Early Ovarian Alarm
This term describes depletion or dysfunction of ovarian follicles with cessation of menses before age 40.
What is primary ovarian insufficiency?
This class of cancer therapy agents (notably alkylators) and higher radiation doses are major iatrogenic risks for POI.
What is chemotherapy and pelvic/whole-body radiation?
If basal FSH is elevated into the menopausal range, this repeat-testing interval is advised before confirming POI.
What is repeat FSH in 1 month?
Beyond symptom relief, the goals of hormonal therapy in adolescents with POI include protecting these two organ systems.
What are bone and cardiovascular health?
This percent range approximates spontaneous pregnancy occurrence in women with POI.
What is about 5–10%?
This common presenting symptom—either primary or secondary—is the most frequent reason adolescents with POI seek evaluation.
What is amenorrhea?
About this percent of women with POI and a normal karyotype have an FMR1 premutation.
What is approximately 6%?
This pelvic imaging modality is part of the initial evaluation after biochemical confirmation.
What is pelvic ultrasonography?
For puberty induction in girls with absent or incomplete breast development, this hormone should be started and increased slowly.
What is estrogen therapy?
This major bone assessment tool has no clear routine guideline in adolescents with POI but is sometimes considered to monitor accrual.
What is dual-energy X-ray absorptiometry (DEXA)?
These two baseline lab tests, drawn at least one month apart, are used to establish the diagnosis.
What are basal FSH and estradiol?
This autoimmune marker testing is appropriate because roughly 4% of women with POI may have evidence suggesting an immune cause.
What are adrenal or ovarian autoantibodies?
These three tests should be included in the initial evaluation to rule out common reversible causes of amenorrhea.
What are pregnancy test, thyroid function, and prolactin testing?
Compared with transdermal estradiol, this oral option carries a higher thromboembolism risk due to first-pass hepatic effects.
What is oral estradiol?
This sensitive nontechnical intervention is recommended for adolescents and families at diagnosis to address emotional distress and impaired self-esteem.
What is psychological counseling and family-centered communication?
This fragile X–related test is recommended when POI occurs without another clear cause or with family history
What is FMR1 premutation testing?
This rare endocrine gene premutation/condition (noted in the ACOG opinion) links genetic inheritance to early ovarian failure risk
What is the FMR1 premutation / fragile X–associated POI?
These two laboratory evaluations are recommended after diagnosis to investigate possible etiologies.
What are karyotype and adrenal antibody testing?
For long-term endometrial protection, this addition is given cyclically for 10–12 days each month along with estrogen.
What is cyclic progesterone?
These two lifestyle or screening counseling points should be addressed annually to optimize long-term health.
What are tobacco avoidance and blood pressure/lipid monitoring/diet & exercise counseling?
When adolescent POI presents with delayed puberty and growth failure, this chromosomal diagnosis is a common cause.
What is Turner syndrome / gonadal dysgenesis?
Besides genetic and gonadotoxic causes, name two other categories of etiologies mentioned for POI in adolescents.
What are infiltrative/infectious processes and pelvic surgery?
(also acceptable: endocrine disorders or idiopathic causes)
This ovarian biomarker is under study for assessing reserve but is currently not yet definitive for POI diagnosis per the ACOG opinion.
What is antimüllerian hormone (AMH)?
Hormone replacement in adolescents with POI is generally continued until this approximate age, to mimic normal ovarian function.
What is around 50 years, the average age of natural menopause?
Because of associations with other autoimmune diseases, this endocrine disorder is seen in about 20% of adults with idiopathic POI.
What is hypothyroidism / Hashimoto thyroiditis?