Ovarian Insufficiency Follow-up

Updated: Nov 17, 2016
  • Author: Vincent A Pellegrini, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Follow-up

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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