Modern aspects of management of patients with premature ovarian failure

Abstract

Premature ovarian failure (POF) is still a disease with an unknown etiology; questions of early diagnosis and treatment remain open. POF is associated with typical menopausal symptoms which develop before the age of 40 years. The authors’ study involved 97 patients aged 26 to 38 years without somatic pathology. The main complaint was menstrual dysfunction as irregular menstruation for 12 months. A complex of clinical and laboratory studies was carried out, including hormonal examination and pelvic ultrasonography. As additional studies we determined the anti-Müllerian hormone level, antral follicles count and measuring the ovaries volume during ultrasound examination. The study identified three groups. Group I consisted of patients without hormonal imbalance (most showed a pronounced psycho-emotional component). Group II consisted of patients with hormonal disorders, such as hyperprolactinemia and increased androgens levels (an additional analysis in such patients was an insulin resistance test, HOMA index). Group III consisted of patients with menstrual dysfunctions as persistent opsomenorrhea and oligomenorrhea (early menopause on the maternal side was noted in most patients in this group). The estimated time of onset of menopause was calculated using a mathematical formula, and an assessment of the risk of cardiovascular disease in connection with the onset of early menopause. A follow-up 12-month follow-up was performed for patients who were planning a pregnancy. The indicators of the onset of spontaneous pregnancy were calculated with reduced rates of ovarian reserve. Results of the study showed that early POF diagnosis allows reducing the frequency of infertility in such women by 33.3% and gives chances of obtaining ovum from the mother, not the donor, without the assisted reproductive technologies. Hormone replacement therapy in patients with POF improves the life quality and reduces the cardiovascular risk. Early diagnosis of POF risks allows infertility prevention

Keywords

• premature ovarian failure
• primary ovarian insufficiency
• hormone replacement therapy
• menopause
• infertility treatment