Treatment of Premature Ovarian Failure with Oral Contraceptive Pill

Prof. dr. Delfi Lutan MSc, SpOG(K)dr. M. Fidel Ganis Siregar, SpOG

Department of Obstetrics & Gynaecology, Faculty of Medicine

University of Sumatera Utara Medan

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Premature ovarian failure refers to a loss of normal function of ovaries before the age of 40 — which can lead to infertility and other problems. . This can be natural or caused by surgery, chemotherapy or radiation.

Amenorrhea and elevated, gonadotropin levels in women under the age of 40 year characterize premature menopause or ovarian failure (POF).

Typically, the menstrual period ceases without obvious genetic abnormalities

The average of age of the menopause is 50 years

PIT HIFERI – DENPASAR , 25 JANUARI 2011

1. Hypergonadotrophic hypogonadism

2. Premature ovarian failure

3. Premature menopause

4. Primary ovarian insufficiency

5. Primary ovarian failure

6. Primary gonadal failure

7. Early menopause

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Total follicle depletion,

No follicles left in ovary, no ability to make more

Follicle dysfunction ,

Some residual follicles in ovary, but they are not working properly.

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Lack of breast development during puberty

Lack of menstrual periods

(Amenorrhea cessation of period or irregular periods)

Loss of energy

Hot flashes

Vaginal dryness

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Mood swings and irritability

Insomnia (not being able to sleep)

Loss of sex drive and painful sex

Bladder problems

Infertility

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High levels of FSH (FSH and estradiol levels)

Genetic tests (Sometimes karyotype analysis)

Autoimmune

Endocrine problems

Retardation

Neurological diseases

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The exact etiology of this disease entity is

unknown

Fewer than normal number of oocytes

Some may exhibit excessive gonadotrophic

stimulation

Exhibiting auto-immune thyroiditis

Antibodies against gonadotrophins

Exhibit genetic mutations in the FSH

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Blood Gonadotrophin Levels

Evaluation of the Patients

Histological Evaluation of Ovarian Biopsies

Infectious Causes of Premature Ovarian Failure

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Age. The risk of ovarian failure rises as women’s age. The incidence of developing premature ovarian failure is about one in 250 by age 35 and one in 100 by age 40.

Family history. Having a family history of premature ovarian failure increases women’s risk of developing this disorder. About 10 percent of cases are familial.

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Hormone replacement therapy (HRT), is used to replace the levels of hormones that these women should have naturally.

Occasionally, combined oral contraceptive pill may be prescribed to provide a woman with increased levels of estrogen and progesterone.

Current research is looking into giving women the hormone testosterone to help prevent bone loss in women with premature ovarian failure

Following a healthy diet and exercising regularly can minimize your risk of osteoporosis as well as heart disease.

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Between 5 and 10 percent of women with POF may spontaneously become pregnant

Currently no fertility treatment has officially been found to effectively increase fertility in women with POF,

And the use of donor eggs with In-Vitro Fertilization (IVF) and

Adoption have become more popular as a means of becoming parents for women with POF.

Dehydroepiandrosterone (DHEA) for the fertility treatment of women suffering with POF

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Cyclical estrogen and progesterone replacement therapy should be considered in all patients.

The combined oral contraceptive pill is a convenient preparation and may be more socially acceptable at diagnosis and in young patients.

Estrogen replacement therapy should then be continued until the time of the natural menopause - typically to age 50.

No proven treatment to restore ovarian function

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Estrogens can be administered orally or transdermally, Such doses usually achieve adequate estrogenization of the vaginal epithelium in young women with and help maintain age-appropriate bone density.

The estrogens can be administered continuously or cyclically (21 d on, 7 d off).

Estrogen therapy (ET) does not prevent ovulation and conception in these patients

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Progestins should be administered cyclically, 10-14 days each month, to prevent endometrial hyperplasia that unopposed estrogen may cause

If an expected withdrawal bleeding is missing, a pregnancy test should be performed and a diagnosis of pregnancy should not be delayed.

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Women with premature ovarian failure should consider taking estrogen-progestin therapy at least until age 50 to prevent osteoporosis and possibly cardiovascular disease. Taking these hormones will have the added benefit of reducing menopausal symptoms, including hot flushes, night sweats, and vaginal dryness.

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Infertility. Infertility is a troubling challenge for many women with premature ovarian failure. Yet, a very small percentage of women with the condition may become pregnant and deliver healthy babies, so natural conception remains a small possibility.

Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen are at an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than are healthy bones.

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Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels may cause some women to become anxious or depressed Drug Treatment.

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