Premature ovarian failure
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Premature ovarian failure
Endocrine system
Adrenal gland disorders
Congenital adrenal hyperplasia
Primary adrenal insufficiency
Waterhouse-Friderichsen syndrome
Hyperaldosteronism
Adrenal cortical carcinoma
Cushing syndrome
Conn syndrome
Thyroid gland disorders
Thyroglossal duct cyst
Hyperthyroidism
Graves disease
Thyroid eye disease (NORD)
Toxic multinodular goiter
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Hypothyroidism
Euthyroid sick syndrome
Hashimoto thyroiditis
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Postpartum thyroiditis
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Hyperparathyroidism
Hypoparathyroidism
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Pancreatic disorders
Diabetes mellitus
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Hyperprolactinemia
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Gigantism
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Hypopituitarism
Growth hormone deficiency
Pituitary apoplexy
Sheehan syndrome
Hypoprolactinemia
Constitutional growth delay
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Gonadal dysfunction
Precocious puberty
Delayed puberty
Premature ovarian failure
Polycystic ovary syndrome
Androgen insensitivity syndrome
Kallmann syndrome
5-alpha-reductase deficiency
Polyglandular syndromes
Autoimmune polyglandular syndrome type 1 (NORD)
Endocrine tumors
Multiple endocrine neoplasia
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Carcinoid syndrome
Pheochromocytoma
Neuroblastoma
Opsoclonus myoclonus syndrome (NORD)
Endocrine system pathology review
Adrenal insufficiency: Pathology review
Adrenal masses: Pathology review
Hyperthyroidism: Pathology review
Hypothyroidism: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Diabetes mellitus: Pathology review
Cushing syndrome and Cushing disease: Pathology review
Pituitary tumors: Pathology review
Hypopituitarism: Pathology review
Diabetes insipidus and SIADH: Pathology review
Multiple endocrine neoplasia: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
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Estrogen p. 654, 680
premature ovarian failure p. 652, 669
Follicle-stimulating hormone (FSH)
premature ovarian failure p. 652, 669
Luteinizing hormone (LH)
premature ovarian failure p. 652, 669
Premature ovarian failure p. 652, 669
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Content Reviewers
Rishi Desai, MD, MPHContributors
Antonia Syrnioti, MD
Sarah Clifford, BMBS, BSc (Hons)
In premature ovarian failure, which is also called primary ovarian insufficiency, the ovaries stop functioning normally, and this means that they stop ovulating, or releasing egg cells, and they also stop producing hormones, mainly estrogen and progesterone, and this all happens before a woman is 40 years old. It’s considered a “primary” problem because the problem is with the ovaries themselves, rather than glands or hormones that act on the ovaries.
Normally, the hypothalamus, which is located at the base of the brain, secretes gonadotropin-releasing hormone, or GnRH. GnRH makes the nearby pituitary gland secrete two hormones of its own, called gonadotropins. These are follicle stimulating hormone, or FSH, and luteinizing hormone, or LH. These hormones travel to the follicles within the ovaries. The follicles are small clusters of granulosa and theca cells that protect the developing egg cell.
FSH acts on the granulosa cells, making the follicles grow and mature, as well as secrete estrogen, while LH stimulates theca cells to secrete progesterone and small amounts of androstenedione, which is a precursor of testosterone. All three of these hormones belong to a class of steroids, or lipid-soluble hormones.
At birth, a woman has millions of follicles, each ready and excited to do its job. During puberty, the monthly menstrual and ovarian cycles begin, which is when the endometrium, or inner lining of the uterus, goes through cyclic changes in response to the ovarian hormones.
During the ovarian cycle, the ovarian hormones also help a handful of follicles to start growing. Eventually, there’s ovulation which is when a single follicle fully matures and ruptures, releasing its egg cell, while the other follicles degenerate and die off.
Summary
Premature ovarian failure (POF) is a condition in which a woman's ovaries stop functioning before age 40. This can lead to symptoms that mimic menopause, but some women with intermittent ovarian function are still able to spontaneously get pregnant. Some cases of POF are attributed to autoimmune disorders, others to genetic disorders such as Turner syndrome and Fragile X syndrome. Symptoms of POF can include irregular or absent menstrual periods, hot flashes, night sweats, vaginal dryness, and reduced fertility. Treatment involves the replacement of the hormones that the ovaries have stopped producing, especially estrogen and progesterone. For women who struggle with infertility, in-vitro fertilization can be used.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
- "Premature ovarian insufficiency (POI) and autoimmunity-an update appraisal" Journal of Assisted Reproduction and Genetics (2019)
- "Primary ovarian insufficiency: a more accurate term for premature ovarian failure" Clinical Endocrinology (2008)
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