Premature Ovarian Failure (POF)

Clicklectureredit Master subtitle style Assistant to

by: Yasmen Mahran
Pharmacology and toxicology AIN Shams University

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contents
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Introduction: POF Clinical picture and diagnosis Etiology of hormones in pathophysiology and management

Role

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Premature Ovarian Failure

refers to development of amenorrhoea due to cessation of ovarian function before the age of 40.

Hypergonadotropic hypogonadism

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Ovarian Failure

FSH
(+)

E2 (-)
menopausal symptoms
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gy lo tio E
Understanding

the term (folliculogenesis) and ovulation as well as the role of each hormone

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Hormone Role Gonadotro + folliculogenesis and estrogen secretion from the ovaries induces expression of FSH receptors on follicles pins 1) FSH 2) LH
LH surge initiates the ovulatory process + progesterone synthesis increased LH receptors. + the proliferation of granulosa cells from small follicles increases granulosa cell gonadotropin receptor levels

Estrogen

makes negative as well as positive feedback effect on gonadotropins initiating their surge for ovulation specific receptor ER alpha and beta

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Progesterone converts theendometriumto its secretory stage to prepare the uterus for implantation

Thyroid hormone
Anti Mullerian Hormone RECENT

Synergizes with FSH to exert stimulatory granulosa cell differentiation and function.

effects

on

regulates the number of follicles that grow from the primordial pool and the selection of the dominant follicle from the FSH-sensitive follicle. Nil level in women with POF

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Causes
Idiopathic Iatrogenic:

*Chemotherapy *Radiotherapy *Pelvic surgery

Autoimmune Gene

diseases

mutations: FSH & LH receptor mutations

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Management

Hormone replacement therapy (HRT)

Infertility

personal and emotional support

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Hormone replacement therapy

standard

treatment estrogen +/- oral contraceptive pill. Exogenous E sensitizes the granulose cells to FSH, ovulation and conception risk of (breast cancer and cardiovascular events) E + progestin to avoid endometrial hyperplasia + testosterone in cases of persistent fatigue and loss of libido

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patients undergoing chemo-\radio-therapy develop POF with ovarian follicular loss

Note

Usually,

gonadotropins releasing hormones agonist (GnRH) (leuprolide , goserelin & triptorelin)

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Treatment of the cause is a must

Note

Hypothyrodism, RECENT

autoimmune diseases

Gene therapy for defective FSH Receptor mutations

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Infertility
The only reliable fertility treatment is the use of in vitro fertilization (IVF) (high success rate) ovulation induction: *Clomiphene (Clomid) * pulsatile GnRh *(r FSH) (Gonal-F, Follistim) corticosteroids +/- clomiphene
Success rate modest

Cryopreservation
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women with POF most likely have follicles that are of lower quality. However, there may not be any other option for being a MOM

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k n a h T u o y
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