Management Of Premature Ovarian Failure Research Articles

Current understanding of the genomic abnormities in premature ovarian failure: chance for early diagnosis and management.

Premature ovarian failure (POF) is an insidious cause of female infertility and a devastating condition for women. POF also has a strong familial and heterogeneous genetic background. Management of POF is complicated by the variable etiology and presentation, which are generally characterized by abnormal hormone levels, gene instability and ovarian dysgenesis. To date, abnormal regulation associated with POF has been found in a small number of genes, including autosomal and sex chromosomal genes in folliculogenesis, granulosa cells, and oocytes. Due to the complex genomic contributions, ascertaining the exact causative mechanisms has been challenging in POF, and many pathogenic genomic characteristics have yet to be elucidated. However, emerging research has provided new insights into genomic variation in POF as well as novel etiological factors, pathogenic mechanisms and therapeutic intervention approaches. Meanwhile, scattered studies of transcriptional regulation revealed that ovarian cell function also depends on specific biomarker gene expression, which can influence protein activities, thus causing POF. In this review, we summarized the latest research and issues related to the genomic basis for POF and focused on insights gained from their biological effects and pathogenic mechanisms in POF. The present integrated studies of genomic variants, gene expression and related protein abnormalities were structured to establish the role of etiological genes associated with POF. In addition, we describe the design of some ongoing clinical trials that may suggest safe, feasible and effective approaches to improve the diagnosis and therapy of POF, such as Filgrastim, goserelin, resveratrol, natural plant antitoxin, Kuntai capsule et al. Understanding the candidate genomic characteristics in POF is beneficial for the early diagnosis of POF and provides appropriate methods for prevention and drug treatment. Additional efforts to clarify the POF genetic background are necessary and are beneficial for researchers and clinicians regarding genetic counseling and clinical practice. Taken together, recent genomic explorations have shown great potential to elucidate POF management in women and are stepping from the bench to the bedside.

Trends in Management of Premature Ovarian Failure: The Role of Anti-Mullerian Hormone (AMH) and Tibolone

Trends in Management of Premature Ovarian Failure: The Role of Anti-Mullerian Hormone (AMH) and Tibolone

Extreme infertility

New germ cells and new organs open new areas in the approach to treating infertility.

Diagnosis and management of premature ovarian failure

The Obstetrician & GynaecologistVolume 13, Issue 2 p. 67-72 Review Diagnosis and management of premature ovarian failure Puneet Arora MD MRCOG, Puneet Arora MD MRCOG Registrar in Obstetrics and Gynaecology Hope Hospital, Stott Lane, Salford M6 8HD, UKSearch for more papers by this authorDavid W Polson MD FRCOG, David W Polson MD FRCOG Consultant in Obstetrics and Gynaecology Hope Hospital, Salford, UKSearch for more papers by this author Puneet Arora MD MRCOG, Puneet Arora MD MRCOG Registrar in Obstetrics and Gynaecology Hope Hospital, Stott Lane, Salford M6 8HD, UKSearch for more papers by this authorDavid W Polson MD FRCOG, David W Polson MD FRCOG Consultant in Obstetrics and Gynaecology Hope Hospital, Salford, UKSearch for more papers by this author First published: 15 April 2011 https://doi.org/10.1576/toag.13.2.67.27648Citations: 4 Email: parora@doctors.org.uk (corresponding author) Please cite this article as: Arora P, Polson DW. Diagnosis and management of premature ovarian failure. The Obstetrician & Gynaecologist 2011;13:67–72. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume13, Issue2April 2011Pages 67-72 This article also appears in:Fertility and Assisted ReproductionSexual and Reproductive Health RelatedInformation

Editorial

Editorial

EMAS position statement: Managing women with premature ovarian failure

Introduction Premature ovarian failure (also known as premature menopause) is defined as menopause before the age of 40. It can be “natural” or “iatrogenic” such as after bilateral oophorectomy. It may be either primary or secondary. In the majority of cases of primary POF the cause is unknown. Chromosome abnormalities (especially X chromosome), follicle-stimulating hormone receptor gene polymorphisms, inhibin B mutations, enzyme deficiencies and autoimmune disease may be involved. Secondary POF is becoming more important as survival after treatment of malignancy through surgery, radiotherapy and chemotherapy continues to improve. Aim To formulate a position statement on the management of premature ovarian failure. Materials and methods Literature review and consensus of expert opinion. Results and conclusions Diagnosis should be confirmed with an elevated FSH greater than 40 IU/L and an estradiol level below 50 pmol/L in the absence of bilateral oophorectomy. Further assessment should include thyroid function tests, autoimmune screen for polyendocrinopathy, karyotype (less than 30 years of age) and bone mineral density. Untreated early ovarian failure increases the risk of osteoporosis, cardiovascular disease, dementia, cognitive decline and Parkinsonism. The mainstay of treatment is hormone therapy which needs to be continued until the average age of the natural menopause. With regard to fertility, while spontaneous ovulation may occur the best chance of achieving pregnancy is through donor oocyte in vitro fertilization. It is essential that women are provided with adequate information as they may find it a difficult diagnosis to accept. It is recommended that women with POF are seen in a specialist unit able to deal with their multiple needs.

The role of hormone replacement therapy in the management of premature ovarian failure

Premature ovarian failure (POF) generally occurs before 40 years of age and is characterized by amenorrhea and follicle-stimulating hormone levels within the menopausal range. Variations in the endogenous estradiol levels can also occur. The potential risks and benefits of hormone replacement therapy for women with POF are discussed in this Viewpoint.

Management of premature menopause

There has been some confusion among women and health professionals since the publication of the Women's Health Initiative and Million Women studies about the management of premature ovarian failure (POF). Both studies were undertaken in women aged 50 and over, and cannot be extrapolated to their younger counterparts, who would normally be producing their endogenous estrogen, since they have functioning ovaries. Estrogen-based replacement therapy is the main stay of treatment for women with POF and is recommended at least until the average age of natural menopause (52 years in the UK). This view is endorsed by regulatory bodies such as the Committee on Safety of Medicines (now the Commission on Human Medicines) in the UK. No evidence shows that estrogen replacement increases the risk of breast cancer to a level greater than that found in normally menstruating women, and women with POF do not need to start mammographic screening early unless other risk factors are present, such as family history.

Premature ovarian failure.

Premature ovarian failure remains a multifactorial syndrome in which genetic, immune, and environmental factors may play a role. The possible etiology and pathophysiology of premature ovarian failure is reviewed. A scheme of the management of premature ovarian failure is illustrated. This allows a logical approach in which the final diagnosis has to be made with laparotomy ovarian biopsy. It is hoped that future research can be directed to the solution of the etiology of premature menopause and insensitive ovary syndrome, as well as the management of patients with insensitive ovary syndrome, so that either by estrogen replacement or stimulation with hypothalamic/pituitary hormone these primordial follicles can be induced to develop normally.