DEFINATION:-

•Resistant ovary syndrome, previously known as Savage Syndrome, is a cause of ovarian failure that can lead to secondary amenorrhea.• There is a rare patient with amenorrhea and normal growth and development, who has:-• elevated GONADOTROPINSDespite the presence of UNSTIMULATED ovarian follicles and there is NO EVIDENCE of AUTO IMMUNE DISEASE.

CAUSE:-

•functional disturbance of the gonadotrophinreceptors in the ovarian follicles.• lack of gonadotropin receptor antibodies (block FSH receptors in ovaries)• It may be a cause of primary or secondary amenorrhoea and is resistant to exogenous gonadotrophin stimulation.• HYPOMENSTURAL SYNDROME:-Amenorrhea, Infertility and Genital Infantilism

DIAGNOSIS:-Diagnosis of this condition requires:-• that the patient has a normal 46,XX karyotype, •normal secondary sexual characteristics, •elevated plasma FSH and LH - in the menopausal range - and that normal, •multiple follicles are seen on ovarian biopsy.• hypoestrogenemia• Ultrasonography reveals hypoplasia of uterus and ovaries.

What is Premature Ovarian Failure (POF)?Premature Ovarian Failure (POF) is defined as the cessation of ovarian function prior to the age of 40. It is diagnosed in women under age 40 when ovarian function ceases, menstruation stops, the onset of menopausal symptoms, estrogen levels falling to a menopausal range (less than 20 pg/ml) and resulting infertility.

Causes of Premature Ovarian Failure (POF)It is estimated that up to 40% of Premature Ovarian Failure (POF) can be attributed to genetic causes, as the disorder has a tendency to be familial. If a woman's mother or maternal grandmother or even maternal aunts had an "early menopause" but was not necessarily diagnosed as Premature Ovarian Failure (POF), that woman is at increased risk of having an "early menopause" herself; and may want to think about having children sooner than later.Autoimmunity has also been shown to play a role, with the most common cause thought to be Hashimoto's thyroiditis.

CLINICS:-Amenorrhea

SIGNS OF CLIMATIC SYNDROME:-Hot FlushesSweatsTirednessCardiac PainHead Ache

DIAGNOSIS:-

Detected by Ultrasonography although the ovaries are small in volume.Increased level of FSH and LH(+ve) test with Estrogen and Progesterone(-ve) test with FSH, LH (no reaction of ovary)

TREATMENT:-

Hormonal replacement therapy before age of normal menopause but now the therapy is carried up to the age of 70years to avoid Post- menopausal symptoms; i.e Osteomyelitis and Cardiac Complications.

Premature Ovarian Failure (POF) vs. Resistant Ovary Syndrome (ROS):-

A syndrome known as Resistant Ovary Syndrome (ROS) is a medical condition that presents, clinically, identical to Premature Ovarian Failure (POF); but the ovary has the normal amount of eggs, and it is thought to be secondary to a receptor block on the surface of the ovary to FSH, antibodies to gonadotrophins (FSH and LH) or a post receptor defect, that prevents the ovary from responding.The only way to distinguish between the two diagnoses is to do an ovarian biopsy and have pathology look for the presence of a normal amount of egg follicles. If no eggs are found, than the diagnosis is Premature Ovarian Failure (POF); on the other hand, if eggs are present in normal amounts, than the diagnosis is Resistant Ovary Syndrome (ROS).Although, there is no treatment for Resistant Ovary Syndrome (ROS), it is clinically treated similarly to Premature Ovarian Failure (POF). Rarely Resistant Ovary Syndrome (ROS) can reverse itself and a woman will spontaneously conceive, always in disbelief because she thought and was told she was "menopausal". There is current research looking at the possibility of maturing and recovering eggs in-vitro (outside the body in a dish) from portions of ovary that have been stimulated with FSH. At the present time, this technology is not available for clinical use.