels are elevated physiologically mid
cycle , at least 2 FSH levels should be obtained at 6 weekly intervals
Other investigations to exclude other causes of secondary amenorrhea are done
such as serum prolactin levels, thyroid function test, serum LH and testosterone
levels, karyotyping, autoimmune screening and ultrasound scan abdomen.
After a diagnosis of premature ovarian failure, women should be carefully
counselled on the severity of the illness.

Management Issues
1. Fertility and Contraception
.Reduced fertility
.May require assisted conception
.Need for contraception if no fertility goals
2. Premature menopause
.Need for estrogen replacement

Fertility could be made possible by in vitro fertilization (ivf) with donor

oocytes and thereby she can achieve pregnancy
These patients can use an IUCD or barrier methods of contraception
Hormonal replacement therapy (HRT) is necessary to avoid the effects of
estrogen deficiency
As estrogen deficiency increases risk of osteoporosis and cardiovascular
disease as well as other menopausal symptoms ( hot flushes, night sweats,
irritability, mood changes, anxiety, loss of libido)
N.B: in a patient with intact uterus estrogen replacement can lead to
endometrial hyperplasia therefore it has to be combined with progesterone
COCP
Exercise, calcium, vitamin D and lifestyle changes are also helpful

Benefits of HRT
Effective in prevention of short term effects
Symptoms of vaginal dryness and urogenital symptoms respond well
Prevention of osteoporosis
Risks of HRT
Risk of breast cancer with continued use
Venous thromboembolism
Coronary heart disease and stroke
Contraindications
Breast and endometrial cancer
Active liver disease
DVT
thrombophilia

Thankyou