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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(08): 511-518
DOI: 10.1055/s-0040-1716929
Febrasgo Position Statement

Premature ovarian insufficiency: A hormonal treatment approach

Number 2 - August 2020
Cristina Laguna Benetti-Pinto 
1   Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
José Maria Soares Júnior 
2   Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Gustavo Arantes Maciel 
2   Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Andrea Prestes Nácul 
3   Hospital Fêmina, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
,
Daniela Angerame Yela 
1   Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Ana Carolina Japur Sá Rosa e Silva 
4   Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Key points

  • Premature ovarian insufficiency (POI) is characterized by loss of ovarian function before the age of 40 years.

  • Diagnosis is based on follicle-stimulating hormone (FSH) levels >25 mIU/mL measured on two occasions (different samples) at least 4 weeks apart.

  • POI is suspected in the presence of irregular menstrual cycles or secondary amenorrhea in women before the age of 40 years, or in girls with primary amenorrhea.

  • Symptoms of hypoestrogenism are usually present, but this not mandatory.

  • Most POI cases are idiopathic, but they may also be due to autoimmune disease, genetic cause, oophorectomy, chemotherapy, radiation therapy (RT), and other less frequent causes.

  • POI is of genetic background in about 10% of cases, most commonly in patients with primary amenorrhea.

  • Chromosomal analysis (Karyotype) is indicated in non-iatrogenic POI cases. In the presence of Y chromosomal material, patients must be submitted to gonadectomy because of the high risk of gonadal tumours.

  • Despite being associated with infertility, spontaneous pregnancy may occur in 5% to 10% of POI cases,

  • Good therapeutic practices include providing guidance on a healthy lifestyle and sexual and psychological assessment and follow-up.

  • Hormonal treatment is mandatory for all POI-women with no contraindication , and it shall be continued until the usual age of menopause.

The National Specialty Commission for Gynecological Endocrinology of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.




Publication History

Article published online:
08 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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