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
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1. 2. 3. 4. 5. 6. 7.

Hypergonadotrophic hypogonadism Premature ovarian failure Premature menopause Primary ovarian insufficiency Primary ovarian failure Primary gonadal failure 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 receptor

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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 womens 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 womens 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 conception in these patients and

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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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