eMedicine Specialties > Obstetrics and Gynecology > Reproductive Endocrinology and Infertility

Ovarian Insufficiency: Follow-up

Author: Lawrence M Nelson, MD, MBA, Head of Integrative Reproductive Medicine Unit, Investigator, Reproductive Biology and Medicine Branch, National Institutes of Health
Coauthor(s): Vaishali Popat, MD, MPH, Fellow in Endocrinology, National Institutes of Health
Contributor Information and Disclosures

Updated: Jan 15, 2008

Follow-up

Further Outpatient Care

  • Patients with overt primary ovarian insufficiency should be seen annually to monitor their ovarian hormone replacement and to detect the development of associated conditions such as hypothyroidism or adrenal insufficiency.
  • Annual measurement of fasting blood sugar, free thyroxine, TSH, and adrenal antibodies is in order.
  • The follow-up care for patients with secondary ovarian insufficiency depends on the mechanism of the disorder.

Complications

  • Loss of menstrual regularity, even without the development of amenorrhea, has been associated with an increased risk of wrist and hip fractures related to reduced bone density. A later menarche and menstrual-cycle intervals greater than 32 days both have been associated with increased fracture rates in later years. Young women with ovarian insufficiency that is unresponsive to therapy require hormone replacement to maintain bone density.

Prognosis

  • Patients with primary ovarian insufficiency should be informed that spontaneous remission could occur.  Women with overt primary ovarian insufficiency have a 5-10% chance of becoming pregnant with no treatment. Sometimes these spontaneous pregnancies occur many years after diagnosis.
  • The prognosis for women with secondary ovarian insufficiency depends on the etiology of the disorder (see Amenorrhea).

Patient Education

  • Carefully counsel patients who are infertile and have overt primary ovarian insufficiency. Waiting an appropriate amount of time to permit a pregnancy to occur by spontaneous remission may be in order.
  • A change in life plans or adoption may be the best solution for some couples.
  • In most cases, infertility is a primary concern of women with ovarian insufficiency. Taking the time to explain that physiologic replacement of estrogen and progesterone will not prevent chances for spontaneous pregnancy will help compliance. Also, explaining that the results of the WHI study do not apply directly to the young women helps with compliance in the long run.
  • At an appropriate time after the couple has developed the needed emotional reserve through support and appropriate counseling, ovum donation is another option for them to consider.
  • For excellent patient education resources, visit eMedicine's Women's Health Center. Also, see eMedicine's patient education articles Female Sexual Problems, and Amenorrhea.

Miscellaneous

Medicolegal Pitfalls

  • Infertility resulting from ovarian insufficiency may present the medical legal dilemma of being asked to administer unproven therapies on an empiric basis. Unproven therapies, such as prednisone or dexamethasone treatment, may have significant adverse sequelae. Complications from empiric therapy, such as osteonecrosis after treating overt primary ovarian insufficiency with prednisone, carry substantial risks of medical legal action and large recoveries.

Special Concerns

  • Often, a delay in diagnosis of ovarian insufficiency occurs because the loss of menstrual regularity may be viewed as a common occurrence that does not need evaluation. The authors believe that a women who is not experiencing regular menses for 3 months should be evaluated for the possibility of primary or secondary ovarian insufficiency.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Vladimir Bakalov, MD and Carmen Pastor, MD, to the development and writing of this article.



More on Ovarian Insufficiency

Overview: Ovarian Insufficiency
Differential Diagnoses & Workup: Ovarian Insufficiency
Treatment & Medication: Ovarian Insufficiency
Follow-up: Ovarian Insufficiency
References
Further Reading
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References

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Further Reading

For further reading, see Medscape's Ob/Gyn and Women's Health.

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Keywords

premature ovarian failure, premature menopause, autoimmune ovarian failure, autoimmune oophoritis, reduced ovarian reserve, hypergonadotropic amenorrhea, menopause, perimenopause, Turner syndrome, gonadal dysgenesis, hyperprolactinemia, hypothalamic amenorrhea, polycystic ovary syndrome, Stein-Leventhal syndrome, primary amenorrhea, secondary amenorrhea, oligomenorrhea, metrorrhagia, polymenorrhea, amenorrhea

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Contributor Information and Disclosures

Author

Lawrence M Nelson, MD, MBA, Head of Integrative Reproductive Medicine Unit, Investigator, Reproductive Biology and Medicine Branch, National Institutes of Health
Lawrence M Nelson, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Endocrine Society, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Vaishali Popat, MD, MPH, Fellow in Endocrinology, National Institutes of Health
Vaishali Popat, MD, MPH is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, American Medical Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Robert K Zurawin, MD, Associate Professor, Director of Fellowship Programs, Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine; Chief of Gynecology, Texas Children's Hospital
Robert K Zurawin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Harris County Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Texas Medical Association
Disclosure: Johnson and Johnson Honoraria Speaking and teaching; Conceptus Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital, Mammoth Lakes, California, Pioneer Valley Hospital, Salt Lake City, Utah, Warren General Hospital, Warren, Pennsylvania and Mountain West Hospital, Tooele, Utah
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

 
 
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