Question

Please give a detailed pathophysiology of premature menopause or primary ovarian insufficiency.

Answer 1

Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. When this happens, your ovaries don't produce normal amounts of the hormone estrogen or release eggs regularly. This condition often leads to infertility.

Premature ovarian failure (POF) affects 1% of young women. This condition has significant psychological sequelae and major health implications. POF seriously interferes with fertility and family planning. Diverse etiologies are associated with POF. Literature review related to the causes and pathogenesis of POF, cited between the year 1900 and May 2010. POF may be either spontaneous or induced. The known causes include:

• Genetic disorders, which could involve the X chromosome or autosomes. However, the growing body of literature demonstrates a list of newly discovered mutations that may be responsible for causing POF. Most of these mutations are extremely rare, and most cases of POF are still considered to be idiopathic.

• Autoimmune causes; there is some evidence of an association of POF with lymphocytic oophoritis and other autoimmune disorders. Antiovarian antibodies are reported in POF, but their specificity and pathogenic role are obscure.

• Iatrogenic causes; chemotherapy, radiotherapy and pelvic surgery can lead to POF.

• Infectious Causes; some viral and microbial infections can be followed by POF.

• Environmental toxins, such as cigarette smoking are reported as risk factors of spontaneous POF.

• Idiopathic; in most cases, no identifiable etiology can be recognized after complete evaluation.