Primary Ovarian Insufficiency in Adolescents and Young Women

Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. There is no consensus on criteria to identify primary ovarian insufficiency in adolescents, and delay in diagnosis is common. Health care providers who make this clinical diagnosis should be mindful of the sensitive nature of this medical condition. Patients and their families should be counseled on the effect of the patient's condition on future fertility, on the risk of comorbidities associated with primary ovarian insufficiency, and on the condition's potential for genetic inheritance. Psychologic counseling also should be offered because impaired self-esteem and emotional distress have been reported after diagnosis of primary ovarian insufficiency. Once primary ovarian insufficiency is diagnosed, patients should be evaluated at least annually. The goals of hormonal therapy extend beyond simply symptom relief to levels that support bone, cardiovascular, and sexual health. Referrals to a reproductive endocrinology and infertility specialist should be made when desired by the patient and family to further discuss available reproductive treatments.