A diagnosis of premature ovarian failure (POF) is made when a woman stops getting periods (amenorrhea) before age 40 along with follicle stimulating hormone (FSH) levels in the menopausal range (generally > 40 mIU/mL). The FSH level should be repeated on at least two occasions a few weeks apart.
The causes of POF were discussed in a previous blog. In this blog, we will discuss diagnostic tests that are done to determine the cause of POF.
Diagnostic tests
These include:
- A Blood Test For Chromosomal Abnormalities And Fragile-X Testing.
- Thyroid Function Tests Are Useful (TSH Level) As Thyroid Involvement Is A Common Association.
- Autoantibody Screen Including Thyroid And Adrenal Antibodies
- Pelvic Ultrasound Will Often Show Small Ovaries With Reduced Or Absent Antral Follicles.
- Anti-Mullerian Hormone Levels Will Be Low Or Undetectable (
- Ovarian Biopsy (Usually By Laparoscopy) Is Not Indicated As It Does Not Alter The Management.
Management of POF
Subsequent management of POF needs to address two major medical issues – hormone replacement therapy (HRT) and infertility. A diagnosis of POF can have a significant negative impact on a woman’s psyche. Personal and emotional support is often required.
Hormone Replacement Therapy (HRT)
Women with POF need long-term HRT for relief of menopausal symptoms (hot flashes, mood swings, fatigue and skin issues, sexual dysfunction). They also need to prevent bone loss (osteoporosis) due to estrogen deficiency.
Estrogen and progesterone replacement is usually indicated. This can be in the form of oral pills, transdermal patches or implants. Vaginal estrogen (creams, pessaries, tablets, vaginal ring) and testosterone need to be considered if needed.
Periodic measurement of bone density with DEXA can be done to assess the status of the bones.
At InVia Fertility Specialists, we only deal with fertility issues in patients with POF. The details of what works and what does not will be discussed in my next blog.
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