Ovarian insufficiency is a failure of the ovary to function adequately in a woman younger than 40 years, in its role either as an endocrine organ or as a reproductive organ. In women aged 40 years or older, the expected physiologic decline of ovarian function that takes place with aging is termed perimenopause or the menopausal transition.
As defined by the World Health Organization, ovarian insufficiency can be caused by a primary disorder in the ovary or it can occur as a result of secondary causes. Ovarian insufficiency is considered primary if the ovary fails to function normally in response to appropriate gonadotropin stimulation provided by the hypothalamus and pituitary. Ovarian insufficiency is considered secondary if the hypothalamus and pituitary fail to provide appropriate gonadotropin stimulation.
Signs and symptoms
Primary ovarian insufficiency (POI) (premature ovarian failure, premature menopause, or early menopause) is a condition characterized by amenorrhea, hypoestrogenism, and elevated serum gonadotropin levels in women younger than 40 years. Although often used as synonyms, POI and menopause are not equivalent. Most women with POI retain intermittent ovarian function for many years, and, unlike women who are menopausal, pregnancies may occur.
See Presentation for more detail.
The following tests should be performed when ovarian failure is suspected or has been diagnosed:
A pregnancy test (urine or beta human chorionic gonadotropin [bhCG] in the blood)
Measurement of serum follicle-stimulating hormone (FSH) level
Measurement of serum luteinizing hormone (LH) level
Measurement of serum estradiol level
A karyotype should be performed as a part of the routine evaluation after the diagnosis of primary ovarian insufficiency is established.
Ovarian ultrasonography can be useful in the workup of patients with primary ovarian insufficiency, as it will identify those women with multifollicular ovaries and suggest the diagnosis of either autoimmune oophoritis or 17-20 desmolase deficiency.
A magnetic resonance imaging (MRI) scan of the pituitary and hypothalamus is indicated in the evaluation of secondary ovarian insufficiency in the following circumstances:
Associated headache or visual-field cuts
Profound estrogen deficiency with otherwise unexplained amenorrhea
See Workup for more detail.
Medical treatment of patients with primary ovarian insufficiency should address the following aspects:
Ovarian hormone replacement
Restoration of fertility
Psychological well-being of the patient