Epidemiology

Etiology

• Idiopathic (up to 70% of cases)
• Autoimmune diseases, e.g.:
  • Hashimoto thyroiditis
  • Adrenal insufficiency
  • Autoimmune lymphocytic oophoritis
• Iatrogenic
  • Radiation and/or chemotherapy

Pathophysiology

Follicular dysfunction or depletion → ↓ estrogen levels → reduced feedback inhibition of estrogen on FSH and LH → ↑ FSH and LH (usually FSH > LH)

Clinical features

• Amenorrhea or abnormal uterine bleeding
• Climacteric symptoms such as vaginal dryness, vasomotor symptoms, dyspareunia, and irritability
• Infertility

Diagnostics

• Age is < 40 years
• There has been irregular menstruation for ≥ 3 consecutive months
• ↑ FSH levels (> 30–40 mIU/mL)
• ↓ Estradiol levels (< 50 pg/mL)

Treatment