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Ovarian Insufficiency Follow-up

  • Author: Vaishali Popat, MD, MPH; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
 
Updated: Jun 17, 2013
 

Further Outpatient Care

See Treatment.

Patients with ovarian failure should be seen annually to monitor their HT.

Symptoms and signs of thyroid disease and adrenal insufficiency should be sought during the annual follow-up visits.

TSH levels should be checked every 3-5 years (every year if antiperoxidase antibody test is positive).

If a woman with POI/POF has positive adrenal antibodies on her initial evaluation, even if all adrenal function tests are normal, she is at high risk of developing adrenal insufficiency and should have an annual ACTH stimulation test. Whether women with initially negative adrenal antibody tests continue to carry higher than normal risk for adrenal insufficiency and whether any follow-up tests are justified is less clear. Until enough evidence is acquired, the authors suggest that an adrenal antibody test should be performed every 3-5 years.

Patients with secondary ovarian failure should be monitored for manifestations of the underlying hypothalamic/pituitary pathology (progression of space-occupying lesions and development/progression of hypopituitarism).

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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 HT to maintain bone density.

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Prognosis

Women with spontaneous POI/POF have a low but real chance of spontaneous pregnancy. Approximately 5-10% become pregnant subsequent to the diagnosis of POI/POF. HT does not prevent such pregnancies. Paradoxically, even oral contraceptives, which are designed for pregnancy protection of women without ovarian abnormalities, may not suppress the rare spontaneous ovulations of women with POI/POF. Therefore, patients with POI/POF should be well instructed about their reproductive situation so that they can make informed decisions regarding fertility.

Ovum donation remains the best current option to resolve the infertility, but patients with POI/POF should not be encouraged hastily because spontaneous pregnancy is a real possibility and ovum donation is as successful in older women as it is in younger women.

The prognosis for women with secondary ovarian insufficiency depends on the etiology of the disorder (see Amenorrhea).

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Patient Education

Women with POI/POF should be educated on the nature of their disease and the current research efforts. The mere understanding of the problem helps patients cope better.

NICHD Primary Ovarian Insufficiency (POI) Website

For patient education resources, see the Women's Health Center. Also, see the patient education articles Female Sexual Problems and Amenorrhea.

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Contributor Information and Disclosures
Author

Vaishali Popat, MD, MPH Clinical Investigator, Intramural Research Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health

Vaishali Popat, MD, MPH is a member of the following medical societies: American College of Physicians, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Lawrence M Nelson, MD, MBA Head of Integrative Reproductive Medicine Group, Intramural Research Program on Reproductive and Adult Endocrinology, National Institutes of Child Health and Human Development, 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, Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Karim Anton Calis, PharmD, MPH FASHP, FCCP, Clinical Professor, Medical College of Virginia, Virginia Commonwealth University; Clinical Professor, University of Maryland; Clinical Investigator, Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health

Karim Anton Calis, PharmD, MPH is a member of the following medical societies: American College of Clinical Pharmacy, American Society of Health-System Pharmacists, Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

A David Barnes, MD, MPH, PhD, FACOG Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, CA), Pioneer Valley Hospital (Salt Lake City, UT), Warren General Hospital (Warren, PA), and Mountain West Hospital (Tooele, UT)

A David Barnes, MD, MPH, PhD, FACOG is a member of the following medical societies: American College of Forensic Examiners Institute, American College of Obstetricians and Gynecologists, Association of Military Surgeons of the US, American Medical Association, Utah Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert K Zurawin, MD Associate Professor, Chief, Section of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine

Robert K Zurawin, MD 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, Central Association of Obstetricians and Gynecologists, Society of Laparoendoscopic Surgeons, Texas Medical Association, AAGL, Harris County Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received consulting fee from Ethicon for consulting; Received consulting fee from Bayer for consulting; Received consulting fee from Hologic for consulting.

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Table. Clinical Situations of Primary Ovarian Insufficiency and Premature Ovarian Failure
Ovarian Clinical Situation Menses Gonadotropins Fertility
Occult insufficiency Normal Normal Reduced
Biochemical insufficiency Abnormal Elevated Reduced
Overt insufficiency Abnormal Elevated Reduced
Premature ovarian failure Absent Elevated Zero
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