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Primary Ovarian Insufficiency

Primary Ovarian Insufficiency is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Primary ovarian insufficiency (POI) is used to describe a spectrum of conditions including hypergonadotropic hypogonadism, premature ovarian failure (POF), and ovarian dysgenesis in women <40 years of age.
  • POI can be transient, intermittent, or progressive and usually results in eventual premature menopause.
  • About 50% of women will have varying degrees of ovulation, 5–10% are able to achieve spontaneous pregnancy (1,2).
  • Diagnosis is made by two follicle-stimulating hormone (FSH) levels in the menopausal range at least 1 month apart in the setting of 4 to 6 months of menstrual irregularity (3).

Epidemiology

Incidence
  • The age-specific incidence is approximately 1/1,000 by age 30 years, 1/250 by age 35 years, and 1/100 by age 40 years (1).
  • Incidence is approximately 10–30% in women with primary amenorrhea and approximately 5–20% in women with secondary amenorrhea.

Prevalence
POI affects approximately 1% of the population in the United States (3).

Etiology and Pathophysiology

Three potential mechanisms (3)

  • Congenital low initial primordial follicle count (e.g., familial 46,XX gonadal dysgenesis)
  • Inability to recruit primordial follicles (e.g., congenital adrenal hyperplasia [CAH], 17α-hydroxylase deficiency)
  • Accelerated follicle depletion (galactosemia, radiation)

Genetics
Turner syndrome, fragile X/FMR1 gene premutations, microdeletions on X chromosome, FOXL2 mutation, galactosemia (GALT mutation)

Risk Factors

  • Autoimmune
    • Ovarian insufficiency
    • Other possible autoimmune diseases: hypothyroidism, adrenal insufficiency, systemic lupus erythematosus, rheumatoid arthritis, type 1 diabetes
    • Autoimmune polyglandular failure
  • Enzyme deficiencies
    • Cholesterol desmolase deficiency, 17α-hydroxylase deficiency, galactosemia, aromatase deficiency
  • Infectious
    • Mumps oophoritis, HIV, cytomegalovirus (CMV)
  • Iatrogenic
    • Chemotherapy and radiation
    • Pelvic surgery (2)

General Prevention

No effective prevention strategies have been identified; however, early diagnosis is key to prevent sequelae.

Commonly Associated Conditions

Commonly, vasomotor symptoms, atrophic vaginitis, infertility, mood disturbances, accelerated cardiovascular aging, osteoporosis, and other autoimmune disorders

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Citation

Stephens, Mark B., et al., editors. "Primary Ovarian Insufficiency." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816949/all/Primary_Ovarian_Insufficiency.
Primary Ovarian Insufficiency. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816949/all/Primary_Ovarian_Insufficiency. Accessed June 27, 2019.
Primary Ovarian Insufficiency. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816949/all/Primary_Ovarian_Insufficiency
Primary Ovarian Insufficiency [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 27]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816949/all/Primary_Ovarian_Insufficiency.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Primary Ovarian Insufficiency ID - 816949 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816949/all/Primary_Ovarian_Insufficiency PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -