title: An update: spontaneous premature ovarian failure is not an early menopause.
abstract: OBJECTIVE
  To update clinicians regarding the management of women with spontaneous premature ovarian failure (POF).
  
  
  METHODS
  Literature review and consensus building among three clinicians with experience in caring for women with spontaneous POF.
  
  
  CONCLUSIONS
  Clearly the ovarian "failure" in this disorder is not permanent in all women. Approximately 5%-10% may conceive spontaneously and unexpectedly after the diagnosis. An integrated approach to management is best, and there is a need to first address physical and mental health issues before addressing plans for family building. Women with spontaneous POF are at increased risk of adrenal insufficiency, which should be detected and managed appropriately, especially before proceeding to ovum or embryo donation procedures. Young women with POF experience pathologically low serum E2 levels at least intermittently. Despite the absence of controlled evidence for this specific population, physiologic replacement of ovarian steroid hormones seems rational until the age of normal menopause. The disorder may be associated with other conditions that require evaluation and management, including hypothyroidism, dry eye syndrome, abnormal karyotype, or a premutation of the FMR1 gene. Finally, clinicians need to be sensitive to the emotional aspects of this disorder when delivering the diagnosis and during subsequent management.
authors.affiliation: Intramural Research Program, Section on Women's Health Research, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. Lawerence_Nelson@nih.gov
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Nelson
authors.forename: Sharon N
authors.initials: SN
authors.lastname: Covington
authors.forename: Robert W
authors.initials: RW
authors.lastname: Rebar
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000523:psychology; D032921:Consensus; D004967:Estrogens / Q000097:blood / Q000172:deficiency; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis / Q000523:psychology; D008594:Menopause, Premature / Q000097:blood* / Q000523:psychology; D016649:Primary Ovarian Insufficiency / Q000097:blood* / Q000175:diagnosis* / Q000523:psychology
chemical_list: D004967:Estrogens