Ovarian failure

Ovaries Turner s syndrome Gonadal dysgenesis Premature ovarian failure Chemotherapy/radiation Lack of ovarian follicles Other genetic anomalies Early loss of follicles Gonadal toxins... 

Therapeutic modalities for amenorrhea are targeted at restoring the normal menstrual cycle. The goals of treatment are to preserve bone density, prevent bone loss, and restore ovulation, thus improving fertility as desired. Amenorrhea resulting from conditions contributing to hypoestrogenism also may affect quality of life via the induction of hot flashes (premature ovarian failure), dyspareunia, and in prepubertal females, lack of secondary sexual characteristics and absence of menarche. 

PREMATURE OVARIAN FAILURE AND PREMENOPAUSAL HORMONE REPLACEMENT... 

Premature ovarian failure is a condition characterized by sex-steroid deficiency, amenorrhea, and infertility in women younger than 40 years of age. It affects 1% of women. Premature ovarian failure is associated with a significantly higher risk for osteoporosis and cardiovascular disease and increased mortality. 

Estrogens are most commonly used as a component of combination contraceptives or as hormone replacement therapy in postmenopausal women. Benefits in postmenopausal women include relief of moderate to severe vasomotor symptoms and decreased risk of osteoporosis. Hormone replacement therapy also may be used in vaginal and vulvar atrophy and in hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure. Less commonly, select breast or prostate cancer... 

Hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure-Treatment usually is initiated with a dose of 1 to 2 mg daily, adjusted as necessary to control presenting symptoms determine the minimal effective dose for maintenance therapy by titration. 

Female castration and primary ovarian failure - 1.25 mg/day cyclically. Adjust according to severity of symptoms and patient response. For maintenance, adjust to lowest effective level. 

Female castration and primary ovarian failure- Give 1.25 mg/day, cyclically. 

Female castration or primary ovarian failure - A daily dose of 1.5 to 9 mg estropipate may be given for the first 3 weeks of a theoretical cycle, followed by a rest period of 8 to 10 days. 

Infertility- Administer 90 mg vaginally once daily. In women with partial or complete ovarian failure, administer 90 mg vaginally twice daily. If pregnancy occurs, continue treatment until placental autonomy is achieved, no more than 10 to 12 weeks. 

Lubiprostone (Amitiza) [Laxative] Uses Chronic idiopathic constipation in adults Action Selective Cl channel activator Dose Adults. 24 meg PO bid w/ food Contra Mechanical GI obst Caution [C, /-] Severe D, severe renal or mod-severe hepatic impair Disp Gel, caps meg SE N, HA, D, GI distention, abd pain EMS Monitor for signs of electrolyte disturbances and h5rpovolemia d/t D OD May cause severe D, hypovolemia, and abd pain/cramps give IV fluids Lutropin Alfa (Luveris) [Hormone] Uses Inf ility Action Recombinant LH Dose 75 Units SQ w/ 75—150 Units FSH, 2 s arate inj max 14 d Caution [X, /M] Contra Primary ovarian failure, uncontrolled thyroid/adrenal dysfxn, intracranial lesion, AUB, hormone-dqjendent GU tumor, ovarian cyst, PRG Disp Inj SE HA, N, ovarian h5rpCTstimulation synd, breast pain, ovarian cysts T risk of multiple births EMS None OD Unlikely to cause life-threatening Sxs... 

Female hypogonadism PO 2.5-7 5 mg/day in divided doses for 20 days rest 10 days. Female castration, primary ovarian failure PO Initially, 1.25 mg/day cyclically. Breast cancer PO 10 mg 3 times/day for at least 3 mo. 

Atrophic vaginitis, female castration, female hypogonadism, kraurosis vulvae, menopausal symptoms, primary ovarian failure, prostatic carcinoma IM Initially, 0 1 or0 5... 

Female hypogonadism, castration, primary ovarian failure PO 1 25-7 5 mg/day for 21 days then off for 8-10 days. Repeat if bleeding does not occur by end of off cycle. Prevention of osteoporosis PO 0.625 mg/day (25 days of 31-day cycle/mo). 

B. Indications and nse Follistim is indicated for the development of multiple follicles in ovulatory patients participating in an assisted reproductive technology program. It is also indicated for the induction of ovulation and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not due to primary ovarian failure. 

Kalantaridou S et al Premature ovarian failure, endothelial dysfunction, and estrogen-progesterone replacement. Trends Endocrinol Metab 2006 17 101. [PMID 16515863]... 

Kalantaridou SN et al Impaired endothelial function in young women with premature ovarian failure Normalization with hormone therapy. J Clin Endocrinol Metab 2004 89 3907. [PMID 15292326]... 

Premature ovarian failure Follicular depletion by the age of 35 years. 

Edmonds SE, Montgomery JC. Reversible ovarian failure induced by a Chinese herbal medicine lei gong teng. Br J Obstet Gynaecol 2003 110 77-8. 

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