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🌱 來自: obs gyn issues

primary ovarian insufficiency

Diagnostic Approach in a Patient with Possible Primary Ovarian Insufficiency.

• Primary ovarian insufficiency should be considered in women younger than 40 years of age who present with new-onset irregular menses or amenorrhea and possibly vasomotor, depressive, or anxiety symptoms; prompt evaluation is indicated to avoid prolonged time to diagnosis and treatment.

• Elevated follicle-stimulating hormone and low serum estradiol levels measured on two occasions 1 month apart are diagnostic.

• The cause (genetic, autoimmune, metabolic, infectious, or iatrogenic) should be sought; in the majority of patients, the cause remains unidentified.

• Management includes counseling the patient about the diagnosis, implications, and uncertainty regarding the clinical course of primary ovarian insufficiency; other concerns to address include fertility, the need for contraception, recommendations for hormone-replacement therapy (HRT), and depending on the cause of the disorder, surveillance for associated medical conditions.

Prompt initiation of HRT is recommended at higher doses than those used in older, naturally postmenopausal women and should be continued at least until the average age of natural menopause.

Research is needed to evaluate the effects of HRT on cardiovascular disease, osteoporosis, and neurodegenerative disorders in women with primary ovarian insufficiency.