early menopause

早発閉経

WordNet

1. very young; "at an early age"
2. before the usual time or the time expected; "she graduated early"; "the house was completed ahead of time" (同)ahead of time, too soon
3. in good time; "he awoke betimes that morning" (同)betimes
4. belonging to the distant past; "the early inhabitants of Europe"; "former generations"; "in other times" (同)former, other
5. at or near the beginning of a period of time or course of events or before the usual or expected time; "early morning"; "an early warning"; "early diagnosis"; "an early death"; "took early retirement"; "an early spring"; "early varieties of peas and tomatoes mature before most standard varieties"
6. being or occurring at an early stage of development; "in an early stage"; "early forms of life"; "early man"; "an early computer"
7. expected in the near future; "look for an early end to the negotiations"
8. of an early stage in the development of a language or literature; "the Early Hebrew alphabetical script is that used mainly from the 11th to the 6th centuries B.C."; "Early Modern English is represented in documents printed from 1476 to 1700"
9. fruiting spike of a cereal plant especially corn (同)spike, capitulum
10. attention to what is said; "he tried to get her ear"
11. good hearing; "he had a keen ear"; "a good ear for pitch"
12. the sense organ for hearing and equilibrium
13. the time in a womans life in which the menstrual cycle ends (同)climacteric, change_of_life
14. a British peer ranking below a marquess and above a viscount

PrepTutorEJDIC

1. (時間・時期が)『早い』,『初期の』 / 昔の / (普通より,予定より)早い / 近い将来の / (時間・時期的に)『早く』 / (予定・ふだんより)早く
2. 〈C〉『耳』 / 《単数形で》『聴覚』,聴力,音感 / 《単数形で》じっと聞くこと,傾聴 / 〈C〉耳の形をした物
3. (麦・とうもろこしなどの)穂
4. 《the ~》(また《話》『change of life』)月経閉止期,更年期
5. (英国の)伯爵

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/03/09 03:32:31」(JST)

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Premature ovarian failure
Classification and external resources
ICD-10	E28.3
ICD-9	256.31
OMIM	311360
DiseasesDB	9441
eMedicine	med/1700
MeSH	D016649

Premature Ovarian Failure (POF), also known as premature ovarian insufficiency, primary ovarian insufficiency (this is the most accurate term as some women may still conceive), premature menopause, hypergonadotropic hypogonadism, is the loss of function of the ovaries before age 40. A commonly cited triad for the diagnosis is amenorrhea, hypergonadotropinism, and hypoestrogenism. If it has a genetic cause, it may be called gonadal dysgenesis

History

Fuller Albright et al. in 1942 first reported a syndrome in young women characterized by menopausal levels of follicle stimulating hormone (FSH), low estrogen levels and amenorrhea. They named the condition "primary ovarian insufficiency" to distinguish the condition from secondary ovarian insufficiency, which is the failure of the pituitary to secrete FSH. Chapter 28 of the early Qing dynasty work Fù Qīngzhǔ Nǚkē (《傅青主女科》Fù Qīngzhǔ's Gynecology) describes the cause and appropriate treatment for premature menopause (年未老经水断 niánwèilǎo jīngshuǐduàn, glosses as: 'age not-yet old menstrual water cut-off').

Incidence/prevalence

It has been estimated that POF affects 1% of the population.

Presentation

On average, the ovaries supply a woman with eggs until age 51, the average age of natural menopause.

POF is not the same as a natural menopause, in that the dysfunction of the ovaries, loss of eggs, or removal of the ovaries at a young age is not a natural physiological occurrence.

Infertility is the result of this condition, and is the most discussed problem resulting from it, but there are additional health implications of the problem, and studies are ongoing. For example, osteoporosis or decreased bone density affects almost all women with POF due to an insufficiency of estrogen. There is also an increased risk of heart disease, hypothyroidism in the form of Hashimoto's thyroiditis, Addison's disease, and other auto-immune disorders.

Hormonally, POF is defined by abnormally low levels of estrogen and high levels of FSH, which demonstrate that the ovaries are no longer responding to circulating FSH by producing estrogen and developing fertile eggs. The ovaries will likely appear shriveled.

The age of onset can be as early as the teenage years, but varies widely. If a girl never begins menstruation, it is called primary ovarian failure. The age of 40 was chosen as the cut-off point for a diagnosis of POF. This age was chosen somewhat arbitrarily, as all women's ovaries decline in function over time, however an age needed to be chosen to distinguish usual menopause from the abnormal state of premature menopause.^{[citation needed]} Premature ovarian failure however often has components to it that distinguish it from normal menopause.

By the age of 40, approximately one percent of women have POF. Women suffering from POF usually experience menopausal symptoms that are more severe than the symptoms found in older menopausal women.

Causes

The cause of POF is usually idiopathic. Some cases of POF are attributed to autoimmune disorders, others to genetic disorders such as Turner syndrome and Fragile X syndrome. An Indian study showed a strong correlation between incidence of POF and certain variants in the inhibin alpha gene. In many cases, the cause cannot be determined. Chemotherapy and radiation treatments for cancer can sometimes cause ovarian failure. In natural menopause, the ovaries usually continue to produce low levels of hormones, but in chemotherapy or radiation-induced POF, the ovaries will often cease all functioning and hormone levels will be similar to those of a woman whose ovaries have been removed. Women who have had their tubes tied, or who have had hysterectomies, tend to go through menopause several years earlier than average, likely due to decreased blood flow to the ovaries. Family history and ovarian or other pelvic surgery earlier in life are also implicated as risk factors for POF.

There are two basic kinds of premature ovarian failure. Case 1) where there are few to no remaining follicles and case 2) where there are an abundant number of follicles. In the first situation the causes include genetic disorders, autoimmune damage, chemotherapy, radiation to the pelvic region, surgery, endometriosis and infection. In most cases the cause is unknown. In the second case one frequent cause is autoimmune ovarian disease which damages maturing follicles, but leaves the primordial follicles intact. Also, in some women FSH may bind to the FSH receptor site, but be inactive. By lowering the endogenous FSH levels with ethinyl estradiol (EE) or with a GnRH-a the receptor sites are free and treatment with exogenous recombinant FSH activates the receptors and normal follicle growth and ovulation can occur. (Since the serum anti-müllerin hormone (AMH) level is correlated with the number of remaining primordial follicles some researchers believe the above two phenotypes can be distinguished by measuring serum AMH levels.)

The POF Fact Sheet lists potential causes of POF in various languages:
http://www.pofsupport.org/information_center.asp

• Genetic disorders
• Autoimmune diseases
• Tuberculosis of the genital tract
• Smoking
• Radiation and/or chemotherapy
• Ovarian failure following hysterectomy
• Prolonged gnrh therapy
• Enzyme defects
• Resistant ovary
• Induction of multiple ovulation in infertility

Genetic associations include:

Type	OMIM	Gene	Locus
POF1	311360	FMR1	Xq26-q28
POF2A	300511	DIAPH2	Xq13.3-q21.1
POF2B	300604	POF1B	Xq13.3-q21.1
POF3	608996	FOXL2	3q23
POF4	300510	BMP15	Xp11.2
POF5	611548	NOBOX	7q35
POF6	612310	FIGLA	2p12
POF7	612964	NR5A1	9q33

Laboratory

Serum follicle-stimulating hormone (FSH) measurement alone can be used to diagnose the disease. Two FSH measurements with one-month interval have been a common practice. The anterior pituitary secretes FSH and LH at high levels due to the dysfunction of the ovaries and consequent low estrogen levels. Typical FSH in POF patients is over 40 mlU/ml (post-menopausal range).

Fertility

Between 5 and 10 percent of women with POF may spontaneously become pregnant. Currently no fertility treatment has officially been found to effectively increase fertility in women with POF, and the use of donor eggs with In-Vitro Fertilization (IVF) and adoption have become more popular as a means of becoming parents for women with POF. Some women with POF choose to live child-free. (See Impaired Ovarian Reserve for a summary of recent randomized clinical trials and treatment methods.)

Currently New York fertility researchers are investigating the use of a mild male hormone called dehydroepiandrosterone (DHEA) in women with POF to increase spontaneous pregnancy rates. Published results from studies conducted on DHEA have indicated that DHEA may increase spontaneously conceived pregnancies, decrease spontaneous miscarriage rates and improve IVF success rates in women with POF.

Additionally, over the last five years a Greek research team has successfully implemented the use of dehydroepiandrosterone (DHEA) for the fertility treatment of women suffering with POF.The majority of the patients were referred for donor eggs or surrogacy, however after a few months of DHEA administration they succeeded in getting pregnant through IVF, IUI, IUTPI or natural conception. Until now a great number of babies have been born after treatment with DHEA.

Ovarian tissue cryopreservation can be performed on prepubertal girls at risk for premature ovarian failure, and this procedure is as feasible and safe as comparable operative procedures in children.

Hormonal replacement

It is important to initiate the hormonal replacement therapy after the diagnosis of POF, as untreated patients are at a great risk of bone loss due to increased osteoclast activities, resulting in osteopenia as well as osteoporosis. Furthermore, most of the patients develop symptoms of estrogen deficiency, including vasomotor flushes and vaginal dryness, both of which respond to estrogen therapy effectively. There are several contraindications of estrogen supplement, including smokers over 35 years of age, uncontrolled hypertension, uncontrolled diabetes mellitus, or history of thromboemboli events. If the patient has strong family history of thromboemboli events, care must be taken to proceed with the hormonal replacement therapy. As the minimum, testing for Factor V Leiden, Protein C, and Protein S should be performed to ensure the low risk of developing thromboemboli events while on the estrogen replacement. The transdermal estradiol patch (typically 100 mcg) is commonly recommended because of several advantages. It provides the replacement by steady infusion rather than by bolus when taking daily pills. It also avoids the first-pass effect in the liver.

Related conditions

• Impaired Ovarian Reserve

In popular culture

In the fourth season of the British television show Skins, the character Katie Fitch is diagnosed with this after going in for a pregnancy test (since she missed several periods). This greatly upsets her because of her wish to have a family one day, and informs her character development.

References

External links

• International Premature Ovarian Failure Association
• POF Fact Sheets, FAQ
• POF Awareness Campaign for patients and health care providers

• National Institutes of Health publication No. 03-5159, Do I have Premature Ovarian Failure?

• National Institutes of Health's Premature Ovarian Failure website

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 自発性早期卵巣障害（早期卵巣機能不全）の臨床症状および評価 clinical manifestations and evaluation of spontaneous primary ovarian insufficiency premature ovarian failure
• 2. 原発性早期卵巣障害（早期卵巣機能不全）のマネージメント management of spontaneous primary ovarian insufficiency premature ovarian failure
• 3. 原発性早期卵巣障害（早期卵巣機能不全）の病因と原因 pathogenesis and causes of spontaneous primary ovarian insufficiency premature ovarian failure
• 4. 自己免疫性原発性卵巣不全（早発卵巣不全）の臨床的特徴および診断 clinical features and diagnosis of autoimmune primary ovarian insufficiency premature ovarian failure
• 5. 患者情報：早期閉経（原発性卵巣機能不全）（詳細） early menopause primary ovarian insufficiency beyond the basics

English Journal

• Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy.

• Franceschetti P, Bondanelli M, Caruso G, Ambrosio MR, Lorusso V, Zatelli MC, Massari L, Degli Uberti EC.SourceSection of Endocrinology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy. Electronic address: p.franceschetti@ospfe.it.
• Bone.Bone.2013 Oct;56(2):426-31. doi: 10.1016/j.bone.2013.07.010. Epub 2013 Jul 17.
• Bisphosphonates (BPs) are the first-line therapy for osteoporosis. In recent years, atypical femoral fractures (AFF) have been described in patients on BPs therapy. However, the relationship between BPs and AFF remains to be clarified. We evaluated clinical and hormonal characteristics of AFF patien
• PMID 23871850

• Increased salt sensitivity of ambulatory blood pressure in women with a history of severe preeclampsia.

• Martillotti G, Ditisheim A, Burnier M, Wagner G, Boulvain M, Irion O, Pechère-Bertschi A.SourceHypertension Unit, University Hospitals of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. antoinette.pechere@hcuge.ch.
• Hypertension.Hypertension.2013 Oct;62(4):802-8. doi: 10.1161/HYPERTENSIONAHA.113.01916. Epub 2013 Aug 26.
• Cardiovascular diseases are the principal cause of death in women in developed countries and are importantly promoted by hypertension. The salt sensitivity of blood pressure (BP) is considered as an important cardiovascular risk factor at any BP level. Preeclampsia is a hypertensive disorder of preg
• PMID 23980074

• Cross cultural analysis of factors associated with age at natural menopause among latin-american immigrants to madrid and their spanish neighbors.

• Pérez-Alcalá I, Sievert LL, Obermeyer CM, Reher DS.SourceDepartment of Sociology II (Human Ecology and Population Studies), Universidad Complutense de Madrid, Madrid, Spain.
• American journal of human biology : the official journal of the Human Biology Council.Am J Hum Biol.2013 Sep 10. doi: 10.1002/ajhb.22447. [Epub ahead of print]
• OBJECTIVES: In this study, age at menopause was examined in relation to demographic and life style factors among Latin-American immigrants to Madrid and their Spanish counterparts.METHODS: Respondents were drawn from the Decisions at Menopause Study (2002-2003) and from a recent sample of Latin-Amer
• PMID 24022910

Japanese Journal

• BMI, reproductive factors, and breast cancer molecular subtypes: A case-control study and meta-analysis

• Ｊｏｕｒｎａｌ　ｏｆ　Ｅｐｉｄｅｍｉｏｌｏｇｙ 27(4), 143-151, 2017
• NAID 130005611914

• 若年性乳癌手術症例の臨床病理学的検討

• 家族性腫瘍 16(2), 29-32, 2016
• NAID 130005665561

• Independent Association between Age at Natural Menopause and Hypercholesterolemia, Hypertension, and Diabetes Mellitus: Japan Nurses' Health Study

• Journal of Atherosclerosis and Thrombosis 20(2), 161-169, 2013
• NAID 130004845431

Related Links

• Early menopause (premature menopause) | womenshealth.gov

Early menopause can be caused by certain medical treatments, or it can just happen on its own. Medical treatments that may ... Genetics. Women with a family history of early menopause are more likely to have early menopause themselves.

• Premature Menopause: Causes, Symptoms, and Treatments - WebMD

In the U.S., the average age of onset for "natural" menopause is 51. However, because of genetics, illness, or medical procedures, some women go through menopause before the age of 40. Menopause that occurs before this age, whether ...

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★リンクテーブル★

リンク元	「早発閉経」
関連記事	「early」「ear」

「早発閉経」

　　[★]

英

premature ovarian failure, premature menopause, early menopause, precocious menopause

同

早発卵巣機能不全

関

閉経、早発卵巣不全、早期卵巣機能不全、抵抗性卵巣症候群

[show details]

早発閉経 : 約 196,000 件
早期閉経 : 約 6,620 件
早発卵巣機能不全 : 約 4,750 件
早期卵巣機能不全 : 約 4,670 件

• 43歳未満で閉経　(⇔　日本では45-55歳が平均)

「early」

　　[★]

• adj.

• (比較級earlier-最上級earliest)早期の、初期の

• adv.

• 早く

関

archaic、beginning、early stage、early-stage、initial、initially、preterm、soon

　 　 　 　 　 　 　 　 　

「ear」

　　[★]

• n.

• 耳