New Review: Premature Ovarian Insufficiency

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Premature Ovarian Failure

Robert W. Rebar, MD

Premature ovarian failure is the term usually used to describe women aged younger than 40
years who present with amenorrhea, hypergonadotropinism, and hypoestrogenism. Such
women may ovulate and even conceive after the diagnosis is made, so it may be more
appropriate to refer to these patients as having “primary ovarian insufficiency,” or alternatively,
as having “hypergonadotropic hypogonadism” or “primary hypogonadism.” The clinical presen-
tation is diverse, and several different disorders can lead to premature ovarian failure. Affected
women should be investigated for premutations of the FMR1 gene (causing fragile X syndrome
in its fullest form) and for adrenal antibodies. Thyroiditis is the most frequent autoimmune
disorder associated with premature ovarian failure and should be ruled out as well. Osteopenia
is increased in women with premature ovarian failure, and measures to prevent accelerated bone
loss are warranted. Hormone therapy (HT) should be provided to eliminate symptoms of
estrogen deficiency and help prevent osteopenia, but will not necessarily (and inexplicably)
prevent pregnancy in the 5–10% of women who conceive spontaneously after the diagnosis is
made. There are no data indicating that these young women are at increased risk of side effects
from HT. If pregnancy is desired, use of donor oocytes with in vitro fertilization is most likely to
result in pregnancy.
(Obstet Gynecol 2009;113:1355–63)