Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure

doi:10.1016/S0029-7844(02)01962-2

Obstetrics & Gynecology

Volume 99, Issue 5, Part 1, May 2002, Pages 720-725

https://doi.org/10.1016/S0029-7844(02)01962-2 Get rights and content

Abstract

OBJECTIVE:

To investigate the experiences of young women with spontaneous premature ovarian failure with regard to the initial presenting symptom, promptness of diagnosis, and patient education.

METHODS:

We asked 50 patients previously diagnosed with spontaneous premature ovarian failure to participate in a structured interview survey consisting of 38 true-or-false, multiple-choice, and open-ended questions.

RESULTS:

Disturbance in menstrual pattern was the most common initial symptom in the 48 women who completed the interview (44 of 48, 92%). Over half of the 44 women who presented with this complaint reported visiting a clinician’s office three or more times before laboratory testing was performed to determine the diagnosis. Over half of them reported seeing three or more different clinicians before diagnosis. In 25% of women it took longer than 5 years for the diagnosis of premature ovarian failure to be established. Patients who spent more than 5 minutes with the clinician discussing the diagnosis were significantly more likely to be satisfied with the manner in which they were informed (P < .001). Ninety percent of participants were college graduates, and 40% had graduate degrees.

CONCLUSION:

Women with spontaneous premature ovarian failure perceived a need for more aggressive evaluation of secondary amenorrhea and oligomenorrhea. Loss of menstrual regularity can be a sign of ovarian insufficiency, and the associated estrogen deficiency is a well-established risk factor for osteoporosis.

Section snippets

Materials and methods

We recruited patients with spontaneous premature ovarian failure under a protocol approved by the Institutional Review Board of the National Institute of Child Health and Human Development. Subjects gave informed consent. Patients qualified for referral if, before age 40 years, they had experienced at least 4 months of amenorrhea in association with two serum follicle-stimulating hormone levels greater than 40 mIU/mL (sampled at least 1 month apart). Patients with known abnormal karyotypes or

Results

All 50 women with spontaneous premature ovarian failure agreed to participate; two women, however, ultimately did not participate in the survey because of scheduling difficulties. The mean age of the 48 women who completed the structured interview was 33.5 ± 4.8 years. Ninety percent (43 of 48) of patients were college graduates, 40% (19 of 48) had graduate degrees, and all had completed high school. Three women were Hispanic, four were Asian, six were black, and 35 were white. In 24 of the

Discussion

More aggressive evaluation and intervention for young women with amenorrhea and estrogen deficiency has been advocated.5, 6 Estrogen deficiency is a well-established risk factor for osteoporosis. Gonadal steroids play an important role in maintaining skeletal health throughout life in both men and women.7 Evidence suggests that more attention should be paid to the skeletal health of young women with amenorrhea. Bone mineral loss is known to occur in these young women, and the amount of loss is

References (29)

R.W Rebar et al.
Clinical features of young women with hypergonadotropic amenorrhea
Fertil Steril
(1990)
J.N Anasti et al.
Bone loss in young women with karyotypically normal spontaneous premature ovarian failure
Obstet Gynecol
(1998)
A.R Lucas et al.
Long-term fracture risk among women with anorexia nervosaA population-based cohort study
Mayo Clin Proc
(1999)
G.A Bachmann et al.
Prevalence of oligomenorrhea and amenorrhea in a college population
Am J Obstet Gynecol
(1982)
F Pettersson et al.
Epidemiology of secondary amenorrhea. I. Incidence and prevalence rates
Am J Obstet Gynecol
(1973)
E.M Belsey et al.
Menstrual bleeding patterns in untreated women. Task Force on Long-Acting Systemic Agents for Fertility Regulation
Contraception
(1997)
S.A Orshan et al.
The lived experience of premature ovarian failure
J Obstet Gynecol Neonatal Nurs
(2001)
C.B Coulam et al.
Incidence of premature ovarian failure
Obstet Gynecol
(1986)
L Sachs
Applied statistics
(1984)
S.J Emans et al.
Estrogen deficiency in adolescents and young adultsImpact on bone mineral content and effects of estrogen replacement therapy
Obstet Gynecol
(1990)

U Ulrich et al.

Osteopenia in primary and secondary amenorrhea

Horm Metab Res

(1995)

Osteoporosis prevention, diagnosis, and therapy

JAMA

(2001)

M.C Davies et al.

Bone mineral loss in young women with amenorrhoea

BMJ

(1990)

U.M Fahy et al.

Osteoporotic fractures in young amenorrheic women

Acta Obstet Gynaecol Scand

(1994)

Cited by (106)

Optimising health after early menopause
2024, The Lancet
The typical age at menopause is 50–51 years in high-income countries. However, early menopause is common, with around 8% of women in high-income countries and 12% of women globally experiencing menopause between the ages of 40 years and 44 years. Menopause before age 40 years (premature ovarian insufficiency) affects an additional 2–4% of women. Both early menopause and premature ovarian insufficiency can herald an increased risk of chronic disease, including osteoporosis and cardiovascular disease. People who enter menopause at younger ages might also experience distress and feel less supported than those who reach menopause at the average age. Clinical practice guidelines are available for the diagnosis and management of premature ovarian insufficiency, but there is a gap in clinical guidance for early menopause. We argue that instead of distinct age thresholds being applied, early menopause should be seen on a spectrum between premature ovarian insufficiency and menopause at the average age. This Series paper presents evidence for the short-term and long-term consequences of early menopause. We offer a practical framework for clinicians to guide diagnosis and management of early menopause, which considers the nature and severity of symptoms, age and medical history, and the individual's wishes and priorities to optimise their quality of life and short-term and long-term health. We conclude with recommendations for future research to address key gaps in the current evidence.
Spontaneous reports of primary ovarian insufficiency after vaccination: A review of the vaccine adverse event reporting system (VAERS)
2023, Vaccine
Since 2012, reports of primary ovarian insufficiency (POI) temporally associated with receipt of human papillomavirus (HPV) vaccine have been published leading to questions about a potential causal association. A Vaccine Safety Datalink study did not find an increased risk for POI after vaccination. We reviewed the Vaccine Adverse Event Reporting System (VAERS) to describe POI reports.
We searched VAERS, a U.S. passive surveillance system, for domestic POI reports received from 01/01/1990 to 12/31/2017 after any vaccination. The search used both Medical Dictionary for Regulatory Activity Preferred Terms and a text-based search for POI and its symptoms. All reports were reviewed, and the American College of Obstetricians and Gynecologists (ACOG) guidelines for POI diagnosis were applied. Data mining for disproportionate reporting was conducted.
Six hundred fifty-two reports met the search criteria and clinical review identified 19 POI reports. Most reports (n = 16) were received between 2013 and 2017. The median age at vaccination was 14.5 years (range 10–25 years) and the median interval between first dose of vaccination and reporting the event to VAERS was 43 months (range 4–132 months; mean 59.6 months). Four reports met ACOG diagnostic criteria; one with an underlying cause (47XXX chromosomal abnormality) reported. Eleven reports documented menstrual irregularity ≥ 3 months; 5 had ≥ 1 laboratory test result used to diagnose POI. Eighteen of 19 reports described receipt of HPV vaccine with or without other vaccines. Other vaccines reported were meningococcal conjugate vaccine, hepatitis A, varicella and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis. Disproportionate reporting was found for three relevant coding terms after HPV vaccination.
POI is rarely reported to VAERS. Most reports contained limited diagnostic information and were submitted after published cases of POI following HPV vaccination. Results of our review do not suggest a safety concern.
Hormone therapy in women with premature ovarian insufficiency: a systematic review and meta-analysis
2022, Reproductive BioMedicine Online
The aim of this systematic review and meta-analysis was to evaluate the effectiveness of different hormone therapies, including hormonal contraceptives, in women with premature ovarian insufficiency (POI). Thirty reports of 28 studies were included, with a total of 4004 participants with POI from diverse aetiologies, of whom 3785 received hormone therapies and 219 received calcium supplementation, vitamin D, placebo or no treatment. Hormone therapy was superior to non-treatment, placebo, calcitriol or calcium in preserving bone mineral density (BMD) in women with POI. Hormone therapy was associated with up to 80% reduction in the prevalence of hot flushes and with stability or improvement in the quality of life scores. Hormone therapy induced significant increases in uterine volume and endometrial thickness in women with POI. The studies yielded convergent results and were of good quality, although some lacked blinding or had incomplete outcome data. Moderate to high quality evidence was found that hormone therapy with oestrogen and progesterone or progestin (including contraceptives) is beneficial to women with POI, not only to mitigate hypoestrogenic symptoms but also to preserve BMD and avoid uterine atrophy. More studies are needed to confirm the long-term safety of this therapy and to assess its possible impact on the risk of hard outcomes such as bone fractures and cardiovascular events.
The effect of selenium and vitamin E supplementation on anti-Mullerian hormone and antral follicle count in infertile women with occult premature ovarian insufficiency: A randomized controlled clinical trial
2021, Complementary Therapies in Medicine
Increased accumulation of reactive oxygen species (ROS) in the process of oogenesis is one of the most well known causes of ovarian insufficiency and decreased ovarian reserve. Selenium and vitamin E as cofactors of glutathione peroxidase plays an important role in the removal of ROS in the ovary. We evaluated the effects of selenium and vitamin E supplementation on anti-Mullerian hormone (AMH) index and antral follicle count (AFC) (primary outcomes) and mean ovarian volume (MOV) and side effects of these supplements (secondary outcome) in infertile women with occult premature ovarian insufficiency (OPOI).
70 patients were allocated into the control and treatment groups through block randomization method. 35 women in the treatment group received 200 ng selenium and 400IU vitamin E and 35 women in the control group received placebo for a total of 90 days. AMH index, AFC and mean ovarian volume (MOV) were investigated in both groups after 12 months of study.
There was no significant difference between groups before intervention in AMH (Mean difference: $-$ 0.08; 95 $%$ CI: $-$ 0.20 to.08; $p = 0.33$ ), AFC ( $-$ 0.71; 95 $%$ CI: $-$ 1.44 to $-$ 0.01; $p = 0.05$ ) and MOV ( $-$ 0.55; 95 $%$ CI: $-$ 0.85 to $-$ 0.24; $p = 0.001$ ). There was a significant increase in AMH (mean difference: 0.59; 95 $%$ CI: 0.48 to 0.71; $p < 0.001$ ), AFC (5.08; 95 $%$ CI: 4.36 to 5.08; $p < 0.001$ ) and MOV (2.17; 95 $%$ CI: 1.87 to 2.47; $p < 0.001$ ) in selenium + vitamin E group compared to placebo group 12 months after intervention. These supplements had no side effects.
Supplementation with selenium and vitamin E can increase AMH, AFC and MOV in women with OPOI.
Serum biomarker analysis in patients with premature ovarian insufficiency
2020, Cytokine
Premature ovarian insufficiency (POI) is a primary ovarian defect characterized by premature depletion of ovarian follicles before 40 years of age. The disorder has been attributed to various causes, but the study of altered proteins in serum levels as the cause is rare. Additionally, identifying novel biomarkers can contribute to more accurate diagnosis or prognosis of POI. In the present study, a solid-phase antibody array simultaneously detecting multiple proteins was used to analyze POI serum with menopausal and healthy fertile subjects as control groups. As a result, compared to the menopause and healthy fertile groups, eleven proteins, including Neurturin, Frizzled-5, Serpin D1, MMP-7, ICAM-3, IL-17F, IFN-gamma R1, IL-29, IL-17R, IL-17C and Soggy-1, were uniquely down-regulated, and Afamin was particularly up-regulated in POI serum. More importantly, all of these factors were firstly found to be associated with POI in this study, suggesting that these proteins may participate in the pathogenesis of POI and may be novel serum biomarkers for POI.
Survey of Canadian PGY-4 and PGY-5 Obstetrics and Gynaecology Residents on Knowledge of and Exposure to Premature Ovarian Insufficiency
2018, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
Creating clinical practice guidelines for POI in Canada is one way to streamline an approach to POI patients among trainees and practitioners. This may increase awareness among physicians about appropriate work-up for amenorrhea in young women and diagnosis of this condition, potentially avoiding treatment delay as shown by Alzubaidi et al.6 In the American obstetrics and gynaecology resident group, there is a lack of exposure to menopause.8
(1) To determine exposure to and general knowledge on premature ovarian insufficiency (POI) among Canadian senior obstetrics and gynaecology residents. (2) To identify opportunity to improve trainee exposure to POI.
Canadian PGY-4 and PGY-5 obstetrics and gynaecology residents were approached to complete an electronic survey. The questions in the survey included the basic POI knowledge, previous exposure to POI, and comfort level in managing POI patients. Data from the survey was summarized descriptively and compared between two trainee groups (PGY-4 and PGY-5) using chi-square or Fisher exact tests.
Responses were received from trainees in all Canadian residency programs with an overall response rate of 45% (95/210 residents). Most respondents (79%, 75/95 residents) identified correct age for POI diagnosis, and 65% (62/95 residents) recognized the most common aetiology. A majority (99%, 92/93 residents) would prescribe hormone therapy for POI patients. Most trainees (62%, 59/95 residents) lack access to a POI clinic at their centre and 63% (59/94 residents) have seen less than six POI patients during residency training. Most feel somewhat comfortable managing POI patients (67%, 64/95 residents), but 22% (21/95 residents) feel totally uncomfortable with a majority of respondents (83%, 78/94 residents), indicating they would benefit from additional training. Compared with PGY-4 residents, the proportion of trainees who could identify the correct age for diagnosis of POI was significantly higher in PGY-5 residents (89% vs. 70%, P = 0.024).
Many senior obstetrics and gynaecology residents in Canada lack knowledge around POI, and most indicate need for further exposure to POI during residency training. We identified an opportunity for improved POI curricula.
1) Déterminer l'étendue des connaissances générales des médecins canadiens en fin de résidence en obstétrique et gynécologie sur l'insuffisance ovarienne prématurée (IOP) et connaître leur exposition à ce trouble; et 2) trouver des occasions d'augmenter l'exposition à l'IOP pendant la formation.
Nous avons demandé à des résidents canadiens en obstétrique et gynécologie de quatrième année (PGY-4) et de cinquième année (PGY-5) de répondre à un sondage électronique. Les questions portaient sur les connaissances de base sur l'IOP, l'exposition antérieure à ce trouble et le degré d'aisance à prendre en charge les patientes atteintes. Les données issues du sondage ont été résumées de façon descriptive, et les deux groupes (PGY-4 et PGY-5) ont été comparés au moyen du test du chi carré et du test exact de Fisher.
Des résidents de tous les programmes canadiens ont répondu au sondage; le taux de réponse global était de 45 % (95 sur 210). La plupart des répondants (79 %; 75 sur 95) ont indiqué le bon âge pour le diagnostic de l'IOP, et 65 % (62 sur 95) connaissaient l'étiologie la plus fréquente. La majorité des résidents interrogés (99 %; 92 sur 93) prescriraient une hormonothérapie. La plupart (62 %; 59 sur 95) ont dit ne pas avoir accès à une clinique d'IOP dans leur centre, et 63 % (59 sur 94) ont vu moins de six patientes atteintes d'IOP durant leur formation. La plupart des résidents se sont dit assez à l'aise de prendre en charge des patientes atteintes d'IOP (67 %; 64 sur 95), mais 22 % (21 sur 95) ont dit ne pas se sentir à l'aise du tout. La majorité des répondants (83 %; 78 sur 94) ont signalé qu'une formation supplémentaire leur serait utile. La proportion des résidents qui ont indiqué le bon âge pour le diagnostic de l'IOP était significativement plus élevée dans le groupe PGY-5 que dans le groupe PGY-4 (89 % c. 70 %; P = 0,024).
Beaucoup de médecins canadiens en fin de résidence en obstétrique et gynécologie manquent de connaissances au sujet de l'IOP, et la plupart estiment qu'il faudrait augmenter l'exposition à ce trouble durant la résidence. Nous avons repéré une occasion d'amélioration du programme sur les IOP.

View all citing articles on Scopus

View full text

Original researchMeeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure

Abstract

Section snippets

Materials and methods

Results

Discussion

Fertil Steril

Obstet Gynecol

Mayo Clin Proc

Am J Obstet Gynecol

Am J Obstet Gynecol

Contraception

J Obstet Gynecol Neonatal Nurs

Incidence of premature ovarian failure

Obstet Gynecol

Applied statistics

Estrogen deficiency in adolescents and young adultsImpact on bone mineral content and effects of estrogen replacement therapy

Obstet Gynecol

Osteopenia in primary and secondary amenorrhea

Horm Metab Res

Osteoporosis prevention, diagnosis, and therapy

JAMA

Bone mineral loss in young women with amenorrhoea

BMJ

Osteoporotic fractures in young amenorrheic women

Acta Obstet Gynaecol Scand

Original research
Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure