Premature ovarian failure

Abstract

Premature ovarian failure is characterized by secondary amenorrhea affecting a woman before the age of 40, leading to hypoestrogenism, infertility, and consequences of premature menopause, such as osteoporosis, cardiovascular disease, neurovegetative alterations, and others. Follicular exhaustion is due to either follicles shortage or oocytes accelerated destruction. Main causes are genetic, autoimmune and iatrogenic. Among genetic causes Xq and Xp deletions, translocations, numeric aberrations (47,XXX, 45,X0), fragil X premutations are frequent. Type I and type II poliglandular insufficiency are important causes among autoimmune diseases. Iatrogenia may occur in surgery of the ovarios and Fallopian tubes and with oncologic treatment that destroys germinal cells in young women with breast cancer. Nowadays use of ovarian function and fertility preservation techniques are suggested. Once the cause is determined estrogens use is recommended although little research on hormone type, dosage and long term consequences has been done. Care must be placed in osteoporosis and cardiovascular disease prevention and treatment. In regards to infertility, there is already experience with embryos and oocytes cryopreservation for autodonation, and cortical ovarian tissue cryopreservation for posterior autotrasplantation, with success as well as limitations. GnRH agonists could protect the ovaries when chemotherapy is used. Attention is placed on experimental gene therapy in cases of premature ovarian failure.