Plan Hopes to ID Early Halt in Reproductive Function

WEDNESDAY Feb. 4, 2009 -- Guidelines to help doctors diagnose and treat a menopause-like condition in girls and women younger than age 40 has been developed by a U.S. government scientist.

In patients with primary ovarian insufficiency, the ovaries stop releasing eggs and producing estrogen and other reproductive hormones. This results in menopause-like symptoms such as the loss of menstrual periods, infertility, hot flashes, night sweats, sleep loss and increased risk for bone fractures and heart disease. The sudden and unexpected loss of fertility often causes patients to suffer grief, anxiety and depression.

Treatment includes hormones to replace those no longer produced by the ovaries and counseling to help patients cope with their emotional challenges.

Dr. Lawrence Nelson, head of the U.S. National Institutes of Health's Integrative and Reproductive Medicine Unit, has conducted extensive research into primary ovarian insufficiency and developed recommendations for the diagnosis and treatment of the condition. The guidelines are published in the Feb. 5 issue of the New England Journal of Medicine.

Nelson said a girl or young woman can be considered to have primary ovarian insufficiency if she hasn't experienced a normal menstrual cycle in four months or more, and if at least two tests taken more than one month apart show she has abnormal levels of follicle-stimulating hormone (FSH), which is produced by the pituitary and stimulates the ovaries to produce estrogen and prepare an egg for release.

Patients with primary ovarian insufficiency have high FSH levels like those of women in menopause.

The cause of primary ovarian insufficiency is unknown in 90 percent of cases, while 10 percent of cases can be attributed to a genetic condition or autoimmunity, in which the immune system attacks the body's own tissues.

Girls and young women with primary ovarian insufficiency should be monitored for signs of severe emotional distress and, when appropriate, referred for counseling or other sources of emotional support, Nelson said.

These patients are also at risk for low bone mineral density and should be told to consume adequate calcium and vitamin D and to exercise to safeguard their bone health, he added.

"The early indicators of primary ovarian insufficiency are subtle, and the condition can be difficult to diagnose. Dr. Nelson's report provides helpful information for health-care professionals and patients on how to recognize the early symptoms of the condition, so that women can benefit from prompt diagnosis and early treatment," Dr. Duane Alexander, director of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in an NIH news release.

More information

The U.S. National Institute of Child Health and Human Development has more about primary ovarian insufficiency.

Posted: February 2009


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