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Premature Ovarian Failure(POF)

by:Yasmen MahranAssistant lecturerPharmacology and toxicologyAIN Shams University

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Introduction:- POF- Clinical picture and diagnosis-

Etiology

Role of hormones in pathophysiology andmanagement

contents

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Premature

Ovarian Failure

refers to development of amenorrhoea due tocessation of ovarian function before the age of 40.

Hypergonadotropic hypogonadism

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Ovarian Failure

E2

(-)FSH(+)

menopausalsymptoms

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Understanding the term (folliculogenesis)and ovulation as well as the role of eachhormone

Etiology

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Hormone Role

Gonadotropins

1) FSH

+ folliculogenesis and estrogen secretion from the ovariesinduces expression of FSH receptors on follicles

2) LH LH surge initiates the ovulatory process+ progesterone synthesisincreased LH receptors.

Estrogen + the proliferation of granulosa cells from small follicles increases granulosa cell gonadotropin receptor levels

makes negative as well as positive feedback effect on

gonadotropins initiating their surge for ovulation

specific receptor ER alpha and beta

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Progesterone converts the endometrium to its secretory stage toprepare the uterus for implantation

Thyroidhormone

Synergizes with FSH to exert stimulatory effects ongranulosa cell differentiation and function.

AntiMullerianHormoneRECENT

regulates the number of follicles that grow from theprimordial pool and the selection of the dominant folliclefrom the FSH-sensitive follicle.

Nil level in women with POF

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Idiopathic

Iatrogenic:

*Chemotherapy*Radiotherapy

*Pelvic surgery

Autoimmune diseases

Gene mutations:

FSH & LH receptor mutations

Causes

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Management

Hormonereplacement therapy(HRT)

Infertility

personal and emotionalsupport

H l

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standard treatmentestrogen +/- oral contraceptive pill.Exogenous E sensitizes the granulose cells to

FSH, ovulation and conception

risk of (breast cancer and cardiovascularevents)

E + progestin to avoid endometrialhyperplasia

+ testosterone in cases of persistent fatigueand loss of libido

Hormone replacementtherapy

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Usually, gonadotropins releasing hormonesagonist (GnRH) (leuprolide , goserelin &

triptorelin)

patients undergoing chemo-\radio-therapydevelop POF with ovarian follicular loss

No

te

http://en.wikipedia.org/wiki/Leuprolidehttp://en.wikipedia.org/wiki/Goserelinhttp://en.wikipedia.org/wiki/Leuprolidehttp://en.wikipedia.org/wiki/Leuprolidehttp://en.wikipedia.org/wiki/Goserelinhttp://en.wikipedia.org/wiki/Leuprolide

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Hypothyrodism, autoimmune diseasesRECENT

Gene therapy for defective FSH Receptormutations

Treatment of the cause is

a must

No

te

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The only reliable fertility treatment is the use of

in vitro fertilization (IVF) (high successrate)ovulation induction:

*Clomiphene (Clomid)

* pulsatile GnRh

*(r FSH) (Gonal-F, Follistim)corticosteroids +/- clomiphene

Cryopreservation

Infertility

S

uccessrate

m

odest

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women with POF most likelyhave follicles that are of lower

quality.

However, there may not be anyother option for being a MOM

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Thank

you