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Kakinuma K, Kakinuma T. Analysis of oxidative stress and antioxidative potential in premature ovarian insufficiency. World J Clin Cases 2023; 11:2684-2693. [PMID: 37214574 PMCID: PMC10198121 DOI: 10.12998/wjcc.v11.i12.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/20/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Premature ovarian insufficiency (POI) is characterized by an early decline in ovarian function, inducing secondary amenorrhea. While the cause of POI has not yet been identified, the function of mitochondria in the ovaries and the cytotoxicity associated with reactive oxygen species (ROS) have been implicated in follicle pool depletion and a decline in follicle quality. Recently developed tests have enabled easy measurement of diacron-reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP). The combination of these two tests is used to comprehensively assess oxidative stress in the blood.
AIM To comprehensively assess the oxidative stress of d-ROMs and BAP in POI.
METHODS Participants were classified into two groups: A POI group of 11 women aged < 40 years examined between January 2021 and June 2022 with a history of secondary amenorrhea for at least 4 mo in our hospital and an FSH value of ≥ 40 mIU/mL; and a control group of healthy women of the same age with normal ovarian function in our hospital. Plasma d-ROMs and BAP were measured in both these groups underwent. Differences between groups were assessed using the t-test.
RESULTS The mean age and mean body mass index (BMI) were 35.8 ± 3.0 years and 20.1 ± 1.9 kg/m2 in the control group and 35.8 ± 2.7 years and 19.4 ± 2.5 kg/m2 in the POI group, respectively. The mean gravidity and parity in control and POI groups were 0.6 ± 0.7 and 0.4 ± 0.5 and 0.6 ± 0.9 and 0.3 ± 0.5, respectively. The two groups did not differ significantly in terms of mean age, BMI, gravidity, or parity. The d-ROMs level was significantly higher in the POI group than in the control group (478.2 ± 58.7 vs 341.1 ± 35.1 U.CARR; P < 0.001); however, the BAP level did not significantly differ between the two groups (2078.5 ± 157.4 vs 2029.0 ± 186.4 μmol/L). The oxidase stress index (d-ROMs/BAP × 100) was significantly higher in the POI group than in the control group (23.7 ± 3.3 vs 16.5 ± 2.1; P < 0.001).
CONCLUSION Oxidative stress was significantly greater in the POI group than in the control group, suggesting oxidative stress as a factor that can serve as a POI biomarker.
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Affiliation(s)
- Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, Nasushiobara 327-2763, Japan
| | - Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, Nasushiobara 327-2763, Japan
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Zafardoust S, Kazemnejad S, Darzi M, Fathi-Kazerooni M, Saffarian Z, Khalili N, Edalatkhah H, Mirzadegan E, Khorasani S. Intraovarian Administration of Autologous Menstrual Blood Derived-Mesenchymal Stromal Cells in Women with Premature Ovarian Failure. Arch Med Res 2023; 54:135-144. [PMID: 36702667 DOI: 10.1016/j.arcmed.2022.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Premature ovarian failure (POF) is a well-known cause of infertility, particularly in women under the age of 40. POF is also associated with elevated gonadotropin levels, amenorrhea and sex-hormone deficiency. AIM OF THE STUDY In this study, the therapeutic potential of autologous mesenchymal stromal cells obtained from menstrual blood (Men-MSCs) for patients with POF was evaluated. METHODS 15 POF patients were included in the study. The cultured Men-MSCs were confirmed by flow cytometry, karyotype, endotoxin and mycoplasma and were then injected into the patients' right ovary by vaginal ultrasound guidance and under general anesthesia and aseptic conditions. Changes in patients' anti-Müllerian hormone (AMH), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteal hormone (LH), and estradiol (E2) levels, as well as general flushing and vaginal dryness were followed up to one year after treatment. RESULTS All patients were satisfied with a decrease in general flushing and vaginal dryness. 4 patients (2.9%) showed a spontaneous return of menstruation without additional pharmacological treatment. There was a significant difference in AFC (0 vs. 1 ± 0.92 count, p value ≤0.001%), FSH (74 ± 22.9 vs. 54.8 ± 17.5 mIU/mL, p-value ≤0.05%), E2 (10.2 ± 6 vs. 21.8 ± 11.5 pg/mL p-value ≤0.01%), LH (74 ± 22.9 vs. 54.8 ± 17.5 IU/L,p-value ≤0.01%) during 3 months post-injection. However, there were no significant changes in AMH (p-value ≥0.05%). There were also no significant differences in assessed parameters between 3 and 6 months after cell injection. CONCLUSION According to the findings of this study, administration of Men-MSCs improved ovarian function and menstrual restoration in some POF patients.
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Affiliation(s)
- Simin Zafardoust
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Somaieh Kazemnejad
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.
| | - Maryam Darzi
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mina Fathi-Kazerooni
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Zahra Saffarian
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Niloofar Khalili
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Haleh Edalatkhah
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Ebrahim Mirzadegan
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Somayeh Khorasani
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society. Maturitas 2022; 163:1-14. [DOI: 10.1016/j.maturitas.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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4
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Du J, Wang X, Wei M, Huang Q, Bi Y, Huang W, Yuan L, Yang Y. The probability and possible influence factors of intermittent ovarian function recovery in patients with premature ovarian insufficiency. Reprod Biomed Online 2022; 45:1275-1283. [DOI: 10.1016/j.rbmo.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
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5
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Impact of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol on cardiovascular markers in women diagnosed with premature ovarian insufficiency or an early menopause: a randomised pilot trial. Maturitas 2022; 161:18-26. [DOI: 10.1016/j.maturitas.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/18/2022]
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Chon SJ, Umair Z, Yoon MS. Premature Ovarian Insufficiency: Past, Present, and Future. Front Cell Dev Biol 2021; 9:672890. [PMID: 34041247 PMCID: PMC8141617 DOI: 10.3389/fcell.2021.672890] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Premature ovarian insufficiency (POI) is the loss of normal ovarian function before the age of 40 years, a condition that affects approximately 1% of women under 40 years old and 0.1% of women under 30 years old. It is biochemically characterized by amenorrhea with hypoestrogenic and hypergonadotropic conditions, in some cases, causing loss of fertility. Heterogeneity of POI is registered by genetic and non-genetic causes, such as autoimmunity, environmental toxins, and chemicals. The identification of possible causative genes and selection of candidate genes for POI confirmation remain to be elucidated in cases of idiopathic POI. This review discusses the current understanding and future prospects of heterogeneous POI. We focus on the genetic basis of POI and the recent studies on non-coding RNA in POI pathogenesis as well as on animal models of POI pathogenesis, which help unravel POI mechanisms and potential targets. Despite the latest discoveries, the crosstalk among gene regulatory networks and the possible therapies targeting the same needs to explore in near future.
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Affiliation(s)
- Seung Joo Chon
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea
| | - Zobia Umair
- Department of Molecular Medicine, College of Medicine, Gachon University, Incheon, South Korea
| | - Mee-Sup Yoon
- Department of Molecular Medicine, College of Medicine, Gachon University, Incheon, South Korea.,Lee Gil Ya Cancer and Diabetes Institute, Incheon, South Korea.,Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
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7
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Modern Concepts of Clinical and Diagnostic Criteria for Premature Ovarian Failure (Literature Review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2020-5.6.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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8
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Kharazi U, Badalzadeh R. A review on the stem cell therapy and an introduction to exosomes as a new tool in reproductive medicine. Reprod Biol 2020; 20:447-459. [DOI: 10.1016/j.repbio.2020.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/18/2020] [Accepted: 07/03/2020] [Indexed: 12/12/2022]
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9
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Safiyeh FD, Mojgan M, Parviz S, Sakineh MA, Behnaz SO. 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. Complement Ther Med 2020; 56:102533. [PMID: 33197657 DOI: 10.1016/j.ctim.2020.102533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE 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). METHODS 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. RESULT 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. CONCLUSION Supplementation with selenium and vitamin E can increase AMH, AFC and MOV in women with OPOI.
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Affiliation(s)
- Farhadi Dizaji Safiyeh
- Department of midwifery, nursing and midwifery Faculty, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mirghafourvand Mojgan
- Social Determinants of Health Research Center, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahabi Parviz
- Department of Physiology, Faculty of Medicine, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mohammad Alizadeh Sakineh
- Department of midwifery, nursing and midwifery Faculty, Tabriz University of Medical sciences, Tabriz, Iran
| | - Sadeghzadeh Oskouei Behnaz
- Department of midwifery, nursing and midwifery Faculty, Tabriz University of Medical sciences, Tabriz, Iran.
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Mittal M, Panay N, Supramaniam PR, Savvas M, Cardozo L, Hamoda H. A direct comparison of women's perceptions and acceptability of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol in the management of young postmenopausal women, under 45 years of age. Post Reprod Health 2020; 26:210-219. [PMID: 33045913 DOI: 10.1177/2053369120960960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the acceptability and perception of postmenopausal women, to two different hormone replacement therapy regimens, in relation to the control of their symptoms and development of adverse effects. STUDY DESIGN Prospectively recruited postmenopausal women, <45 years, were randomised to one of two treatment arms for 12-months: cyclical micronised progesterone or medroxyprogesterone acetate in combination with transdermal oestradiol. A self-reported questionnaire with matrix rating scales was completed and repeated after 3, 6 and 12-months. MAIN OUTCOME MEASURES Symptom control and development of adverse effects. RESULTS Seventy-one individuals were screened, with baseline data available for 67 subjects. A total of 190 questionnaires were returned. The most commonly reported symptoms were low energy levels, vasomotor symptoms and sexual dysfunction. The prevalence of adverse effects ranged between 57.89 and 87.50%, with a reduction seen in the transdermal oestradiol + micronised progesterone arm (73.91% at 3-months, decreasing to 57.89% at 12-months; p = 0.33), compared to the transdermal oestradiol + medroxyprogesterone acetate arm (76.92% at 3-months, increasing to 87.50% at 12-months; p = 0.69). The main reported adverse effects were bloating, weight change and psychological symptoms. A significant difference was documented between the groups after set intervals, with a greater proportion reporting breast tenderness after 3-months (p = 0.01), lower numbers reporting mood swings at 6-months (p = 0.01) and irritability at 12-months (p = 0.03) in the transdermal oestradiol + micronised progesterone arm compared to the transdermal oestradiol + medroxyprogesterone acetate arm. CONCLUSIONS The acceptability of both regimens was high despite adverse effects, but tolerability of transdermal oestradiol combined with micronised progesterone appeared to be better with fewer women reporting psychological concerns.
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Affiliation(s)
- M Mittal
- Imperial College Healthcare NHS Trust, St Mary's and Hammersmith Hospitals, London, UK
| | - N Panay
- Imperial College Healthcare NHS Trust and Chelsea and Westminster NHS Foundation Trust, London, UK
| | - P R Supramaniam
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - M Savvas
- King's College Hospital NHS Foundation Trust, London, UK
| | - L Cardozo
- King's College Hospital NHS Foundation Trust, London, UK
| | - H Hamoda
- King's College Hospital NHS Foundation Trust, London, UK
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12
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Lee SR, Cho MK, Cho YJ, Chun S, Hong SH, Hwang KR, Jeon GH, Joo JK, Kim SK, Lee DO, Lee DY, Lee ES, Song JY, Yi KW, Yun BH, Shin JH, Chae HD, Kim T. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med 2020; 26:69-98. [PMID: 32893509 PMCID: PMC7475284 DOI: 10.6118/jmm.20000] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon Kyoung Cho
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Busan, Korea
| | - Sungwook Chun
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seung Hwa Hong
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gyun Ho Jeon
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University Hospital, Busan, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Dong Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Li XT, Li PY, Liu Y, Yang HS, He LY, Fang YG, Liu J, Liu BY, Chaplin JE. Health-related quality-of-life among patients with premature ovarian insufficiency: a systematic review and meta-analysis. Qual Life Res 2019; 29:19-36. [PMID: 31620985 PMCID: PMC6962283 DOI: 10.1007/s11136-019-02326-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To systematically review studies investigating health-related quality-of-life (HrQoL) in patients with premature ovarian insufficiency (POI), to examine questionnaires used and to conduct a meta-analysis of control studies with normal ovarian function. METHODS Data sources: PubMed, Embase, Web of science, CNKI, and CQVIP, searched from inception until June 2018. The search strategy was a combination of medical (e.g. POI), subjective (e.g. well-being) and methodological (e.g. questionnaires) keywords. PRISMA guidelines were used to assess outcome data quality/validity by one reviewer, verified by a second reviewer. Risk of bias within studies was evaluated. A meta-analysis compared HrQoL in patients and non-patients. Due to measurement differences in the studies, the effect size was calculated as standard mean difference. RESULTS We identified 6869 HrQoL studies. Nineteen geographically diverse studies met inclusion criteria, dated from 2006, using 23 questionnaires. The meta-analysis included six studies with 645 POI participants (age 33.3 ± 5.47) and 492 normal-ovarian control subjects (age 32.87 ± 5.61). Medium effect sizes were found for lower overall HrQoL (pooled SMD = - 0.73, 95% CI - 0.94, - 0.51; I2 = 54%) and physical function (pooled SMD = - 0.54, 95% CI - 0.69, - 0.39; I2 = 55%). Heterogeneity was investigated. Effect sizes varied for sexual function depending on the measure (SMD = - 0.27 to - 0.74), overall HrQoL (SF-36) had the largest effect size (- 0.93) in one study. The effect sizes for psychological and social HrQoL were small. CONCLUSION POI is associated with low-to-medium effect size on HrQoL compared to normal ovarian controls. The greatest effects are found in general HrQoL and most sexual function areas. Condition-specific questionnaires and RCTs are recommended for further investigation.
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Affiliation(s)
- X T Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - P Y Li
- Department of Pediatrics, The Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden
| | - Y Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - H S Yang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - L Y He
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Y G Fang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - J Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - B Y Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
| | - J E Chaplin
- Department of Pediatrics, The Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden
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15
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Bartmann AK, Silveira LDF, Silva LFI, Formolo FSS, Amaral JPD, Serra HM, Frolich LCS. Autoimmune hypothyroidism and intermittent ovarian failure - Case Report. JBRA Assist Reprod 2019; 23:287-289. [PMID: 31056890 PMCID: PMC6724380 DOI: 10.5935/1518-0557.20190015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Case presentation: a 35 year-old physical educator sought gynecological care for
secondary amenorrhea and infertility. She denied the occurrence of similar
problems in her family and referred to hypothyroidism as her only comorbidity,
for which she was on levothyroxine 88µg daily. She was tested for
beta-HCG, prolactin and TSH levels. She was negative for beta-HCG, and had
prolactin and TSH levels of 19ng/ml and 2.04 mIU/ml, respectively. Her
progesterone test was negative. The combined test (estradiol + norethisterone
acetate) was positive, excluding the possibility of an anatomical cause. One
month later, her blood tests were as follows: FSH 100mIU/ml, TSH 1.54mIU/ml,
free T4 1.22ng/dl, and anti-TPO 261U/ml. Her FSH level was above 100 and she was
diagnosed with premature ovarian failure. Reproductive treatment with donor eggs
was proposed as an option. Karyotyping and a test for fragile X syndrome were
ordered. A few months later the patient came to our clinic saying she was having
menstrual cycles. Blood tests were as follows: FSH 9.2mIU/ml; TSH 2.21mIU/ml;
and anti-TPO 14U/ml. Transvaginal ultrasound showed a normal uterus with a thin
endometrium and atrophic ovaries. After two years of irregular menstrual cycles,
she became amenorrheic again. She chose not to undergo assisted reproduction.
This paper discusses the diagnosis of premature ovarian failure in light of
current protocols and the association of this condition with diseases such as
Hashimoto's thyroiditis, and looks into the difficulty of performing
differential diagnosis against Savage syndrome and of offering reproductive
counseling especially in cases where the menstrual cycle returns.
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Affiliation(s)
- Ana K Bartmann
- Human Reproduction Center of the Ana Bartmann Clinic, Ribeirão Preto, SP, Brazil.,Medical School, University of Ribeirão Preto (UNAERP), SP, Brazil.,Biotechnology Department, University of Ribeirão Preto (UNAERP), SP, Brazil
| | | | - Liliane F I Silva
- Human Reproduction Center of the Ana Bartmann Clinic, Ribeirão Preto, SP, Brazil
| | - Flavia S S Formolo
- Human Reproduction Center of the Ana Bartmann Clinic, Ribeirão Preto, SP, Brazil
| | | | - Heloisa M Serra
- Medical School, University of Ribeirão Preto (UNAERP), SP, Brazil
| | - Luciana C S Frolich
- Human Reproduction Center of the Ana Bartmann Clinic, Ribeirão Preto, SP, Brazil
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Fruzzetti F, Palla G, Gambacciani M, Simoncini T. Tailored hormonal approach in women with premature ovarian insufficiency. Climacteric 2019; 23:3-8. [PMID: 31352836 DOI: 10.1080/13697137.2019.1632284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Premature ovarian insufficiency (POI) is probably one of the most devastating diagnoses for women of reproductive age. The major implications for fertility, climacteric symptoms, and quality of life, the great impact of long-term consequences such as bone loss and cardiovascular health, and the lack of a coherent and shared clinical approach make the choice for the right hormonal therapy challenging. In this review we propose an integrated and patient-based hormonal approach for women with POI, from puberty to late reproductive age.
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Affiliation(s)
- F Fruzzetti
- UO Gynecology and Obstetrics I, University of Pisa, Pisa, Italy
| | - G Palla
- UO Gynecology and Obstetrics I, University of Pisa, Pisa, Italy
| | - M Gambacciani
- UO Gynecology and Obstetrics I, University of Pisa, Pisa, Italy
| | - T Simoncini
- UO Gynecology and Obstetrics I, University of Pisa, Pisa, Italy
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Domniz N, Meirow D. Premature ovarian insufficiency and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2019; 60:42-55. [PMID: 31495598 DOI: 10.1016/j.bpobgyn.2019.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/13/2023]
Abstract
Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years and has a potentially devastating effect upon women's health, both physically and psychologically. An underlying autoimmune disease has been identified in approximately 20% of patients with POI, the most common of which are disorders of the thyroid and adrenal glands. Nevertheless, in the majority of cases, the etiology is unknown. The damage mechanism to the ovary is usually caused by antibodies, and autoimmune POI is usually characterized by cellular infiltration of the theca cells of growing follicles by various inflammatory cells. Yet, other various factors and proteins of unknown clinical significance are present. The major diagnostic tool for otherwise idiopathic POI is the presence of autoantibodies against various ovarian components that strongly support the option of autoimmune etiology of POI. Treatment of the underlying cause of POI is the main strategy, although immunosuppressive therapy should be considered in a selected population of well-defined autoimmune POI and, as in idiopathic POI, in whom the resumption of ovarian activity is possible.
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Affiliation(s)
- Noam Domniz
- Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel.
| | - Dror Meirow
- Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel
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Nappi RE, Cucinella L, Martini E, Rossi M, Tiranini L, Martella S, Bosoni D, Cassani C. Sexuality in premature ovarian insufficiency. Climacteric 2019; 22:289-295. [DOI: 10.1080/13697137.2019.1575356] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - L. Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - E. Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - M. Rossi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - L. Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - S. Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - D. Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - C. Cassani
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Everhov ÅH, Khalili H, Askling J, Myrelid P, Ludvigsson JF, Halfvarson J, Nordenvall C, Söderling J, Olén O, Neovius M. Sick Leave and Disability Pension in Prevalent Patients With Crohn's Disease. J Crohns Colitis 2018; 12:1418-1428. [PMID: 30165593 DOI: 10.1093/ecco-jcc/jjy123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease may affect the ability to work and lead to permanent disability. We aimed to investigate work loss in prevalent patients. METHODS We identified patients with Crohn's disease and general population comparators matched by sex, birth year, healthcare region and education. We assessed days of sick leave and disability pension retrieved from the Swedish Social Insurance Agency and estimated the absolute and relative risk of receiving disability pension [minimum 25% work impairment]. RESULTS In 2014, the 20638 Crohn's disease patients [median age 44 years] had more than twice as many mean lost workdays [disability pension: 44; sick leave: 19] as the 102038 comparators [disability pension: 20; sick leave: 8], mean difference 35 days [95% confidence interval 33-37]. However, the majority had no lost workdays [68% of patients and 85% of comparators]. The proportion of patients receiving disability pension was 15% (6.5% in the comparators, risk ratio 2.34 [2.25-2.43]) and was higher in all subgroups, especially in female patients [28% vs 13% in the comparators], in those with ≤9 years of education [41% vs 23%] and in ages 60-64 years [46% vs 25%]. The relative risk of disability pension within the patient cohort [adjusted for age, sex, region and education] was higher in patients with complicated disease behaviour, extraintestinal manifestations, need of surgery or treatment with biologics. The differences between patients and comparators remained when comparing other calendar years [2006-2013]. CONCLUSION Work loss was found in approximately one-third of patients. The mean number of lost workdays was twice as high as in the comparators.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pär Myrelid
- Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Jarcevic R, Christakis MK, Wolfman W, Ye XY, Shirreff L. Survey of Canadian PGY-4 and PGY-5 Obstetrics and Gynaecology Residents on Knowledge of and Exposure to Premature Ovarian Insufficiency. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1324-1328. [PMID: 30025870 DOI: 10.1016/j.jogc.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/26/2017] [Accepted: 01/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES (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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Radomir Jarcevic
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
| | - Marie K Christakis
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
| | - Xiang Y Ye
- Micare Research Centre, Mount Sinai Hospital, Toronto, ON
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
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Song K, Cai H, Zhang D, Huang R, Sun D, He Y. Effects of human adipose-derived mesenchymal stem cells combined with estrogen on regulatory T cells in patients with premature ovarian insufficiency. Int Immunopharmacol 2018; 55:257-262. [DOI: 10.1016/j.intimp.2017.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/09/2017] [Accepted: 12/21/2017] [Indexed: 01/14/2023]
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Kanj RV, Ofei-Tenkorang NA, Altaye M, Gordon CM. Evaluation and Management of Primary Ovarian Insufficiency in Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2018; 31:13-18. [PMID: 28782660 DOI: 10.1016/j.jpag.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/23/2017] [Accepted: 07/31/2017] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVE To identify clinical features associated with primary ovarian insufficiency (POI) and collect data on the evaluation and treatment received. DESIGN Retrospective chart review. Data were abstracted on etiology of POI, history, laboratory evaluation, imaging results, return for clinical care, and treatment plans. SETTING Urban children's hospital in Cincinnati, Ohio. PARTICIPANTS Fifty female patients, age 11-26 years, with initial presentation of POI between January 1, 2006 and December 31, 2015. MAIN OUTCOME MEASURES Etiology of POI, bone mineral density (BMD), laboratory evaluation, and services utilized at presentation. RESULTS Three hundred thirty-one charts were reviewed, 71 with confirmed diagnosis of POI, and 50 with sufficient data for inclusion. Among the 50, 21 (42%) had Turner syndrome, 18 (36%) remained idiopathic, and 11 (22%) had another condition (eg, autoimmune polyglandular syndrome, galactosemia, etc). Thirty-six (72%) were karyotyped; in 14 (28%), 21-hydroxylase antibodies were measured; 32 (64%) underwent dual-energy x-ray absorptiometry BMD measures of lumbar spine. Eight of 50 patients (16%) reported fracture. Of these, at presentation, 4 (50%) had low BMD, and 2 (25%) had slightly low BMD. On initial spinal dual-energy x-ray absorptiometry, 9 of 32 (28%) had low BMD (Z-score ≤ -2.0) and 7 of 32 (22%) were slightly low (-1.0 to -1.9). All started estrogen therapy within 2 years of presentation. In follow-up, only 2 patients (4%) saw a mental health consultant for emotional support. CONCLUSION POI is a model of estrogen deficiency with most cases due to Turner syndrome or idiopathic causes. At presentation, many had low BMD and few were seen for psychological support as part of multidisciplinary care.
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Affiliation(s)
- Rula V Kanj
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nana Ama Ofei-Tenkorang
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Catherine M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Utine GE, Şimşek-Kiper PÖ, Akgün-Doğan Ö, Ürel-Demir G, Alanay Y, Aktaş D, Boduroğlu K, Tunçbilek E, Alikaşifoğlu M. Fragile x-associated premature ovarian failure in a large Turkish cohort: Findings of Hacettepe Fragile X Registry. Eur J Obstet Gynecol Reprod Biol 2017; 221:76-80. [PMID: 29275276 DOI: 10.1016/j.ejogrb.2017.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/08/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine frequency of fragile X associated premature ovarian insufficiency (FXPOI) among Turkish premutation carriers. STUDY DESIGN FMR1 premutation is the single most common genetic cause of POI (FXPOI). Fragile X Registry at Hacettepe University has been reviewed for the frequency of FXPOI among female premutation carriers. Since 1991 when FMR1 testing was available, 760 individuals from 243 families have been registered. Actual data on menstrual status of female premutation carriers were gathered and analysed. RESULTS Among 314 premutation-bearing females in the cohort, 268 could be reached for an update of their menstrual history; 107 adults were 40 or younger and 156 were older than 40 years of age, whereas the remaining 5 patients were prepubertal. Among 263 postpubertal females with premutations, 90 women stopped menstruating before or at 40 years of age (premature ovarian failure - POF), constituting 34.2% of our cohort. Additionally, one carrier of a gray zone allele experienced FXPOI. History of twinning was present once in 18 women (5.7%) and twice in two women (0.6%), one of the latter interestingly bearing a full-mutation. CONCLUSIONS FXPOI rates in the present cohort are higher than those reported in other populations. Higher FXPOI rates in Turkish premutation carriers might be a reflection of younger mean menopause age and higher POI rates in otherwise healthy Turkish women. Since POI is much more frequent among premutation carriers than in general population, testing for CGG repeat expansions in FMR1 should be included in the work-up.
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Affiliation(s)
- Gülen Eda Utine
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey.
| | - Pelin Özlem Şimşek-Kiper
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
| | - Özlem Akgün-Doğan
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
| | - Gizem Ürel-Demir
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
| | - Yasemin Alanay
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey; Acibadem University, School of Medicine, Department of Pediatrics, Pediatric Genetics Unit, Istanbul, Turkey
| | - Dilek Aktaş
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
| | - Koray Boduroğlu
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
| | - Ergül Tunçbilek
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
| | - Mehmet Alikaşifoğlu
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Genetics, Ankara, Turkey
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Torrealday S, Kodaman P, Pal L. Premature Ovarian Insufficiency - an update on recent advances in understanding and management. F1000Res 2017; 6:2069. [PMID: 29225794 PMCID: PMC5710309 DOI: 10.12688/f1000research.11948.1] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 12/11/2022] Open
Abstract
Premature ovarian insufficiency is a complex and relatively poorly understood entity with a myriad of etiologies and multisystem sequelae that stem from premature deprivation of ovarian sex hormones. Timely diagnosis with a clear understanding of the various comorbidities that can arise from estrogen deficiency is vital to appropriately counsel and treat these patients. Prompt initiation of hormone therapy is critical to control the unsolicited menopausal symptoms that many women experience and to prevent long-term health complications. Despite ongoing efforts at improving our understanding of the mechanisms involved, any advancement in the field in recent decades has been modest at best and researchers remain thwarted by the complexity and heterogeneity of the underpinnings of this entity. In contrast, the practice of clinical medicine has made meaningful strides in providing assurance to the women with premature ovarian insufficiency that their quality of life as well as long-term health can be optimized through timely intervention. Ongoing research is clearly needed to allow pre-emptive identification of the at-risk population and to identify mechanisms that if addressed in a timely manner, can prolong ovarian function and physiology.
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Affiliation(s)
- Saioa Torrealday
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Pinar Kodaman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lubna Pal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
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Podfigurna A, Lukaszuk K, Czyzyk A, Kunicki M, Maciejewska-Jeske M, Jakiel G, Meczekalski B. Testing ovarian reserve in pre-menopausal women: why, whom and how? Maturitas 2017; 109:112-117. [PMID: 29292013 DOI: 10.1016/j.maturitas.2017.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Numerous social and environmental factors (environmental hazards, social factors such as education and career, higher economic status desired before the decision is made to have children) influence a women's decision to postpone pregnancy until late reproductive age. In turn, age is related to a fall in ovarian reserve. The main goal of testing ovarian reserve is the identification of women with so-called diminished ovarian reserve (DOR). Additionally, it provides assistance in the counselling of women who are planning to use assisted reproductive techniques (ART). This review examines current methods of testing ovarian reserve and their application. The most useful methods of assessing ovarian reserve are ultrasonographic count of ovarian antral follicles (AFC) and serum tests of both the anti-Müllerian hormone (AMH) level and the third-day level of follicle stimulating hormone (FSH). However, there are limitations to the currently used methods of testing ovarian reserve, especially in relation to their specificity and sensitivity. It is also difficult to predict egg quality based on these tests. The value of screening programmes of ovarian reserve is yet to be determined.
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Affiliation(s)
- Agnieszka Podfigurna
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland; INVICTA Fertility and Reproductive Center, Warsaw, Poland; Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland; Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland
| | - Adam Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Kunicki
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
| | | | - Grzegorz Jakiel
- INVICTA Fertility and Reproductive Center, Warsaw, Poland; Department of Obstetrics and Gynecology, Center of Postgraduate Education, Warsaw, Poland
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
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Man L, Lekovich J, Rosenwaks Z, Gerhardt J. Fragile X-Associated Diminished Ovarian Reserve and Primary Ovarian Insufficiency from Molecular Mechanisms to Clinical Manifestations. Front Mol Neurosci 2017; 10:290. [PMID: 28955201 PMCID: PMC5600956 DOI: 10.3389/fnmol.2017.00290] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
Fragile X syndrome (FXS), is caused by a loss-of-function mutation in the FMR1 gene located on the X-chromosome, which leads to the most common cause of inherited intellectual disability in males and the leading single-gene defect associated with autism. A full mutation (FM) is represented by more than 200 CGG repeats within the FMR1 gene, resulting in FXS. A FM is inherited from women carrying a FM or a premutation (PM; 55–200 CGG repeats) allele. PM is associated with phenotypes distinct from those associated with FM. Some manifestations of the PM are unique; fragile-X-associated tremor/ataxia syndrome (FXTAS), and fragile-X-associated primary ovarian insufficiency (FXPOI), while others tend to be non-specific such as intellectual disability. In addition, women carrying a PM may suffer from subfertility or infertility. There is a need to elucidate whether the impairment of ovarian function found in PM carriers arises during the primordial germ cell (PGC) development stage, or due to a rapidly diminishing oocyte pool throughout life or even both. Due to the possibility of expansion into a FM in the next generation, and other ramifications, carrying a PM can have an enormous impact on one’s life; therefore, preconception counseling for couples carrying the PM is of paramount importance. In this review, we will elaborate on the clinical manifestations in female PM carriers and propose the definition of fragile-X-associated diminished ovarian reserve (FXDOR), then we will review recent scientific findings regarding possible mechanisms leading to FXDOR and FXPOI. Lastly, we will discuss counseling, preventative measures and interventions available for women carrying a PM regarding different aspects of their reproductive life, fertility treatment, pregnancy, prenatal testing, contraception and fertility preservation options.
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Affiliation(s)
- Limor Man
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell MedicineNew York, NY, United States
| | - Jovana Lekovich
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell MedicineNew York, NY, United States
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell MedicineNew York, NY, United States
| | - Jeannine Gerhardt
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell MedicineNew York, NY, United States
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Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study. Br J Cancer 2017. [PMID: 28632729 PMCID: PMC5520518 DOI: 10.1038/bjc.2017.169] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The relationship between hormone exposure and breast cancer risk in women treated with chest radiotherapy for childhood cancer is uncertain. METHODS Participants included 1108 females from the Childhood Cancer Survivor Study who were diagnosed with childhood cancer 1970-1986, treated with chest radiotherapy, and survived to ages ⩾20 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) from Cox models adjusted for chest radiation field, delivered dose, anthracycline exposure, and age at childhood cancer estimated risk. RESULTS Among 195 women diagnosed with breast cancer, 102 tumours were oestrogen-receptor positive (ER+). Breast cancer risk increased with ⩾10 years of ovarian function after chest radiotherapy vs <10 years (HR=2.89, CI 1.56-5.53) and for radiotherapy given within 1 year of menarche vs >1 year from menarche (HR=1.80, CI 1.19-2.72). Risk decreased with decreasing age at menopause (Ptrend=0.014). Risk factors did not differ for ER+ breast cancer. Survivors with an age at menopause <20 years treated with hormone therapy had a lower breast cancer risk than premenopausal survivors (HR=0.47, CI 0.23-0.94). CONCLUSIONS Endogenous hormones are key contributors to breast cancer observed among childhood cancer survivors. Hormone therapy given for premature ovarian insufficiency does not fully replace the function that endogenous hormones have in breast cancer development.
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Abstract
Early menopause or premature ovarian insufficiency (POI) is a common cause of infertility in women and affects about one per cent of young women. This disorder has significant psychological sequelae and major health implications. Its relevance has increased in recent years due to the fact that age of motherhood is being delayed in developed countries, with the risk of having either primary ovarian insufficiency or less possibilities of pregnancy. The main characteristics are absence of ovulation, amenorrhoea and high levels of serum gonadothropins (hypergonadotropic hypogonadism). Although the aetiology remains uncertain in most cases, several rare specific causes have been elucidated. Potential causes for POI are iatrogenic (ovarian surgery, radiotherapy or chemotherapy), environmental factors, viral infections, metabolic and autoinmune diseases, and genetic alterations. Because of the association with other autoimmune diseases, close follow up is recommended in patients with POI. The traditional indicators to evaluate ovarian ageing are age, serum hormonal levels, anti-Mullerian hormone, antral follicle count, and ultrasonography of ovaries. Hormone replacement therapy remains the mainstay of treatment, and the best chance of achieving a pregnancy is through oocyte donation. This article aims to present an overview of potential causes, clinical manifestations, and treatment options of POI.
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Affiliation(s)
- Claudio Hernández-Angeles
- Gynecoobstetrics number 4 "Luis Castelazo Ayala" Hospital, Mexican Social Security Institute, Mexico
| | - Camil Castelo-Branco
- Clínic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
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Torelli FR, Brancalion MF, Yela DA, Benetti-Pinto CL. Determinants of percent mammographic density in women with premature ovarian insufficiency. Climacteric 2017; 20:280-284. [PMID: 28391726 DOI: 10.1080/13697137.2017.1310836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the determinants of breast density in women with premature ovarian insufficiency (POI). METHODS In a cross-sectional study of 163 women with POI undergoing mammography, percent mammographic density (PMD) was evaluated by digitizing the image. PMD was correlated with age, age at menarche, age at POI, time since POI, body mass index (BMI), gestational history and hormone therapy (HT) use (duration, dose, regimen). RESULTS POI was diagnosed at a mean age of 32.3 ± 5.9 years. The mean age of the women at mammography was 41.3 ± 5.4 years; mean BMI was 27.4 ± 5.4 kg/m2 and mean PMD was 24.3 ± 18.5. Mean PMD did not differ between the different age groups evaluated (29-39, 40-49 and 50-55 years) or between users and non-users of HT. Mean duration of HT use was 5.6 ± 4.7 years. PMD was higher in nulligravidas compared to women who had been pregnant (p = 0.0016); however, POI occurred earlier in nulligravidas (p < 0.0001). PMD correlated negatively with BMI (r = -0.27; p = 0.0005). CONCLUSION In women with POI, HT use had no effect on PMD, irrespective of the duration of use, dose or regimen. Pregnancy and BMI were consistently associated with PMD, with density being greater in nulligravidas and in women with lower BMI.
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Affiliation(s)
- F R Torelli
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas , São Paulo , Brazil
| | - M F Brancalion
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas , São Paulo , Brazil
| | - D A Yela
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas , São Paulo , Brazil
| | - C L Benetti-Pinto
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas , São Paulo , Brazil
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Autoimmune premature ovarian failure. MENOPAUSE REVIEW 2017; 15:210-214. [PMID: 28250725 PMCID: PMC5327623 DOI: 10.5114/pm.2016.65666] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022]
Abstract
Premature ovarian failure (POF), also termed as primary ovarian insufficiency (POI), is a highly heterogenous condition affecting 0.5-3.0% of women in childbearing age. These young women comprise quite a formidable group with unique physical and psychological needs that require special attention. Premature ovarian senescence (POS) in all of its forms evolves insidiously as a basically asymptomatic process, leading to complete loss of ovarian function, and POI/POF diagnoses are currently made at relatively late stages. Well-known and well-documented risk factors exist, and the presence or suspicion of autoimmune disorder should be regarded as an important one. Premature ovarian failure is to some degree predictable in its occurrence and should be considered while encountering young women with loss of menstrual regularity, especially when there is a concomitant dysfunction in the immune system.
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Study of the Genetic Etiology of Primary Ovarian Insufficiency: FMR1 Gene. Genes (Basel) 2016; 7:genes7120123. [PMID: 27983607 PMCID: PMC5192499 DOI: 10.3390/genes7120123] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 01/28/2023] Open
Abstract
Menopause is a period of women’s life characterized by the cessation of menses in a definitive way. The mean age for menopause is approximately 51 years. Primary ovarian insufficiency (POI) refers to ovarian dysfunction defined as irregular menses and elevated gonadotrophin levels before or at the age of 40 years. The etiology of POI is unknown but several genes have been reported as being of significance. The fragile X mental retardation 1 gene (FMR1) is one of the most important genes associated with POI. The FMR1 gene contains a highly polymorphic CGG repeat in the 5′ untranslated region of exon 1. Four allelic forms have been defined with respect to CGG repeat length and instability during transmission. Normal (5–44 CGG) alleles are usually transmitted from parent to offspring in a stable manner. The full mutation form consists of over 200 repeats, which induces hypermethylation of the FMR1 gene promoter and the subsequent silencing of the gene, associated with Fragile X Syndrome (FXS). Finally, FMR1 intermediate (45–54 CGG) and premutation (55–200 CGG) alleles have been principally associated with two phenotypes, fragile X tremor ataxia syndrome (FXTAS) and fragile X primary ovarian insufficiency (FXPOI).
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Abstract
Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Despite the description of different genetic, immune and iatrogenic factors of POI, the etiology of most cases of this disease are unexplained, and optimal management strategies are still unclear. Recent data showed that POI may have a long period of oligomenorrhea before the fully developed form (complete ovarian failure stage), with the occurrence of amenorrhea and climacteric symptoms. The main problem in the recognition of early stages of POI is the lack of proper diagnostic criteria. Patients with an undiagnosed occult form of POI may present with menstrual irregularities, unexplained infertility or repeated IVF failures. We evaluated 23 patients with unexplained oligomenorrhea and/or infertility. After a proper evaluation of these patients, a low ovarian reserve was identified, and an occult form of POI was diagnosed.
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Affiliation(s)
- I G Shestakova
- a Department of Obstetrics and Gynecology with Course of Perinatology of the Russian University of Peoples' Friendship , Moscow , Russia
| | - V E Radzinsky
- a Department of Obstetrics and Gynecology with Course of Perinatology of the Russian University of Peoples' Friendship , Moscow , Russia
| | - M B Khamoshina
- a Department of Obstetrics and Gynecology with Course of Perinatology of the Russian University of Peoples' Friendship , Moscow , Russia
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Autoimmune polyglandular syndrome type 3 (APS-3) among patients with premature ovarian insufficiency (POI). Eur J Obstet Gynecol Reprod Biol 2016; 203:61-5. [PMID: 27240263 DOI: 10.1016/j.ejogrb.2016.05.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/25/2016] [Accepted: 05/13/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Autoimmune polyglandular syndrome type 3 - (APS-3), is defined as the coexistence of autoimmune thyroiditis with other non-ovarian autoimmune diseases without primary adrenal insufficiency. Additionally the definition of APS-3 also includes primary ovarian insufficiency (POI) coexistence with autoimmune thyroiditis. The main goal of that study is to assess the prevalence of APS-3 defined as coexistence of autoimmune thyroiditis with POI in population of 46 XX karyotype women with primary ovarian insufficiency (POI). The second goal is to investigate hormonal profile and insulin sensitivity in women with POI and subgroups of women with APS-3 - POI/APS-3(+) and without APS 3 - POI/APS-3(-). MATERIALS AND METHODS Anthropometric measurements, coexistence of autoimmune diseases, androgens, fasting glucose and insulin, glucose and insulin at 60' and 120' of oral glucose tolerance test (OGTT) and homeostasis model for insulin resistance (HOMA-IR), were determine in 98 patients aged between 18 and 39 with spontaneous 46 XX primary ovarian insufficiency (POI), in 33 POI/APS-3(+), 65 POI/APS-3(-), and 75 healthy controls. RESULTS Continuous data were summarized by the mean±standard deviation (SD), and categorical data by number (percentages). Data were checked for normality using Shapiro-Wilk test, the comparison between groups were performed using non-parametric Mann-Whitney or Kruskall-Wallis test. Pearson's correlation coefficient was used to assess the relationships between parameters. Statistical significance was defined as p values <0.05. Autoimmune thyroid disease (ATD) was presented in 33/98 (33.7%) patients with POI. The groups did not differ significantly in respect to age and body mass index (BMI). Women with POI, POI/APS-3(+) and POI/APS-3(-) showed significantly lower serum androgens in comparison to controls. Additionally women with POI/APS-3(+) showed hyperinsulinemia after 1h of OGTT; No significant differences in serum fasting glucose, insulin and during 2h OGTT between groups were observed. CONCLUSIONS The prevalence of APS-3 is 33.7% in patients with spontaneous 46 XX primary ovarian insufficiency. Women with POI, POI/APS-3(+) and POI/APS-3(-) feature lower testosterone, androstendione, dehydroepiandrostendione sulphate in comparison to controls. Women with POI/APS-3(+) could have hyperinsulinemia and should be carefully evaluated for metabolic disorders.
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Yldrm G, Tokmak A, Kokanal MK, Sarkaya E, Züngün C, İnal HA, Ylmaz FM, Ylmaz N. Association between some inflammatory markers and primary ovarian insufficiency. Menopause 2016; 22:1000-5. [PMID: 25647778 DOI: 10.1097/gme.0000000000000423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study investigated the discriminative values of neutrophil-to-lymphocyte ratio (NLR), serum amyloid A protein (SAA), and C-reactive protein (CRP) in cases of primary ovarian insufficiency (POI). METHODS A total of 84 women were included in this comparative cross-sectional study. The study group consisted of 43 women diagnosed as having POI, and the control group consisted of 41 women with normal fertility. After obtaining a written informed consent form from all participants, we retrieved clinical and demographic data and laboratory findings from the participants and the hospital database. The following variables were analyzed: age, body mass index, smoking, family history, comorbidities, sonographic findings, complete blood count, baseline hormone levels, CRP, and SAA. RESULTS NLR was significantly lower in the study group than in the control group (mean [SD], 1.3 [0.7] vs 2.0 [0.7]; P < 0.001). The mean SAA level was 151.6 ng/mL (range, 48.5-12,554.7 ng/mL) in the study group and 147.8 ng/mL (range, 29.8-3,760.4 ng/mL) in the control group (P > 0.05). There was no significant difference in serum CRP levels between two groups (P > 0.05). Receiver operating characteristic analysis revealed that NLR, but not SAA and CRP, was a significantly discriminative parameter for POI (area under the curve, 0.829; P < 0.001). Multivariate logistic regression analysis showed that a family history of POI, smoking, and NLR of 1.5 or less were independent risk factors for POI. CONCLUSIONS SAA and CRP do not seem to be valuable discriminative markers for POI, whereas NLR may be a significant promising marker before presentation or in the early stages of POI and may be useful for developing appropriate fertility treatment options.
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Affiliation(s)
- Gülçin Yldrm
- 1Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey 2Department of Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Dhingra R, Darrow LA, Klein M, Winquist A, Steenland K. Perfluorooctanoic acid exposure and natural menopause: A longitudinal study in a community cohort. ENVIRONMENTAL RESEARCH 2016; 146:323-330. [PMID: 26802619 DOI: 10.1016/j.envres.2015.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/27/2015] [Accepted: 12/31/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Perfluorooctanoic acid (PFOA), a suspected endocrine disruptor, is a bio-persistent chemical found at low levels in the serum of nearly all U.S. residents. Early menopause has been positively associated with serum PFOA in prior cross-sectional studies. METHODS We conducted a longitudinal analysis of age at menopause among women, aged ≥40 years, (N=8759) in a Mid-Ohio Valley community cohort, exposed to high PFOA levels via contaminated drinking water. Using estimated retrospective year-specific serum PFOA concentrations (1951-2011), we examined the associations between PFOA, as cumulative exposure or year-specific serum estimates, and natural menopause using a Cox proportional hazards models. As participants were initially recruited in 2005-2006, we also analyzed the cohort prospectively (i.e., from the time of enrollment), using both modeled cumulative PFOA, and PFOA serum levels measured in 2005-2006. Women with hysterectomy (a competing risk) were either censored or excluded from the analysis. RESULTS Neither in the retrospective nor the prospective cohort did we find a significant (at α=0.05) trend between PFOA exposure and natural menopause. The non-significant, hazard ratios by quintile of increasing cumulative serum PFOA were 1.00 (referent), 1.00, 1.09, 1.05 and 1.06 (trend test for log cumulative exposure: p=0.37) with hysterectomies censored, and 1.00 (referent), 1.06, 1.13, 1.09 and 1.11 (trend test for log cumulative exposure: p=0.85) with hysterectomies excluded. Year-specific serum estimates were also not associated with early menopause. CONCLUSION Our data suggest that earlier age at menopause is not associated with PFOA exposure.
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Affiliation(s)
- Radhika Dhingra
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Mitch Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
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Abstract
A heterogeneous disorder, premature menopause is not an uncommon entity, affecting approximately 1% of women younger than 40 years. Multisystem implications are recognized as sequelae to the premature deprivation of ovarian steroids, posing unique health-related challenges in this population. An integrated management approach that addresses both the physical and psychological health concerns and the overall well-being of this relatively chronologically young population is paramount.
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Affiliation(s)
- Saioa Torrealday
- Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28311, USA
| | - Lubna Pal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
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Abstract
Abnormal menstruation in adolescent girls can cause psychological and physical strain from excess, unpredictable, painful, or even absent bleeding. Care providers who understand what is normal and what is concerning can educate and often reassure the young woman and her family. When there is an abnormal or concerning scenario, they can initiate investigations and/or treatment in an expedient fashion to limit psychosocial and/or physical morbidity. This article provides pediatricians, family doctors, nurse practitioners, and adult gynecologists with the knowledge and understanding of the common complaints, differential diagnoses, and treatment strategies.
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Affiliation(s)
- Mary Anne Jamieson
- Department of Obstetrics & Gynecology, Queen's University, 99 University Ave, Kingston, Ontario K7L 3N6, Canada.
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Labrie F, Archer DF, Bouchard C, Girard G, Ayotte N, Gallagher JC, Cusan L, Baron M, Blouin F, Waldbaum AS, Koltun W, Portman DJ, Côté I, Lavoie L, Beauregard A, Labrie C, Martel C, Balser J, Moyneur É. Prasterone has parallel beneficial effects on the main symptoms of vulvovaginal atrophy: 52-week open-label study. Maturitas 2015; 81:46-56. [DOI: 10.1016/j.maturitas.2015.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
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Benetti-Pinto CL, Brancalion MF, Assis LH, Tinois E, Giraldo HPD, Cabello C, Yela DA. Mammographic breast density in women with premature ovarian failure: a prospective analysis. Menopause 2015; 21:933-7. [PMID: 24518154 DOI: 10.1097/gme.0000000000000204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to compare breast density between two mammograms in women with premature ovarian failure (POF). METHODS A cohort study evaluated 56 women with POF. Two mammograms performed at least 2 years apart were analyzed. Mammogram films were digitalized, and images were assessed using a computer-assisted method; the percentage of breast image that is radiologically dense is referred to as the percentage of mammographic density (PMD). Age at menarche, age at onset of POF, length of POF, length of estrogen-progestin therapy (EPT), body mass index (BMI), pregnancy, and age at the time of each mammogram were evaluated. RESULTS The mean (SD) age at POF diagnosis was 32.35 (5.95) years. In the first mammogram, the mean (SD) age, BMI, and length of POF were 37.58 (3.72) years, 26.79 (4.86) kg/m, and 5.25 (4.61) years, respectively. EPT had been used for a mean (SD) of 2.71 (3.12) years. In the second mammogram, the mean (SD) age, BMI, and length of POF were 43.23 (4.98) years, 27.6 (5.39) kg/m, and 10.5 (5.11) years, respectively. EPT had been used for a mean (SD) of 7.25 (4.6) years. The mean (SD) interval between mammograms was 5.25 (3) years, and the mean (SD) PMD decreased from 27.78% (21.04%) to 17.53% (15.71%) (P = 0.007). Comparing PMD between women taking EPT and those not taking EPT, we observed no significant differences. In both instances, multiparous women had lower PMD than nulliparous women (P < 0.05). BMI, length of POF, and pregnancy were negatively correlated with PMD. CONCLUSIONS Breast density in young women with POF decreases across a period of 5 years, regardless of EPT use. Further studies may elucidate how this result will correlate with decision-making in clinical therapeutics and breast cancer risk in POF.
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Affiliation(s)
- Cristina Laguna Benetti-Pinto
- From the 1Department of Gynecology and Obstetrics, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil; and 2Institute of Security and Technology in Radiation, Campinas, São Paulo, Brazil
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Bouchard C, Labrie F, Archer DF, Portman DJ, Koltun W, Elfassi É, Grainger DA, Ayotte N, Cooper TA, Martens M, Waldbaum AS, Labrie C, Côté I, Lavoie L, Martel C, Balser J. Decreased efficacy of twice-weekly intravaginal dehydroepiandrosterone on vulvovaginal atrophy. Climacteric 2015; 18:590-607. [DOI: 10.3109/13697137.2014.992012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Bakhsh H, Dei M, Bucciantini S, Balzi D, Bruni V. Premature ovarian insufficiency in young girls: repercussions on uterine volume and bone mineral density. Gynecol Endocrinol 2015; 31:65-9. [PMID: 25203144 DOI: 10.3109/09513590.2014.958987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVE To evaluate biological differences among young subjects with premature ovarian insufficiency (POI) commencing at different stages of life. DESIGN Retrospective observational study. SETTING Careggi University Hospital Participants: One hundred sixty-two females aged between 15 and 29 years with premature ovarian insufficiency. METHODS Data were collected as a retrospective chart review of baseline evaluation at diagnosis of premature ovarian insufficiency (POI). About 162 participants were divided into four groups based on gynecological age. Two primary outcome variables (uterine development and bone mineral density (BMD)) were analyzed in terms of differences among groups and in a multivariate logistic regression analysis. RESULTS Uterine development was clearly jeopardized when estrogen insufficiency started at a very young age. Total body BMD showed significant differences among the four groups studied, clearly corresponding to the duration of ovarian function. Data were discussed in relation to the choice of hormone replacement therapy regimens.
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Affiliation(s)
- Hanadi Bakhsh
- Pediatric and Adolescent Gynecology Unit, Careggi Hospital , Florence , Italy
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Sassarini J, Lumsden MA, Critchley HOD. Sex hormone replacement in ovarian failure - new treatment concepts. Best Pract Res Clin Endocrinol Metab 2015; 29:105-14. [PMID: 25617176 DOI: 10.1016/j.beem.2014.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Premature ovarian failure is associated with decreased bone mass and fractures, and an increased risk of premature death from cardiovascular disease. There is also fertility compromise associated not only with the loss of ovarian function but, in those with pre-pubertal POF, inadequate uterine morphology. A wide variety of hormone replacement regimes are reported, but there is no clear evidence of best practice. Hormone replacement therapy (HRT) and the combined oral contraceptive pill (COCP) will suppress menopausal symptoms; however neither is designed to achieve physiological replacement of oestrogen and progesterone. There is evidence that physiological sex steroid replacement is superior to standard hormone replacement, in improving uterine volume as well as an improved blood pressure profile and bone mineral density. Sex steroid replacement therapy is long-term in these women, and therefore it is essential that the risk benefit ratio is optimal to maximise longer term health.
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Affiliation(s)
- Jenifer Sassarini
- Obstetrics and Gynaecology, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, G31 2ER, United Kingdom.
| | - Mary Ann Lumsden
- Obstetrics and Gynaecology, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, G31 2ER, United Kingdom.
| | - Hilary O D Critchley
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom.
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Labrie F. All sex steroids are made intracellularly in peripheral tissues by the mechanisms of intracrinology after menopause. J Steroid Biochem Mol Biol 2015; 145:133-8. [PMID: 24923731 DOI: 10.1016/j.jsbmb.2014.06.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/21/2014] [Accepted: 06/06/2014] [Indexed: 11/22/2022]
Abstract
Following the arrest of estradiol secretion by the ovaries at menopause, all estrogens and all androgens in postmenopausal women are made locally in peripheral target tissues according to the physiological mechanisms of intracrinology. The locally made sex steroids exert their action and are inactivated intracellularly without biologically significant release of the active sex steroids in the circulation. The level of expression of the steroid-forming and steroid-inactivating enzymes is specific to each cell type in each tissue, thus permitting to each cell/tissue to synthesize a small amount of androgens and/or estrogens in order to meet the local physiological needs without affecting the other tissues of the organism. Achieved after 500 million years of evolution, combination of the arrest of ovarian estrogen secretion, the availability of high circulating levels of DHEA and the expression of the peripheral sex steroid-forming enzymes have permitted the appearance of menopause with a continuing access to intratissular sex steroids for the individual cells/tissues without systemic exposure to circulating estradiol. In fact, one essential condition of menopause is to maintain serum estradiol at biologically inactive (substhreshold) concentrations, thus avoiding stimulation of the endometrium and risk of endometrial cancer. Measurement of the low levels of serum estrogens and androgens in postmenopausal women absolutely requires the use of MS/MS-based technology in order to obtain reliable accurate, specific and precise assays. While the activity of the series of steroidogenic enzymes can vary, the serum levels of DHEA show large individual variations going from barely detectable to practically normal "premenopausal" values, thus explaining the absence of menopausal symptoms in about 25% of women. It should be added that the intracrine system has no feedback elements to adjust the serum levels of DHEA, thus meaning that women with low DHEA activity will not be improved without external supplementation. Exogenous DHEA, however, follows the same intracrine rules as described for endogenous DHEA, thus maintaining serum estrogen levels at substhreshold or biologically inactive concentrations. Such blood concentrations are not different from those observed in normal postmenopausal women having high serum DHEA concentrations. Androgens, on the other hand, are practically all made intracellularly from DHEA by the mechanisms of intracrinology and are always maintained at very low levels in the blood in both pre- and postmenopausal women. Proof of the importance of intracrinology is also provided, among others, by the well-recognized benefits of aromatase inhibitors and antiestrogens used successfully for the treatment of breast cancer in postmenopausal women where all estrogens are made locally. Each medical indication for the use of DHEA, however, requires clinical trials performed according to the FDA guidelines and the best rules of clinical medicine.
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Ge P, Xing N, Ren Y, Zhu L, Han D, Kuang H, Li J. Preventive Effect of American Ginseng Against Premature Ovarian Failure in a Rat Model. Drug Dev Res 2014; 75:521-8. [DOI: 10.1002/ddr.21234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 10/24/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Pengling Ge
- Department of Pharmacology; School of Basic Medical Sciences; Heilongjiang University of Chinese Medicine; Harbin 150040 China
- The Key Laboratory of Myocardial Ischemia (Harbin Medical University); Chinese Ministry of Education; Harbin 150086 China
| | - Nannan Xing
- Department of Pharmacology; School of Basic Medical Sciences; Heilongjiang University of Chinese Medicine; Harbin 150040 China
| | - Yanhai Ren
- Department of Neurosurgery; Affiliated Hongqi Hospital of Mudanjiang Medical College; Mudanjiang 150007 China
| | - Lei Zhu
- Department of Pharmacology; School of Basic Medical Sciences; Heilongjiang University of Chinese Medicine; Harbin 150040 China
| | - Dongwei Han
- The Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China; Department of Formulas of Traditional Chinese Medicine; School of Basic Medical Sciences; Heilongjiang University of Chinese Medicine; Harbin 150040 China
| | - Haixue Kuang
- Key Laboratory of Chinese Materia Medica; Heilongjiang University of Chinese Medicine; Ministry of Education; Harbin 150040 China
| | - Ji Li
- The Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China; Department of Formulas of Traditional Chinese Medicine; School of Basic Medical Sciences; Heilongjiang University of Chinese Medicine; Harbin 150040 China
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Mittal M, Savvas M, Narvekar N, Panay N, Hamoda H. A cross-sectional national questionnaire survey assessing the clinical attitudes of members of the British Menopause Society to the management of women with premature ovarian insufficiency. Post Reprod Health 2014; 20:90-97. [PMID: 24973048 DOI: 10.1177/2053369114540883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the current clinical attitudes of members of the British Menopause Society to the management of premature ovarian insufficiency. DESIGN An electronic cross-sectional questionnaire survey. SETTING Members of the British Menopause Society. POPULATION All members of the British Menopause Society with a valid email address. METHOD Completion of an electronic survey. MAIN OUTCOME MEASURES Investigations and treatment options and preferences for the management of women with premature ovarian insufficiency. RESULTS A total of 130 questionnaires were returned and analysed. The majority of responses were from Hospital Consultants (n = 55/130; 42.3%). A total of 53/124 (42.7%) clinicians routinely performed a bone density scan. A total of 73/130 (56.2%) clinicians would prescribe hormone replacement therapy in preference to combined ethinyl estradiol and progesterone (COC; 27/130, 20.8%). A total of 44/108 (40.7%) routinely prescribed oral estradiol in preference to transdermal administration (62/108, 57.4%). A total of 26/128 (20.3%) prescribed oral micronised progesterone, 31/128 (24.2%) oral progestogens, while 42/128 (32.8%) preferred the intra-uterine system. Fertility concerns remain an important aspect of care, with 33.9% (n = 39/115) of clinicians indicating that more than 50% of their patients had a concern regarding their fertility. CONCLUSION The majority of clinicians indicated a preference for hormone replacement therapy instead of the COC as their choice of hormone replacement in women with premature ovarian insufficiency. However, there was a significant variation in practices. This information can be useful in counselling women and in guiding clinical practitioners. The results highlight the need for further research to determine the optimal regimens for the management of women with premature ovarian insufficiency.
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Affiliation(s)
- Monica Mittal
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
| | - Michael Savvas
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
| | - Nitish Narvekar
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
| | - Nick Panay
- Queen Charlotte's and Chelsea & Westminster Hospitals, London, UK
| | - Haitham Hamoda
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
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Ye Y, Lan X, Cong J, Li N, Wu Y, Zhang M, Liu J, Cui Y, Wu BL, An Y, Wu J. Analysis of CGG repeats in FMR1 in Chinese women with idiopathic premature ovarian failure. Reprod Biomed Online 2014; 29:382-7. [DOI: 10.1016/j.rbmo.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/30/2014] [Accepted: 05/01/2014] [Indexed: 01/26/2023]
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Mittal M, Kreatsa M, Narvekar N, Savvas M, Hamoda H. Fertility desires, choice of hormone replacement and the effect of length of time since menopause on bone density in women with premature ovarian insufficiency: a review of 223 consecutive new referrals to a tertiary centre. Post Reprod Health 2014; 20:104-11. [PMID: 24973049 DOI: 10.1177/2053369114539151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Premature ovarian insufficiency can have significant implications for the affected women. This review assesses the fertility desires, choice of hormone replacement, and the effect of time since menopause on the bone density of these women. This is a retrospective analysis of 223 consecutive new referrals. The average age (mean [± standard deviation]) of the women was 37.35 (± 5.88) years, with 24.1% (n = 19/79) presenting within 12 months of the onset of symptoms, most commonly, vasomotor type symptoms (n = 98/223; 43.9%). Of the women included, 58.7% (n = 131/223) took hormone replacement therapy (HRT), most commonly, an oral (n = 90/131; 68.7%) sequential preparation (n = 91/131; 69.5%), with a significant number of women >40 years of age preferring the transdermal route (n = 26/54; 48.1%; p<0.01). A total of 37.7% (n = 84/223) of the women expressed concerns regarding their future fertility, more notable in women ≤ 40 years (n = 72/142; 50.7%; p < 0.01). Of these, 41.7% (n = 35/84) took HRT, most commonly, a sequential regimen (n = 26/35; 74.3%) with oral estradiol (n = 30/35; 85.7%); 69.5% (n = 155/223) of the women had had a bone densitometry scan performed, with 66.5% (n = 103/155) showing normal bone mineral density (BMD), but a greater likelihood of having reduced BMD the greater the time delay in presentation. No difference was seen for the three broad categories of BMD when further analysed for the cause of premature ovarian insufficiency, but a significant difference was noted for the spinal Z-scores, whereby women who underwent a surgically induced menopause were noted to have lower BMD compared with the other causes (p < 0.01). These findings can be useful in counselling women and guiding clinicians in their management of women with premature ovarian insufficiency.
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Affiliation(s)
- Monica Mittal
- King's College Hospital NHS Foundation Trust, London, UK
| | - Maria Kreatsa
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Michael Savvas
- King's College Hospital NHS Foundation Trust, London, UK
| | - Haitham Hamoda
- King's College Hospital NHS Foundation Trust, London, UK
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