DR Medhat MRCP

3) Infertility : (under specialist supervision)
Weight reduction if appropriate.
Clomifene (main TTT) &/or Metformin are used to stimulate ovulation (metformin if
‏(سؤال obese as it increases the peripheral insulin sensitivity
Gonadotropins
There is a potential risk of multiple pregnancies with anti-oestrogen* therapies
such as clomifene
*work by occupying hypothalamic oestrogen receptors without activating them.
This interferes with the binding of oestradiol and thus prevents negative feedback
inhibition of FSH secretion .
Premature ovarian failure :
• Def : premature menopause before the age of 40 years.
• Incidence : 1% of females under 40 years old.
• Causes :
1) Autoimmune ovarian failure (the commonest, 20% of the cases)
- In 10% of women with Addison`s disease & 25% of women with autoimmune
thyroid disease.
2) Irradiation
3) Drugs e.g cyclophosphamide
4) Oophorectomy.
• Features :
2ndry amenorrhoea (premature menopause).
Postmenopausal synptoms e.g hot flushes.
Low estradiol level
High FSH & LH levels.
U.S : usually small ovaries ,small uterus & thin endometrium.
• Treatment :
Hormonal (estrogen) replacement therapy :
- Cyclical estrogen/progesterone (21/28 d) → - - osteoporosis & vaginal atrophy
- Should be continued up to the age of expected menopause.
- Patients wishing to remain amenorrhoeic should receive continuous oestrogen
and low dose progestrone ,2-5 mg daily→ ↓ postmenopausal symptoms.
In vivo fertilization (IVF) using donated ova :
- Is the recommended ttt in those women wishing to still bear children.