Premature ovarian failure

Premature ovarian failure is said to have occurred when menstruation ceases before the age of 40 years and early menopause before the age of 45 years. Although there are many causes of early ovarian failure, the main cause is spontaneous or idiopathic. The main identified genetic causes are Turner's syndrome and Fragile X. Recently, forkhead genes (FOX03A defect) have been discovered which lead to early follicular activation and thus premature depletion of the follicle pool. Other causes include FSH receptor polymorphisms, where follicles are present but unable to respond due to the loss of the FSH receptor.

Proliferative Secretory

Ovulation Bleed

Proliferative Secretory

Ovulation Bleed

(a) Oestrogen Oestrogen+progestogen

(a) Oestrogen Oestrogen+progestogen

Proliferative

Hyperplasia

Carcinoma

Proliferative

Hyperplasia

Carcinoma

Fig. 47.2 Endometrial effects of perimenopause: (a) Normal cycle; (b) Unopposed oestrogen effect. From Kumar RJ (ed.) (2002) Blaustein's pathology of the female genital tract, 5th edn. New York: Springer.

Fig. 47.2 Endometrial effects of perimenopause: (a) Normal cycle; (b) Unopposed oestrogen effect. From Kumar RJ (ed.) (2002) Blaustein's pathology of the female genital tract, 5th edn. New York: Springer.

The proportion of women with iatrogenic premature ovarian failure is growing as increasing numbers of women survive leukaemias, lymphomas and gynaecological cancers due to improved surgical techniques, radiotherapy and chemotherapeutic regimens.

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