EMAS position statement: Managing women with premature ovarian failure.
BACKGROUND
Premature ovarian failure (also known as premature menopause) is defined as menopause before the age of 40. It can be "natural" or "iatrogenic" such as after bilateral oophorectomy. It may be either primary or secondary. In the majority of cases of primary POF the cause is unknown. Chromosome abnormalities (especially X chromosome), follicle-stimulating hormone receptor gene polymorphisms, inhibin B mutations, enzyme deficiencies and autoimmune disease may be involved. Secondary POF is becoming more important as survival after treatment of malignancy through surgery, radiotherapy and chemotherapy continues to improve.


OBJECTIVE
To formulate a position statement on the management of premature ovarian failure.


METHODS
Literature review and consensus of expert opinion.


CONCLUSIONS
Diagnosis should be confirmed with an elevated FSH greater than 40 IU/L and an estradiol level below 50 pmol/L in the absence of bilateral oophorectomy. Further assessment should include thyroid function tests, autoimmune screen for polyendocrinopathy, karyotype (less than 30 years of age) and bone mineral density. Untreated early ovarian failure increases the risk of osteoporosis, cardiovascular disease, dementia, cognitive decline and Parkinsonism. The mainstay of treatment is hormone therapy which needs to be continued until the average age of the natural menopause. With regard to fertility, while spontaneous ovulation may occur the best chance of achieving pregnancy is through donor oocyte in vitro fertilization. It is essential that women are provided with adequate information as they may find it a difficult diagnosis to accept. It is recommended that women with POF are seen in a specialist unit able to deal with their multiple needs.
Vujovic
Svetlana
S
Institute of Endocrinology, Clinical Center of Serbia, Belgrade School of Medicine, Dr Subotica 13, 11000 Beograd, Serbia.vujovics@EUnet.rs
Brincat
Marc
M
Erel
Tamer
T
Gambacciani
Marco
M
Lambrinoudaki
Irene
I
Moen
Mette H
MH
Schenck-Gustafsson
Karin
K
Tremollieres
Florence
F
Rozenberg
Serge
S
Rees
Margaret
M
D000328:Adult; D015914:Estrogen Replacement Therapy; D005260:Female; D005298:Fertility; D006801:Humans; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012016:Reference Values