eMedicine Specialties > Obstetrics and Gynecology > Reproductive Endocrinology and Infertility
Ovarian Insufficiency: Follow-up
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.
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 |
| « Previous Page |
References
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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
Follow-up: Ovarian Insufficiency