Human ovary is the organ that is involved in the process of reproduction as well as the function of the endocrine system and these two activities are interrelated.
For women, regularity in menstrual periods during the reproductive age is suggestive of optimal functioning of the ovaries. Every month, a sequence of hormonal changes and modifications in the structure of the ovary initiate and discharge a mature egg for fertilization. Any interruptions in this process can result in anovulation and the absence of ovarian steroid hormones.
During the reproductive years, there is a progressive depletion of the ovarian follicles, which results in irregular menstrual cycles, hormonal imbalances, anovulation, decreased fertility, and eventually menopause, at the average age of 51 years.
Epidemiology
Premature ovarian insufficiency (POI) or failure (POF) affects around 1% of women in the U. S., with rising incidence as women age: one in 1000 before the age of thirty and one in 250 before the age of thirty-five and one in 100 before the age of forty. It is observed in 10 to 28% of women with primary amenorrhea and 4 to 18% with secondary amenorrhea.
The incidence rate is comparable among the different ethnic groups; however, the condition may be more apparent in Hispanic and African American women and less apparent among Chinese and Japanese women. Osteoporosis related to estrogen deficiency is also common with African American and Asian women with POI, attributed to low vitamin D level, calcium intake, and compliance to hormone treatment.
POI/POF is a condition that affects women below the age of 40 years.
Anatomy
Pathophysiology
Oocytes are formed during fetal development and the total number that can be counted is at its highest, about 6-7 million during twentieth week of gestation. These oocytes are enclosed in tiny structures called primordial follicles that lie just beneath the ovarian surface and are still in the prophase of meiosis I. A human female is born with 1 to 2 million but at puberty only 300,000-400,000. This is because oocytes are continuously depleted thereby giving a lifespan of 400-500 oocytes that are ovulated in a woman’s reproductive age.
Luteinizing hormone (LH) sets in ovulation after triggering the maturation process of the largest Graafian follicle, which also resumes meiosis I phase. The oocyte completes its meiotic division upto metaphase II and remains in this phase until fertilization occurs. The exact details of the pathophysiology of POI are however not well understood because the condition exhibits a lot of variability.
Etiology
Ovarian insufficiency can arise from either ovarian or central (hypothalamus and pituitary) causes. When due to an ovarian disorder, it is termed primary ovarian insufficiency (POI). When it results from inadequate stimulation from the hypothalamus or pituitary, it is called secondary ovarian insufficiency or central ovarian insufficiency.
Causes of Primary Ovarian Insufficiency:
Iatrogenic (due to medical intervention)
Abnormal karyotype
Isolated autoimmune ovarian failure
FMR1 gene premutation
Autoimmune conditions like autoimmune polyglandular syndrome or IgA deficiency
Pituitary tumors, such as prolactinomas or hormone-secreting tumors (Cushing’s, acromegaly)
Pituitary necrosis (Sheehan syndrome)
Hypothalamic tumors or conditions like craniopharyngioma, Kallmann syndrome, or sarcoidosis
Genetics
Prognostic Factors
POI/POF is a rare endocrine disorder affecting young women who have a 5-10% prospect of spontaneous conception despite diagnosis. Hormone therapy and oral contraceptives do not completely suppress ovulation; the patients require adequate advice on fertility choices. However, spontaneous pregnancy can still occur and therefore ovum donation is a very effective solution, but the decision should not be made in haste.
Some of the chronic conditions are; increased morbidity and mortality, prevalence of stroke, development of osteoporosis due to low bone density and cardiovascular disease due to low estrogen level. POI/POF can also be associated with other disorders including hypothyroidism and autoimmune diseases. The diagnosis can exert a psychological pressure on the patients especially causing depression.
Clinical History
Age Group
POI usually affects women below the age of forty years, with the spontaneous type being prevalent among teenagers and young adults.
Secondary Ovarian Insufficiency can develop in women of any age, depending on the specific conditions, pituitary or hypothalamic.
Physical Examination
There may be little signs of ovarian insufficiency, and the primary symptoms are frequently seen only in the initial stages of the disease. Nevertheless, primary and severely secondary ovarian insufficiency patients may present signs of estrogen deficiency through their physical assessment including atrophic vaginitis. Since ovarian insufficiency may deteriorate with irregular estrogen release, the symptoms are not always manifested.
A bimanual exam may reveal the presence of ovarian enlargement which could be attributed to disorders such as Lymphocytic oophoritis or Steriodogenic enzyme deficiencies. Turner syndrome has specific phenotypical characteristics, but cases with smaller deletions on the X chromosome might not manifest the same. Autoimmune disorders linked to POI may present with characteristic signs: premature graying might point towards autoimmune hypothyroidism while vitiligo or increased pigmentation might be suggestive of Addison’s disease which is marked by loss of body hair. Thyroid enlargement could be due to autoimmune thyroid diseases including Hashimoto’s or Graves’ disease.
Age group
Associated comorbidity
Autoimmune Disorders: POI frequently occurs along with autoimmune disorders such as hypothyroidism, Addison’s disease, and type 1 diabetes mellitus.
Genetic Conditions: POI has been linked with genetic disorders like Turner syndrome, fragile X premutation, and some enzymopathies (e.g. galactosemia).
Chronic Diseases or Treatments: The causes of secondary ovarian insufficiency include continued medical therapies such as chemotherapy, uncontrolled systemic disorders, or activity, for example, rigorous exercise.
Psychiatric Disorders: It is caused by hypothalamic dysfunction which could result from stress, eating disorders, or psychiatric conditions; possible causes of secondary ovarian insufficiency include.
Associated activity
Acuity of presentation
Gradual Onset: The onset is gradual and may present with symptoms such as irregular menstrual periods (oligomenorrhea or amenorrhea), hot flushes, dryness of the vagina and mood swings.
Acute Presentation: While ovarian insufficiency can occur with sub-acute onset, this is more common if the onset has been precipitated by factors such as surgical removal of ovaries, or exposure to gonadotoxic, medications or irradiation.
Associated Symptoms: Somatological manifestations involve reproductive symptoms as well hormonal changes such as osteopenia, hot flash, and cardiac complications. Sometimes there are psychological factors that might develop such as depression or anxiety.
Balanced Diet: Take calcium and vitamin D supplemented foods such as dairy and green leafy vegetables to enhance bone strength and decrease osteoporosis chances.
Anti-inflammatory Foods: Make use of fruits, vegetables, nuts and fatty fish as these foods are known to enhance the anti-inflammatory response among other benefits.
Adequate Protein Intake: Avoid foods that are high in fats because they cause addition weight gain due to their high calorie content but rather take lean meats to build muscles and for good health.
Exercise: Perform weight-bearing activities (e.g. walking, jogging, strength training, etc) for bone and cardiovascular health and to alleviate stress. Introduce aerobics such as Yoga or Pilates that can be useful in improving flexibility and balance, thus decreasing the possibility of fractures.
stress-management
Mindfulness and Relaxation Techniques: Introduce mindfulness meditation, diaphragmatic breathing, and progressive muscle relaxation techniques to cope with stress and enhance mental health.
Counselling and Support Groups: Talk to a crisis counsellor or seek support from other patients with similar conditions for emotional support and company.
Lifestyle Modifications: Overweight and obesity are associated with additional stress on the body and hormonal changes. Minimize contact with pollutants, as well as abstain from smoking or overindulging in alcohol to help keep the reproductive organs and person healthy.
Role of Estrogens
Estradiol Transdermal System (Alora): Stimulates the synthesis of DNA, RNA, and numerous proteins in the target tissues.
Conjugated Equine Estrogens (Premarin): An estrogen drug combination extracted from pregnant mares’ urine containing estrone, equilin, and equilenin. It contains sodium estrone sulfate and sodium equilin sulfate in addition to sodium sulfate conjugates of 17-alpha-dihydroequilin 17-alpha-estradiol, and 17-beta-dihydroequilin. It is available in the oral tablet forms of 0. 3 mg, 0. 625 mg, 0. 9 mg, 1. 25 mg, and 2. 5 mg.
Role of Progestins
Medroxyprogesterone Acetate (Provera): It belongs to synthetic progesterone derivative with pronouced niadogenic and anabolic properties yet possessing only low estrogenicity. Orally, it blocks the secretion of gonadotropins, thus arresting the growth of follicles and ovulation in cases where it is parenterally administered. However, this effect is not normally seen in the daily oral dose that is usually administered in humans.
Progesterone (Prometrium): Used for the prevention of the occurrence of endometrial hyperplasia in women with a uterus taking estrogen.
Role of Androgens
Methyltestosterone (Android): A synthetic androgen taken from the testosterone with prominent androgen characteristics. It comes in the doses of 5mg, 10mg and 25 of the tablet.
Testosterone Enanthate or Cypionate: Exogenous substances that are modelled on the primary endogenous hormone androgen, testosterone, which are given intramuscular injections. The esterification of the 17-beta-hydroxy group increases the drugs active time and is metabolized in the body into free testosterone. The preparation of the sterile solution contains 200 mg of testosterone enanthate per milliliter of the solution while sesame oil is used to dissolve the compound, and 5 mg of chlorobutanol (chlorebutyl) a chloral derivative is used as a preservative.
Ovarian Tissue Cryopreservation: This includes the cutting or removal of ovarian tissues with frosts and with the intention of using it later. This procedure is often used for women with ovarian insufficiency who desire cryopreservation for future use. Later, the frozen tissue can be reimplanted or used for in vitro fertilization (IVF) if needed.
Egg (Oocyte) Cryopreservation: This process is done by removing and freezing eggs that are in the ovaries for use in the future. Women with ovarian insufficiency may opt for their eggs to be retrieved and frozen with hormonal stimulation may be used, success rates will depend on the level of ovarian function.
Ovum Donation: This is a form of infertility treatment whereby one or both partners cannot produce healthy eggs and thus eggs from a different donor are used. It proves beneficial for women with severe ovarian insufficiency or women who cannot produce healthy eggs through ovum donation.
Hormone Replacement Therapy (HRT): Prescribing estrogen and/or progesterone, which will help to maintain certain female biological rhythms and reduce the signs of estrogen depletion. This treatment also has no impact on the endocrine functionality of the ovaries but is effective in alleviating the symptomology related to hormonal dysregulation.
In Vitro Fertilization (IVF) with Donor Eggs: IVF in which the egg is from a donor while the sperm is either from the partner or a donor. This procedure can therefore assist in making pregnancies in women with ovarian insufficiency especially those who cannot conceive using their own eggs.
Treatment of ovarian insufficiency depends with the stage of the disease process and this requires a step wise approach. The first aims at identification, diagnosis through hormone levels, and imaging to discover the degree of ovarian dysfunction. The second phase focuses on symptom control and more specifically, wanting to have children. This may require estrogen replacement in form of Hormone Replacement Therapy (HRT) for symptoms of estrogen deficiency or fertility preservation measures such as Ovum donation or egg Cryopreservation. The final stage is the maintenance phase in which patients require follow up care and treatment of other related diseases including osteoporosis or cardiovascular disease.
Human ovary is the organ that is involved in the process of reproduction as well as the function of the endocrine system and these two activities are interrelated.
For women, regularity in menstrual periods during the reproductive age is suggestive of optimal functioning of the ovaries. Every month, a sequence of hormonal changes and modifications in the structure of the ovary initiate and discharge a mature egg for fertilization. Any interruptions in this process can result in anovulation and the absence of ovarian steroid hormones.
During the reproductive years, there is a progressive depletion of the ovarian follicles, which results in irregular menstrual cycles, hormonal imbalances, anovulation, decreased fertility, and eventually menopause, at the average age of 51 years.
Premature ovarian insufficiency (POI) or failure (POF) affects around 1% of women in the U. S., with rising incidence as women age: one in 1000 before the age of thirty and one in 250 before the age of thirty-five and one in 100 before the age of forty. It is observed in 10 to 28% of women with primary amenorrhea and 4 to 18% with secondary amenorrhea.
The incidence rate is comparable among the different ethnic groups; however, the condition may be more apparent in Hispanic and African American women and less apparent among Chinese and Japanese women. Osteoporosis related to estrogen deficiency is also common with African American and Asian women with POI, attributed to low vitamin D level, calcium intake, and compliance to hormone treatment.
POI/POF is a condition that affects women below the age of 40 years.
Oocytes are formed during fetal development and the total number that can be counted is at its highest, about 6-7 million during twentieth week of gestation. These oocytes are enclosed in tiny structures called primordial follicles that lie just beneath the ovarian surface and are still in the prophase of meiosis I. A human female is born with 1 to 2 million but at puberty only 300,000-400,000. This is because oocytes are continuously depleted thereby giving a lifespan of 400-500 oocytes that are ovulated in a woman’s reproductive age.
Luteinizing hormone (LH) sets in ovulation after triggering the maturation process of the largest Graafian follicle, which also resumes meiosis I phase. The oocyte completes its meiotic division upto metaphase II and remains in this phase until fertilization occurs. The exact details of the pathophysiology of POI are however not well understood because the condition exhibits a lot of variability.
Ovarian insufficiency can arise from either ovarian or central (hypothalamus and pituitary) causes. When due to an ovarian disorder, it is termed primary ovarian insufficiency (POI). When it results from inadequate stimulation from the hypothalamus or pituitary, it is called secondary ovarian insufficiency or central ovarian insufficiency.
Causes of Primary Ovarian Insufficiency:
Iatrogenic (due to medical intervention)
Abnormal karyotype
Isolated autoimmune ovarian failure
FMR1 gene premutation
Autoimmune conditions like autoimmune polyglandular syndrome or IgA deficiency
Pituitary tumors, such as prolactinomas or hormone-secreting tumors (Cushing’s, acromegaly)
Pituitary necrosis (Sheehan syndrome)
Hypothalamic tumors or conditions like craniopharyngioma, Kallmann syndrome, or sarcoidosis
POI/POF is a rare endocrine disorder affecting young women who have a 5-10% prospect of spontaneous conception despite diagnosis. Hormone therapy and oral contraceptives do not completely suppress ovulation; the patients require adequate advice on fertility choices. However, spontaneous pregnancy can still occur and therefore ovum donation is a very effective solution, but the decision should not be made in haste.
Some of the chronic conditions are; increased morbidity and mortality, prevalence of stroke, development of osteoporosis due to low bone density and cardiovascular disease due to low estrogen level. POI/POF can also be associated with other disorders including hypothyroidism and autoimmune diseases. The diagnosis can exert a psychological pressure on the patients especially causing depression.
Age Group
POI usually affects women below the age of forty years, with the spontaneous type being prevalent among teenagers and young adults.
Secondary Ovarian Insufficiency can develop in women of any age, depending on the specific conditions, pituitary or hypothalamic.
There may be little signs of ovarian insufficiency, and the primary symptoms are frequently seen only in the initial stages of the disease. Nevertheless, primary and severely secondary ovarian insufficiency patients may present signs of estrogen deficiency through their physical assessment including atrophic vaginitis. Since ovarian insufficiency may deteriorate with irregular estrogen release, the symptoms are not always manifested.
A bimanual exam may reveal the presence of ovarian enlargement which could be attributed to disorders such as Lymphocytic oophoritis or Steriodogenic enzyme deficiencies. Turner syndrome has specific phenotypical characteristics, but cases with smaller deletions on the X chromosome might not manifest the same. Autoimmune disorders linked to POI may present with characteristic signs: premature graying might point towards autoimmune hypothyroidism while vitiligo or increased pigmentation might be suggestive of Addison’s disease which is marked by loss of body hair. Thyroid enlargement could be due to autoimmune thyroid diseases including Hashimoto’s or Graves’ disease.
Autoimmune Disorders: POI frequently occurs along with autoimmune disorders such as hypothyroidism, Addison’s disease, and type 1 diabetes mellitus.
Genetic Conditions: POI has been linked with genetic disorders like Turner syndrome, fragile X premutation, and some enzymopathies (e.g. galactosemia).
Chronic Diseases or Treatments: The causes of secondary ovarian insufficiency include continued medical therapies such as chemotherapy, uncontrolled systemic disorders, or activity, for example, rigorous exercise.
Psychiatric Disorders: It is caused by hypothalamic dysfunction which could result from stress, eating disorders, or psychiatric conditions; possible causes of secondary ovarian insufficiency include.
Gradual Onset: The onset is gradual and may present with symptoms such as irregular menstrual periods (oligomenorrhea or amenorrhea), hot flushes, dryness of the vagina and mood swings.
Acute Presentation: While ovarian insufficiency can occur with sub-acute onset, this is more common if the onset has been precipitated by factors such as surgical removal of ovaries, or exposure to gonadotoxic, medications or irradiation.
Associated Symptoms: Somatological manifestations involve reproductive symptoms as well hormonal changes such as osteopenia, hot flash, and cardiac complications. Sometimes there are psychological factors that might develop such as depression or anxiety.
Premature menopause
Hypothalamic dysfunction
Turner syndrome
Galactosemia
Pituitary insufficiency
Polycystic ovarian syndrome
Endocrinology, Metabolism
Diet and Nutrition:
Balanced Diet: Take calcium and vitamin D supplemented foods such as dairy and green leafy vegetables to enhance bone strength and decrease osteoporosis chances.
Anti-inflammatory Foods: Make use of fruits, vegetables, nuts and fatty fish as these foods are known to enhance the anti-inflammatory response among other benefits.
Adequate Protein Intake: Avoid foods that are high in fats because they cause addition weight gain due to their high calorie content but rather take lean meats to build muscles and for good health.
Exercise: Perform weight-bearing activities (e.g. walking, jogging, strength training, etc) for bone and cardiovascular health and to alleviate stress. Introduce aerobics such as Yoga or Pilates that can be useful in improving flexibility and balance, thus decreasing the possibility of fractures.
Endocrinology, Metabolism
Mindfulness and Relaxation Techniques: Introduce mindfulness meditation, diaphragmatic breathing, and progressive muscle relaxation techniques to cope with stress and enhance mental health.
Counselling and Support Groups: Talk to a crisis counsellor or seek support from other patients with similar conditions for emotional support and company.
Lifestyle Modifications: Overweight and obesity are associated with additional stress on the body and hormonal changes. Minimize contact with pollutants, as well as abstain from smoking or overindulging in alcohol to help keep the reproductive organs and person healthy.
Endocrinology, Metabolism
Estradiol Transdermal System (Alora): Stimulates the synthesis of DNA, RNA, and numerous proteins in the target tissues.
Conjugated Equine Estrogens (Premarin): An estrogen drug combination extracted from pregnant mares’ urine containing estrone, equilin, and equilenin. It contains sodium estrone sulfate and sodium equilin sulfate in addition to sodium sulfate conjugates of 17-alpha-dihydroequilin 17-alpha-estradiol, and 17-beta-dihydroequilin. It is available in the oral tablet forms of 0. 3 mg, 0. 625 mg, 0. 9 mg, 1. 25 mg, and 2. 5 mg.
Endocrinology, Metabolism
Medroxyprogesterone Acetate (Provera): It belongs to synthetic progesterone derivative with pronouced niadogenic and anabolic properties yet possessing only low estrogenicity. Orally, it blocks the secretion of gonadotropins, thus arresting the growth of follicles and ovulation in cases where it is parenterally administered. However, this effect is not normally seen in the daily oral dose that is usually administered in humans.
Progesterone (Prometrium): Used for the prevention of the occurrence of endometrial hyperplasia in women with a uterus taking estrogen.
Endocrinology, Metabolism
Methyltestosterone (Android): A synthetic androgen taken from the testosterone with prominent androgen characteristics. It comes in the doses of 5mg, 10mg and 25 of the tablet.
Testosterone Enanthate or Cypionate: Exogenous substances that are modelled on the primary endogenous hormone androgen, testosterone, which are given intramuscular injections. The esterification of the 17-beta-hydroxy group increases the drugs active time and is metabolized in the body into free testosterone. The preparation of the sterile solution contains 200 mg of testosterone enanthate per milliliter of the solution while sesame oil is used to dissolve the compound, and 5 mg of chlorobutanol (chlorebutyl) a chloral derivative is used as a preservative.
Endocrinology, Metabolism
Ovarian Tissue Cryopreservation: This includes the cutting or removal of ovarian tissues with frosts and with the intention of using it later. This procedure is often used for women with ovarian insufficiency who desire cryopreservation for future use. Later, the frozen tissue can be reimplanted or used for in vitro fertilization (IVF) if needed.
Egg (Oocyte) Cryopreservation: This process is done by removing and freezing eggs that are in the ovaries for use in the future. Women with ovarian insufficiency may opt for their eggs to be retrieved and frozen with hormonal stimulation may be used, success rates will depend on the level of ovarian function.
Ovum Donation: This is a form of infertility treatment whereby one or both partners cannot produce healthy eggs and thus eggs from a different donor are used. It proves beneficial for women with severe ovarian insufficiency or women who cannot produce healthy eggs through ovum donation.
Hormone Replacement Therapy (HRT): Prescribing estrogen and/or progesterone, which will help to maintain certain female biological rhythms and reduce the signs of estrogen depletion. This treatment also has no impact on the endocrine functionality of the ovaries but is effective in alleviating the symptomology related to hormonal dysregulation.
In Vitro Fertilization (IVF) with Donor Eggs: IVF in which the egg is from a donor while the sperm is either from the partner or a donor. This procedure can therefore assist in making pregnancies in women with ovarian insufficiency especially those who cannot conceive using their own eggs.
Endocrinology, Metabolism
Treatment of ovarian insufficiency depends with the stage of the disease process and this requires a step wise approach. The first aims at identification, diagnosis through hormone levels, and imaging to discover the degree of ovarian dysfunction. The second phase focuses on symptom control and more specifically, wanting to have children. This may require estrogen replacement in form of Hormone Replacement Therapy (HRT) for symptoms of estrogen deficiency or fertility preservation measures such as Ovum donation or egg Cryopreservation. The final stage is the maintenance phase in which patients require follow up care and treatment of other related diseases including osteoporosis or cardiovascular disease.
Human ovary is the organ that is involved in the process of reproduction as well as the function of the endocrine system and these two activities are interrelated.
For women, regularity in menstrual periods during the reproductive age is suggestive of optimal functioning of the ovaries. Every month, a sequence of hormonal changes and modifications in the structure of the ovary initiate and discharge a mature egg for fertilization. Any interruptions in this process can result in anovulation and the absence of ovarian steroid hormones.
During the reproductive years, there is a progressive depletion of the ovarian follicles, which results in irregular menstrual cycles, hormonal imbalances, anovulation, decreased fertility, and eventually menopause, at the average age of 51 years.
Premature ovarian insufficiency (POI) or failure (POF) affects around 1% of women in the U. S., with rising incidence as women age: one in 1000 before the age of thirty and one in 250 before the age of thirty-five and one in 100 before the age of forty. It is observed in 10 to 28% of women with primary amenorrhea and 4 to 18% with secondary amenorrhea.
The incidence rate is comparable among the different ethnic groups; however, the condition may be more apparent in Hispanic and African American women and less apparent among Chinese and Japanese women. Osteoporosis related to estrogen deficiency is also common with African American and Asian women with POI, attributed to low vitamin D level, calcium intake, and compliance to hormone treatment.
POI/POF is a condition that affects women below the age of 40 years.
Oocytes are formed during fetal development and the total number that can be counted is at its highest, about 6-7 million during twentieth week of gestation. These oocytes are enclosed in tiny structures called primordial follicles that lie just beneath the ovarian surface and are still in the prophase of meiosis I. A human female is born with 1 to 2 million but at puberty only 300,000-400,000. This is because oocytes are continuously depleted thereby giving a lifespan of 400-500 oocytes that are ovulated in a woman’s reproductive age.
Luteinizing hormone (LH) sets in ovulation after triggering the maturation process of the largest Graafian follicle, which also resumes meiosis I phase. The oocyte completes its meiotic division upto metaphase II and remains in this phase until fertilization occurs. The exact details of the pathophysiology of POI are however not well understood because the condition exhibits a lot of variability.
Ovarian insufficiency can arise from either ovarian or central (hypothalamus and pituitary) causes. When due to an ovarian disorder, it is termed primary ovarian insufficiency (POI). When it results from inadequate stimulation from the hypothalamus or pituitary, it is called secondary ovarian insufficiency or central ovarian insufficiency.
Causes of Primary Ovarian Insufficiency:
Iatrogenic (due to medical intervention)
Abnormal karyotype
Isolated autoimmune ovarian failure
FMR1 gene premutation
Autoimmune conditions like autoimmune polyglandular syndrome or IgA deficiency
Pituitary tumors, such as prolactinomas or hormone-secreting tumors (Cushing’s, acromegaly)
Pituitary necrosis (Sheehan syndrome)
Hypothalamic tumors or conditions like craniopharyngioma, Kallmann syndrome, or sarcoidosis
POI/POF is a rare endocrine disorder affecting young women who have a 5-10% prospect of spontaneous conception despite diagnosis. Hormone therapy and oral contraceptives do not completely suppress ovulation; the patients require adequate advice on fertility choices. However, spontaneous pregnancy can still occur and therefore ovum donation is a very effective solution, but the decision should not be made in haste.
Some of the chronic conditions are; increased morbidity and mortality, prevalence of stroke, development of osteoporosis due to low bone density and cardiovascular disease due to low estrogen level. POI/POF can also be associated with other disorders including hypothyroidism and autoimmune diseases. The diagnosis can exert a psychological pressure on the patients especially causing depression.
Age Group
POI usually affects women below the age of forty years, with the spontaneous type being prevalent among teenagers and young adults.
Secondary Ovarian Insufficiency can develop in women of any age, depending on the specific conditions, pituitary or hypothalamic.
There may be little signs of ovarian insufficiency, and the primary symptoms are frequently seen only in the initial stages of the disease. Nevertheless, primary and severely secondary ovarian insufficiency patients may present signs of estrogen deficiency through their physical assessment including atrophic vaginitis. Since ovarian insufficiency may deteriorate with irregular estrogen release, the symptoms are not always manifested.
A bimanual exam may reveal the presence of ovarian enlargement which could be attributed to disorders such as Lymphocytic oophoritis or Steriodogenic enzyme deficiencies. Turner syndrome has specific phenotypical characteristics, but cases with smaller deletions on the X chromosome might not manifest the same. Autoimmune disorders linked to POI may present with characteristic signs: premature graying might point towards autoimmune hypothyroidism while vitiligo or increased pigmentation might be suggestive of Addison’s disease which is marked by loss of body hair. Thyroid enlargement could be due to autoimmune thyroid diseases including Hashimoto’s or Graves’ disease.
Autoimmune Disorders: POI frequently occurs along with autoimmune disorders such as hypothyroidism, Addison’s disease, and type 1 diabetes mellitus.
Genetic Conditions: POI has been linked with genetic disorders like Turner syndrome, fragile X premutation, and some enzymopathies (e.g. galactosemia).
Chronic Diseases or Treatments: The causes of secondary ovarian insufficiency include continued medical therapies such as chemotherapy, uncontrolled systemic disorders, or activity, for example, rigorous exercise.
Psychiatric Disorders: It is caused by hypothalamic dysfunction which could result from stress, eating disorders, or psychiatric conditions; possible causes of secondary ovarian insufficiency include.
Gradual Onset: The onset is gradual and may present with symptoms such as irregular menstrual periods (oligomenorrhea or amenorrhea), hot flushes, dryness of the vagina and mood swings.
Acute Presentation: While ovarian insufficiency can occur with sub-acute onset, this is more common if the onset has been precipitated by factors such as surgical removal of ovaries, or exposure to gonadotoxic, medications or irradiation.
Associated Symptoms: Somatological manifestations involve reproductive symptoms as well hormonal changes such as osteopenia, hot flash, and cardiac complications. Sometimes there are psychological factors that might develop such as depression or anxiety.
Premature menopause
Hypothalamic dysfunction
Turner syndrome
Galactosemia
Pituitary insufficiency
Polycystic ovarian syndrome
Endocrinology, Metabolism
Diet and Nutrition:
Balanced Diet: Take calcium and vitamin D supplemented foods such as dairy and green leafy vegetables to enhance bone strength and decrease osteoporosis chances.
Anti-inflammatory Foods: Make use of fruits, vegetables, nuts and fatty fish as these foods are known to enhance the anti-inflammatory response among other benefits.
Adequate Protein Intake: Avoid foods that are high in fats because they cause addition weight gain due to their high calorie content but rather take lean meats to build muscles and for good health.
Exercise: Perform weight-bearing activities (e.g. walking, jogging, strength training, etc) for bone and cardiovascular health and to alleviate stress. Introduce aerobics such as Yoga or Pilates that can be useful in improving flexibility and balance, thus decreasing the possibility of fractures.
Endocrinology, Metabolism
Mindfulness and Relaxation Techniques: Introduce mindfulness meditation, diaphragmatic breathing, and progressive muscle relaxation techniques to cope with stress and enhance mental health.
Counselling and Support Groups: Talk to a crisis counsellor or seek support from other patients with similar conditions for emotional support and company.
Lifestyle Modifications: Overweight and obesity are associated with additional stress on the body and hormonal changes. Minimize contact with pollutants, as well as abstain from smoking or overindulging in alcohol to help keep the reproductive organs and person healthy.
Endocrinology, Metabolism
Estradiol Transdermal System (Alora): Stimulates the synthesis of DNA, RNA, and numerous proteins in the target tissues.
Conjugated Equine Estrogens (Premarin): An estrogen drug combination extracted from pregnant mares’ urine containing estrone, equilin, and equilenin. It contains sodium estrone sulfate and sodium equilin sulfate in addition to sodium sulfate conjugates of 17-alpha-dihydroequilin 17-alpha-estradiol, and 17-beta-dihydroequilin. It is available in the oral tablet forms of 0. 3 mg, 0. 625 mg, 0. 9 mg, 1. 25 mg, and 2. 5 mg.
Endocrinology, Metabolism
Medroxyprogesterone Acetate (Provera): It belongs to synthetic progesterone derivative with pronouced niadogenic and anabolic properties yet possessing only low estrogenicity. Orally, it blocks the secretion of gonadotropins, thus arresting the growth of follicles and ovulation in cases where it is parenterally administered. However, this effect is not normally seen in the daily oral dose that is usually administered in humans.
Progesterone (Prometrium): Used for the prevention of the occurrence of endometrial hyperplasia in women with a uterus taking estrogen.
Endocrinology, Metabolism
Methyltestosterone (Android): A synthetic androgen taken from the testosterone with prominent androgen characteristics. It comes in the doses of 5mg, 10mg and 25 of the tablet.
Testosterone Enanthate or Cypionate: Exogenous substances that are modelled on the primary endogenous hormone androgen, testosterone, which are given intramuscular injections. The esterification of the 17-beta-hydroxy group increases the drugs active time and is metabolized in the body into free testosterone. The preparation of the sterile solution contains 200 mg of testosterone enanthate per milliliter of the solution while sesame oil is used to dissolve the compound, and 5 mg of chlorobutanol (chlorebutyl) a chloral derivative is used as a preservative.
Endocrinology, Metabolism
Ovarian Tissue Cryopreservation: This includes the cutting or removal of ovarian tissues with frosts and with the intention of using it later. This procedure is often used for women with ovarian insufficiency who desire cryopreservation for future use. Later, the frozen tissue can be reimplanted or used for in vitro fertilization (IVF) if needed.
Egg (Oocyte) Cryopreservation: This process is done by removing and freezing eggs that are in the ovaries for use in the future. Women with ovarian insufficiency may opt for their eggs to be retrieved and frozen with hormonal stimulation may be used, success rates will depend on the level of ovarian function.
Ovum Donation: This is a form of infertility treatment whereby one or both partners cannot produce healthy eggs and thus eggs from a different donor are used. It proves beneficial for women with severe ovarian insufficiency or women who cannot produce healthy eggs through ovum donation.
Hormone Replacement Therapy (HRT): Prescribing estrogen and/or progesterone, which will help to maintain certain female biological rhythms and reduce the signs of estrogen depletion. This treatment also has no impact on the endocrine functionality of the ovaries but is effective in alleviating the symptomology related to hormonal dysregulation.
In Vitro Fertilization (IVF) with Donor Eggs: IVF in which the egg is from a donor while the sperm is either from the partner or a donor. This procedure can therefore assist in making pregnancies in women with ovarian insufficiency especially those who cannot conceive using their own eggs.
Endocrinology, Metabolism
Treatment of ovarian insufficiency depends with the stage of the disease process and this requires a step wise approach. The first aims at identification, diagnosis through hormone levels, and imaging to discover the degree of ovarian dysfunction. The second phase focuses on symptom control and more specifically, wanting to have children. This may require estrogen replacement in form of Hormone Replacement Therapy (HRT) for symptoms of estrogen deficiency or fertility preservation measures such as Ovum donation or egg Cryopreservation. The final stage is the maintenance phase in which patients require follow up care and treatment of other related diseases including osteoporosis or cardiovascular disease.
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*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
