Ovarian failure

Premature ovarian failure affects approximately 1% of women in the US and 3.7% worldwide.

Primary ovarian insufficiency is a disorder in women younger than 40 years of age, and is characterized by a decline in ovarian function, loss of oocytes and folliculogenesis, and elevated gonadotropin levels.

Prevalence of primary ovary insufficiency among ethnic groups: White, 1%, Black, 1.4%, Hispanic, 1.4%, Chinese 0.5%, and Japanese 0.1%.

It leads to compromise, fertility, and marked reduction of ovarian hormone production.

Primary ovarian insufficiency arises from premature decrease in the number of ovarian follicles, acceleration of follicle destruction, or poor follicular response to gonadotropins.

Patients with premature ovarian failure present with at least six month history of amenorrhea and elevated levels of FSH.

Premature ovarian failure can result from premature depletion of the follicle pool, follicular atresia, follicular growth arrest, or ovarian dysgenesis.

Majority of cases are idiopathic.

Can be caused by infectious agents, chemotherapy, pelvic surgery, autoimmune disease, environmental factors, and genetic conditions.

Can be an isolated process or a part of the syndrome such as Turner’s syndrome and the BPES (blepharophimosis, ptosis, and epicanthus inversus syndrome.

10-15% of patients with premature ovarian failure have a genetic cause.

Genetic changes leading to primary ovarian failure include chromosomal deletions, rearrangements, autosomal and X-linked mutations.

After adjuvant chemotherapy occurs in 50-85% of women treated.

Ovary failure from chemotherapy is caused by apoptotic oocyte death in primordial follicles, decreasing ovarian reserve and int2242upting follicle recruitment and maturation.

After chemotherapy age is the most important determinate of ovarian failure.

60% of patients undergoing adjuvant chemotherapy for breast cancer will experience ovarian failure within one year of beginning treatment (Pfeilschifter J).

Ovarian dysfunction rate in premenopausal women aged greater than 50 years is at 90%, and remains higher for women age greater than 40 years compared to those less than 40 years of age when receiving adjuvant chemotherapy (Bines J).

Chemotherapy induced ovarian dysfunction with amenorrhea occurs in almost all women, at least temporarily.

Suppression of ovarian function with a gonadotropin releasing hormone analog can reduce risk of ovarian failure in patients treated with cyclophosphamide for lupus nephritis.

The reduction of systemic estrogen before natural menopause is associated with development of: osteoporosis, cardiovascular disease, and possibly accelerated neurodegenerative aging.

Treatment involves attention to psychological counseling, symptom relief, reproductive options, and preventive bone and cardiovascular health strategies.

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