Premature ovarian failure

Specialty: Gynecology and breast.

• Early menopause
• premature ovarian failure
• cessation of ovarian function before age 40

Why it occurs

• Idiopathic (most common cause, probably occult autoimmune)
• Genetic alterations (Turner syndrome with mosaicism, carriers of the premutation of the FMR1 gene for fragile X syndrome)
• Iatrogenic ovarian damage (chemotherapy with alkylating agents or previous pelvic radiotherapy)
• Previous gynecological surgery (bilateral oophorectomy or drastic reduction of the ovarian parenchyma due to endometriomas)
• Polyglandular autoimmune diseases (Hashimoto's thyroiditis, Addison's disease)

Initial workup

Serum analytical determination of FSH greater than 25-40 IU/L confirmed in two determinations separated by at least 4 weeks, associated with estradiol levels less than 20 pg/mL. Determination of undetectable anti-Müllerian hormone (AMH). Complete karyotype and screening for the FMR1 mutation if the patient is under 30 years of age. Autoimmunity profile (antiadrenal and antithyroid antibodies). Transvaginal pelvic ultrasound to evaluate the absence of antral follicles.

Standard management

• Physiological replacement Hormone Replacement Therapy (HRT) continued until at least the average age of natural menopause (50-51 years): Estradiol valerate 2 mg orally daily (or transdermal estradiol 50-100 mcg in a weekly patch of choice to avoid hepatic passage) associated with micronized progesterone 100-200 mg orally during 12-14 days a month if you have a uterus to avoid endometrial hyperplasia
• Daily supplementation with Calcium Carbonate 1000 mg and Vitamin D3 800-1000 IU (note: HRT in these patients seeks to mitigate the premature risk of osteoporosis and cardiovascular disease).