61. UpToDate Pathogenesis And Causes Of Spontaneous Premature Ovarian Failure Premature ovarian failure is defined as primary hypogonadism in a woman under the age of 40 years 1. It is characterized by loss of oocytes, http://patients.uptodate.com/topic.asp?file=r_endo_f/4878

62. UpToDate Treatment Of Spontaneous Premature Ovarian Failure This topic will review the treatment of premature ovarian failure. The management of women with primary hypogonadism depends upon the cause of the http://patients.uptodate.com/topic.asp?file=r_endo_f/4856

63. Amenorrhea The causes of primary amenorrhea are also quite different from secondary She has no signs or symptoms that suggest ovarian failure or thyroid disease. http://www.advancedfertility.com/amenor.htm

IVF Pregnancy Rates IVF Pricing Options In Vitro Fertilization Egg Donation ... Become a Patient Secondary Amenorrhea Lack of menstrual periods in a woman that has had periods previously Our live birth rates for 2003 IVF cycles are now available Background Secondary amenorrhea is the absence of menstrual periods for 6 months in a woman who had previously been regular, or for 12 months in a woman who had irregular periods. This problem is seen in about 1% of women of reproductive age. Primary amenorrhea is when the woman has never had a period in her life. This page will not discuss primary amenorrhea which is rare. The causes of primary amenorrhea are also quite different from secondary amenorrhea. The most common cause of secondary amenorrhea in reproductive age women is pregnancy and this should always be excluded by physical exam and laboratory testing for the pregnancy hormone - HCG. History A good history can reveal the etiologic diagnosis in up to 85% of cases of amenorrhea. A detailed menstrual history should be taken. Any history of galactorrhea (milky discharge from the breasts) is important and indicates the need for a prolactin hormone level to rule out hyperprolactinemia.

64. Menstruation: Absent Periods (Amenorrhea) - UMMC The most common cause of primary amenorrhea is delayed puberty due to some Premature ovarian failure is a significant cause of infertility and women who http://www.umm.edu/patiented/articles/what_some_specific_causes_of_amenorrhea_th

var MenuLinkedBy='AllWebMenus [2]', awmBN='530'; awmAltUrl=''; Home Medical Reference Patient Education WHAT ARE SOME SPECIFIC CAUSES OF AMENORRHEA AND THEIR TREATMENTS? Delayed Puberty The most common cause of primary amenorrhea is delayed puberty due to some genetic factor that delays physical development. Being short is the most common sign of this, although sometimes a family history of delayed menstruation can indicate this situation. Time usually resolves the problem. Functional Hypothalamic Amenorrhea (FHA) and Eating Disorders Functional hypothalamic amenorrhea (FHA) is the absence of menstruation due to disturbances in the thyroid gland and hypothalamus-pituitary-adrenal (HPA) system. FHA may be due to different factors, most unknown. The hypothalamus and the pituitary gland regulate the reproductive hormones and also manage appetite and mood. It also triggers the production and release of steroid hormones ( glucocorticoids ), including the primary stress hormone cortisol Causes of FHA. The eating disorders anorexia and bulimia are factors in many cases of FHA. Both severe weight loss and changes of appetite can cause hormonal abnormalities. Some experts theorize that such changes may be due to a primitive protective biologic mechanism that was designed to prevent potentially harmful pregnancies during times of famine. Hormonal changes to extreme weight loss and reduced fat stores include low thyroid levels (hypothyroidism) and excessive stress hormone levels (hypercortisolism), which in turn reduce reproductive hormones. Reducing stress hormones, in one study, helped elevate reproductive hormones in women with FHA.

65. Premature Ovarian Failure (POF) Premature ovarian failure (POF) Back to Law and Policy Institutions Home Page Some health care providers also use the term primary ovarian insufficiency http://lpig.doereport.com/displaymonograph.php?MID=153

66. Index.html primary premature ovarian failure can occur at any age, even in children. It can present as either primary or secondary amenorrhoea. http://www.the-bms.org/fact_sheet.htm

FACT SHEETS Fact Sheets 1-4, please click on the following links Premature Menopause Medical Alternatives to Hormone Replacement Therapy Alternative and Complementary Therapies The Initial Menopause Consultation ... links British Menopause Society 4-6 Eton Place, Marlow, Buckinghamshire. UK SL7 2QA Tel: 00 44 01628 890199 Fax: 01628 474042 Registered Charity no:

67. Best Dx/Best Rx Amenorrhea primary menses does not begin by age 16 yr (or if patient misses important pubertal Premature ovarian failure. Measure serum FSH levels three times, http://www.acpmedicine.com/dxrx/dxrx1601.htm

Amenorrhea Robert L. Barbieri, M.D. Harvard Medical School Definition/Key Clinical Features Best Tests Best Therapy Best References Definition/Key Clinical Features Primary: menses does not begin by age 16 yr (or if patient misses important pubertal milestones, e.g., no breast development by age 14 yr) Most common causes Gonadal dysgenesis resulting from chromosome abnormality Physiologic delay of puberty Müllerian agenesis Obstructed outflow Absence of GnRH secretion Secondary (adult onset): previously menstruating woman has no menses for > 3 cycles or for 6 mo In nonpregnant women, most common causes of secondary amenorrhea Hypothalamic dysfunction (low GnRH secretion associated with stress, intensive exercise, low body mass index (BMI), low-fat diet, or combination of these) Pituitary dysfunction (prolactin-secreting pituitary tumor, empty sella syndrome, Sheehan syndrome, Cushing disease, or GH-secreting tumor) Loss of ovarian follicles (premature ovarian failure) Polycystic ovary syndrome Asherman syndrome (intrauterine adhesions) Thyroid disease Best Tests Primary Amenorrhea Serum FSH Breast exam Pelvic ultrasound or MRI to determine presence of cervix and uterus Elevated FSH level indicates gonadal dysgenesis; obtain karyotype for presence of Y chromosome

68. Pituitary Profile LH is useful in differentiating between primary and secondary ovarian failure. ovarian failure due to inappropriate regulatory signals (hypothalamic or http://www.biodia.com/test223.html

BACK to Hormones Main Page Requires Blood Draw This profile is ordered as part of the diagnostic workup of infertility and pituitary disorders. Sample required: one 10 mL SST (tiger top) decanted serum Lab reporting time: 7 - 10 business days Markers: LH and FSH levels rise and fall together during the menstrual cycle. LH is useful in differentiating between primary and secondary ovarian failure. Ovarian failure due to inappropriate regulatory signals (hypothalamic or pituitary pathology) is known as secondary ovarian failure. Ovarian failure due to a pathological process directly affecting the ovaries (e.g. chemotherapy, irradiation, autoimmunity, chromosomal abnormalities) is known as primary ovarian failure. A simple means of distinguishing between the 2 conditions is to measure serum FSH and LH levels (elevated in primary ovarian failure and low or normal in secondary ovarian failure). In males LH acts on the interstitial cells of the testes stimulating them to synthesize and secrete the male sex hormone, testosterone.

69. Clinical Trial: Goserelin In Preventing Ovarian Failure In Women Receiving Adjuv OBJECTIVES primary. Compare the rate of premature ovarian failure in women with stage IIIIA hormone receptor-negative breast cancer treated with adjuvant http://www.clinicaltrials.gov/ct/show/NCT00068601

Home Search Browse Resources ... About Goserelin in Preventing Ovarian Failure in Women Receiving Adjuvant Chemotherapy for Breast Cancer This study is currently recruiting patients. Verified by National Cancer Institute (NCI) April 2005 Sponsors and Collaborators: Southwest Oncology Group National Cancer Institute (NCI) Cancer and Leukemia Group B Eastern Cooperative Oncology Group Information provided by: National Cancer Institute (NCI) ClinicalTrials.gov Identifier: Purpose RATIONALE: Goserelin blocks hormone production in the ovaries. It is not yet known whether ovarian suppression using goserelin will prevent ovarian failure (early menopause) in women receiving chemotherapy for breast cancer. PURPOSE: This randomized phase III trial is studying how well ovarian suppression using goserelin works in preventing early menopause in women who are receiving adjuvant chemotherapy for stage I, stage II, or stage IIIA breast cancer. Condition Intervention Phase Breast Cancer Hot Flashes menopausal symptoms Osteoporosis sexual dysfunction and infertility Drug: cyclophosphamide Drug: goserelin Procedure: chemotherapy Procedure: complications of therapy assessment/management Procedure: fertility assessment/management Procedure: hot flashes attenuation Procedure: menopausal symptoms attenuation Procedure: supportive care/therapy Phase III MedlinePlus related topics: Breast Cancer Menopause Osteoporosis Reproductive Health ... Genetics Home Reference related topics: breast cancer Study Type: Interventional

70. Clinical Trial: Hormone Replacement In Young Women With Premature Ovarian Failur Women with premature ovarian failure have abnormally low levels of androgens The primary outcome parameter is femoral neck bone mineral density, http://www.clinicaltrials.gov/ct/gui/show/NCT00001951

Home Search Browse Resources ... About Hormone Replacement in Young Women with Premature Ovarian Failure This study is currently recruiting patients. Verified by National Institutes of Health Clinical Center (CC) December 7, 2004 Sponsored by: National Institute of Child Health and Human Development (NICHD) Information provided by: National Institutes of Health Clinical Center (CC) ClinicalTrials.gov Identifier: Purpose The human ovary produces male sex hormones (androgen) and female sex hormones (estrogen). Currently, androgen is not included in hormone replacement therapy for women with premature ovarian failure. Present hormone replacement therapy (HRT) was designed to treat women who experience ovarian failure at menopause (around the age of 50). However, 1% of women will experience premature failure of the ovaries before the age of 40. There have been no studies conducted to determine proper hormone replacement therapies for these younger women. Some research suggests that the usual menopausal hormone replacement therapy is not adequate to protect young women with premature ovarian failure from developing osteoporosis. Women with premature ovarian failure have abnormally low levels of androgens circulating in their blood. This may contribute to the increase risk for osteoporosis. This study will compare two treatment plans for women with premature ovarian failure. Treatment plan one will be physiological estrogen hormone replacement. Treatment plan two will be physiological estrogen hormone replacement plus androgen. The study will attempt to determine which plan is more beneficial to women in relation to osteoporosis and heart disease.

71. Premature Ovarian Failure (POF) What is premature ovarian failure (POF)? The Ovary The Ovary Some health care providers also use the term primary ovarian insufficiency to describe this http://patton.lexipal.com/monograph/153

9 Sep 2005 OUR PHILOSOPHY OUR TEAM IN THE COMMUNITY PRACTICE AREAS ... Free Case Consultation Legal Information Medical Topics VIEW FULL LIST Axonal Shear Injury Back Pain - Conditions Back Pain Treatment ... Whiplash Neck Injury Medical Categories Aging and Health Alternative Health Diagnostic and Surgical Procedures Diseases, Conditions and Injuries ... Women's Health Medical Illustrations Abdomen Anatomy Back and Spine Cancer ... Urology Premature Ovarian Failure (POF) What is premature ovarian failure (POF)? The Ovary Health care providers use the term POF to describe a stop in normal functioning of the ovaries in a woman under the age of 40. Many women naturally experience a decline in fertility at age 40; this age may also mark the beginning of irregularities in their menstrual cycles that signal the onset of menopause. For women with POF, the fertility decline and menstrual irregularities occur before age 40, sometimes even in the teens. Some health care providers also use the term primary ovarian insufficiency to describe this condition. In the past, health care providers called this condition premature menopause, but this term is not an accurate description of what happens in a woman with POF. A woman who has gone through natural menopause will rarely ever have another period; a woman with POF is much more likely to have periods, even though they might not come regularly. There is virtually no chance for a woman who has gone through menopause naturally to get pregnant; in some cases, a woman with POF can still get pregnant.

72. Amenorrhoea - Patient UK primary ovarian causes – ovaries without gametes cannot produce normal steroid FSH, LH raised in ovarian failure or rarely resistant ovary syndrome. http://www.patient.co.uk/showdoc/40000034/

PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people. Amenorrhoea This is complete cessation of menses. Prevalence (in women of menstruating age) is primary 0.3%, secondary 3%. Primary amenorrhoea - menses have not occurred by the time of expected menarche (14 years in absence of secondary sexual characteristics, otherwise 16) Primary amenorrhoea (anatomical, endocrine or constitutional) Secondary sexual characteristics present: Pregnancy Constitutional delay (no abnormality detectable, will start spontaneously) Genitourinary malformation - imperforate hymen or transverse vaginal septum (cyclical pelvic pain), absence of uterus/vagina (most common), testicular feminisation (androgen resistance) syndrome. Primary ovarian causes – ovaries without gametes cannot produce normal steroid hormones. Dysgenesis - most common is Turner’s syndrome (45XO) – women have "streak" gonads derived from either testis or ovary and male/female karyotype, absent vagina and rudimentary uterus (renal abnormalities in 40% cases) Secondary sexual characteristics absent: Chronic illness, stress

73. 300510 OVARIAN DYSGENESIS 2; ODG2 ovarian failure, HYPERGONADOTROPIC, DUE TO ovarian DYSGENESIS ovarian dysgenesis accounts for about half the cases of primary amenorrhea (Timmreck and http://srs.sanger.ac.uk/srsbin/cgi-bin/wgetz?[omim-ID:300510] -e

74. THE MERCK MANUAL, Sec. 18, Ch. 235, Menstrual Abnormalities And Amenorrhea is traditionally categorized as primary (menarche has not occurred Various disorders can cause premature ovarian failure (see Table 2352). http://www.merck.com/mrkshared/mmanual/section18/chapter235/235d.jsp

75. RIMS Home Page 252.01 primary hyperparathyroidism. 252.02 Secondary hyperparathyroidism, non 256.39, Other ovarian failure (delayed menarche, ovarian hypofunction, http://plans.iscd.org/ICD9CodesGen.asp

Click here to go back to state list page. View Printable Page ICD-9-CM Diagnostic Codes (Revision Date: 1-Apr-05) CPT codes are maintained by AMA The following is a list of selected conditions that may be associated with osteoporosis. This coding reference is not intended in anyway to replace the ICD #9 Code Manual. Please refer to the current ICD #9 Code Manual to check the appropriateness of using a particular code. Hyperparathyroidism Hyperparathyroidism, unspecified Primary hyperparathyroidism Secondary hyperparathyroidism, non-renal Other hyperparathyroidism (tertiary hyperpaprthyroidism) Cushing's Syndrome Postablative ovarian failure (ovarian failure: iatrogenic, postirradiation, postsurgical) Premature menopause Other ovarian failure (delayed menarche, ovarian hypofunction, primary ovarian failure NOS) Postablative testicular hypofunction (testicular hypofunction: iatrogenic, postirradiation, postsurgical) Other testicular hypofunction Unspecified endocrine disorder Osteomalacia, unspecified Unspecified vitamin D deficiency Renal osteodystrophy Secondary hyperparathyroidism (of renal origin) Menopausal or female climacteric state (symptoms, such as flushing, sleeplessness, etc., associated with menopause)

76. Hospital Practice: Analyzing Amenorrhea The absence of hot flashes argues against premature ovarian failure, If the low estradiol level in this patient were due to a primary ovarian problem, http://www.hosppract.com/issues/1998/07/dmmbrau.htm

Analyzing Amenorrhea GLENN D. BRAUNSTEIN Cedars-Sinai Medical Center, Los Angeles Case Commentary: ELIZABETH MORRISON University of California, Irvine When menarche has failed to occur or menstrual cycles have stopped, the problem can be traced back to a functional or structural defect in the hypothalamus, pituitary, ovaries, or uterus. In most cases, the history is the principal source of diagnostic information. Necessary laboratory studies include one for the most common cause of amenorrhea: pregnancy. Dr. Braunstein is Chairman, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, and Professor of Medicine, University of California, Los Angeles, UCLA School of Medicine. Dr. Morrison is Assistant Clinical Professor of Family Medicine, University of California, Irvine, College of Medicine. Case 1 Presentation A 19-year-old Caucasian woman sought medical attention because of her concern that she had never had a menstrual period. Early childhood development had been normal, and there had been no significant illness or injury during childhood or adolescence. Breast development had begun at age nine, followed shortly thereafter by axillary and pubic hair. A growth spurt had occurred at age 13. The patient currently experienced monthly bloating and breast tenderness that lasted approximately three days. She did not have hot flashes and was not taking any medication. She exercised for about one hour four days a week and ate well-balanced meals. There was no family history of endocrine or reproductive disorders.

77. Ivf-infertility.com | Polycystic Ovarian Syndrome (PCOS) Polycystic ovarian syndrome (PCOS), is a primary ovarian condition and is the risk of destruction of the ovaries leading to ovarian failure. http://www.ivf-infertility.com/infertility/pcos.php

Community Message Board Chat Forum Infertility Introduction Causes Of Infertility Age And Infertility PCOS ... Sex Selection IVF and ICSI Introduction IVF Procedure Risks Of IVF Outcome Of IVF ... ICSI GIFT and ZIFT GIFT And ZIFT Tubal Embryo Transfer Donation Introduction Sperm Donation Egg Donation Embryo Donation Insemination Introduction Vaginal Insemination Cervical Insemination Intrauterine Insemination ... Intratubal Insemination Surrogacy Introduction Guidelines And Protocols Adoption Introduction Adopting In The UK Children With Disabilities Overseas Adoption Resources Fertility Calculator Pregnancy Calculator FAQs Glossary ... Advertising PCOS Polycystic Ovarian Syndrome Incidence of Polycystic Ovarian Syndrome Polycystic ovarian syndrome (PCOS) accounts for 90% of women with oligomenorrhoea (infrequent periods) and 30% of women with amenorrhoea (absent of periods) and over 70% of women with anovulation. Diagnosis of Polycystic Ovarian Syndrome Laparoscopy Laparoscopy allows direct inspection of the ovaries; the ovaries are enlarged and polycystic. However, polycystic ovaries may appear normal at laparoscopy.

78. Primary Ovarian Ectopic Pregnancy Progressed To 28 Weeks, Mimicking An Intrauter an unyielding cervical os and failure of medical induction of labour, Presented here is a 28 weeks primary ovarian ectopic with foetal death, http://bhj.org/journal/2003_4502_april/primaryovarian_389.htm

CASE REPORTS Primary Ovarian Ectopic Pregnancy Progressed to 28 Weeks, Mimicking An Intrauterine Foetal Death Punam M Satpute, Sneha D Shirodkar, Vaishali Patil, Vijay R Badhwar Primary ovarian ectopic of 28 wks gestation mimicking an intrauterine foetal death is rare. The diagnosis is usually surgical, however, an unyielding cervical os and failure of medical induction of labour, should alert the obstetrician of an extrauterine gestation. Presented here is a 28 weeks primary ovarian ectopic with foetal death, that mimicked an intrauterine foetal death clinically, was missed by 2 transabdominal USG scans and was suspected only after failed medical induction of labour. Timely surgical intervention before disseminated intravascular coagulopathy sets in, is recommended. INTRODUCTION Primary ovarian ectopic pregnancy is an uncommon ectopic gestation and accounts to 0.3-3% of all ectopic gestations. It is rare to progress upto 28 weeks. It is usually known to mimic an ovarian tumour, but to mimic a 28 week intrauterine gestation with foetal death clinically, and mislead by ultrasound, makes this an interesting case. CASE REPORT A 30 year primigravida with 7 months of amenorrhoea, conceived spontaneously after 11 yrs of infertility, was referred as a c/o IUFD. O/E - A single IUFD of 28 wks in a longitudinal lie with cephalic presentation and a relaxed uterus were noted. Pervaginum - 2.5 cm long tubular uneffaced cervix with a pinpoint external os and a closed internal os were seen. USG confirmed an IUFD of 28 wks (spalding sign+). Since it was a precious conception, patient repeated and confirmed the IUFD with her own sonologist. Routine investigations were WNL. Coagulation tests (BT-50 secs, CT - 4 1/2 minutes) were also WNL.

79. Karger Publishers primary ovarian disorders include chromosome abnormalities (eg Turner s syndrome) Premature ovarian failure (generally diagnosed as cessation of ovarian http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=

80. Ovarian Dysgenesis With Balanced Autosomal Translocation. Tullu MS, Arora P, Par 7 These cases had ovarian dysgenesis.7 We report a case of primary Premature ovarian failure and ovarian dysgenesis associated with balanced and http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2001;volume=47;issue=2

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