Uterine ovarian failure

Premature ovarian failure can be induced in offspring exposed in utero by active metabolites such as 6-mercaptopurine. Tamoxifen (treatments for breast cancer) and clomiphene (to induce ovulation) are antiestrogens that can inhibit uterine decidual induction in pseudopregnant rats. 

There is no characteristic menstrual pattern or history that precedes premature ovarian failure. Approximately 50% of patients with this condition have a history of oligomenorrhea or dysfunctional uterine... 

It is indicated in the management of moderate to severe vasomotor symptoms associated with menopause treatment of atrophic vaginitis, kraurosis vulvae, fanale hypogonadism, symptoms of female castration, and primary ovarian failure prevention and treatment of osteoporosis (conjugated estrogens) palliative treatment of metastatic breast or prostate cancer in selected women and men treatment of postpartum breast engorgement and abnormal uterine bleeding. 

Estrogen, possessing antineoplastic and antiosteoporotic properties, is indicated in abnormal uterine bleeding (hormonal imbalance), in castration, primary ovarian failure, and osteoporosis, in female hypogonadism, in menopausal symptoms, atrophic vaginitis, or kraurosis vulvae, in prostatic cancer, and in breast cancer (see also Figure 48). 

Moderate to severe vasomotor mptoms associated with menopause, atrophic vaginitis, female hypogonadism, female castration, primary ovarian failure, palliative therapy for breast and prostate cancer, treatment of abnormal uterine bleeding due to hormone imbalance Moderate to severe vasomotor symptoms associated with menopause, atrophic vaginitis, female hypogonadism, female castration, primary ovarian failure Same as conjugated estrogens... 

Vascular anastomotic communications between the uterine and ovarian arteries provide a route by which embolization materials can affect the ovarian blood supply and ovarian function, either permanently or temporarily [71], One case report describes embolic microspheres found within the ovarian arterial vasculature of a pathological specimen following uneventful UAE [66]. Unintentional embolization of the ovarian arteries is theorized to cause ovarian failure. However, the incidence of ovarian failure post UAE is no different to hysterectomy [100]. In fact, it is not clear whether UAE has any effect on ovarian function at all. There are studies that support its lack of effect [3,17,99,100] and a few case reports that document transient or permanent amenorrhea [92,98]. 

It is thought that the ovarian arteries shrink with age leading to increased ovarian dependence upon uterine-tubal anastomoses [9]. This may explain an increased chance (from 0% incidence compared with 21%) of ovarian failure post UAE in patients aged 45 years or older [18]. A similar study looking at basal FSH after UAE showed a significantly increased risk of perimenopausal FSH levels in patients older than 45 years [84]. Thus, older women appear to be more at risk of losing their ovarian function than younger women. 

Amato P, Roberts AC (2001) Transient ovarian failure a complication of uterine artery embolization. Fertil Steril 75 438-439... 

Stringer NH, Grant T et al (2000) Ovarian failure after uterine artery embolization for treatment of myomas. J Am Assoc Gynecol Laparosc 7 395-400... 

Communications between the ovarian artery and the uterine artery has two potential adverse outcomes, it may allow continued blood supply to the fibroid, leading to failure of the procedure, and alternatively it can lead to permanent ovarian failure following embolization. Because of these potential problems, there has been considerable interest in how best to evaluate the ovarian arteries. Flush arteriography has been an approach to evaluating the ovarian arteries to determine if there is enlargement of the ovarian artery and supply to the fibroid [23]. In one study [23] of 294 aortograms, 75 ovarian... 

Hascalik S, Celik O, Sarac K, Hascalik M (2004) Transient ovarian failure a rare complication of uterine fibroid embolization. Acta Obstet Gynecol Scand 83 682-685... 

Women with acquired uterine hypoplasia due to drugs, pelvic irradiation, or ovarian failure may have a disproportionately small uterine corpus. In these patients, the ratio of the uterine body to the cervix is reduced to less than the normal 2 1, similar to a premenarchal uterus. 

Nikolic B, Spies JB et al (1999) Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization a case report. J Vase Interv Radiol 10 1167-1170... 

There are some important anatomic variations associated with failure. These include tortuous artery, small uterine artery in one or both sides, absence of uterine arteries, ovarian artery supply of the fibroids and other less common variants such as a round ligament artery supply [7]. 

The role of ovarian arteries as a cause of failure is well known. Ovarian arteries may feed the fibroids through different pathways. The visualization of an ovarian artery is not systematically associated with failure. In one study, 25% of patients had large ovarian arteries before embolization [8]. Only arteries that directly participate in feeding the uterus cause failure. In cases of a small uterine artery or absence of one or both arteries, the ovarian artery supply should be suspected (Fig. 10.5.3). However, additional supply to the fibroids may come from the ovarian arteries, even if large sized bilateral uterine arteries are present [9, 10]. 

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