Primary ovarian insufficiency
The pathophysiology of POI is related to decreasing follicles (low starting amount versus increased destruction) and/or poor follicular response to gonadotrophins. The etiology for POI is unknown in the majority of cases but may be related to injury to ovarian tissue caused by surgery, chemotherapy, radiation, or autoimmune processes. Rarely, autoimmune oophoritis, which may occur with adrenal autoimmunity, can be a cause. There is evidence of a genetic component to this condition; underlying fragile X syndrome or Turner syndrome can also cause POI.
Patients can present with a variety of complaints, but the most common presentation is absence or decreased frequency of menses. Other symptoms may include vasomotor symptoms, mood changes, vaginal dryness, recurrent miscarriage, or inability to become pregnant.
E28.39 – Other primary ovarian failure
237788002 – Premature ovarian failure
Differential Diagnosis & Pitfalls
- Pregnancy – Check beta-human chronic gonadotropin (hCG) or urine pregnancy test.
- Prolactinoma – Check prolactin and possibly an MRI.
- Thyroid abnormality – Check thyroid tests.
- Amenorrhea secondary to weight / nutrition issues – Evaluate body mass index.
- Drug-induced amenorrhea
- Congenital adrenal hyperplasia – Check testosterone.
Drug Reaction Data