Clinical practice. Primary ovarian insufficiency

Abstract

A 30-year-old woman presents with a history of no menses since she stopped taking oral contraceptives 6 months ago in order to conceive. She had undergone puberty that was normal in both timing and development, with menarche at 12 years of age. At 18 years of age, she started taking oral contraceptives for irregular menses. She reports stress at work. Her weight is 59 kg, and her height 1.66 m; her body-mass index (the weight in kilograms divided by the square of the height in meters) is 21.3. There is no galactorrhea, hirsutism, or acne. The pelvic examination is normal, a pregnancy test is negative, the prolactin level is normal, and the follicle-stimulating hormone (FSH) level is in the menopausal range. How should she be evaluated and treated?

Conflict of interest statement

Dr. Nelson reports being an inventor on three United States patents directed to MATER (a potential antigen in autoimmune primary ovarian insufficiency) and its applications (U.S. patent numbers 7,189,812; 7,217,811; and 7,432,067), as well as one pending United States patent application (U.S. patent application number 11/586,160) and foreign counterparts. No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1. Transvaginal Ultrasound Scan from a Patient with Spontaneous 46,XX Primary Ovarian Insufficiency Who Had Follicle Dysfunction Due to Autoimmune Oophoritis

The ovary appears normal, with the presence of multiple follicles, despite amenorrhea, estrogen deficiency, and menopausal-level gonadotropins. Autoimmune oophoritis with thecal infiltration by lymphocytes was confirmed histologically by means of an ovarian biopsy performed when the patient was 26 years of age.