Abstract
Twenty-six patients with premature ovarian failure (last menstrual period before the age of 30 years) were evaluated clinically and endocrinologically and, in addition, ovarian biopsies were obtained in 15 out of the 26 patients. Only 1 of the patients revealed a family history of early menopause. The typical menstrual pattern indicated a normal age at menarche with regular periods for various length of time followed either by amenorrhoea abruptly or by a period of oligomenorrhoea before the onset of amenorrhoea. All patients showed normal or slightly underdeveloped secondary sexual characteristics, and it should be noted that 2 patients had been pregnant previously.
It was characteristic of all patients that the excretion of total gonadotropins was constantly increased and that the excretion of total oestrogens was low, whereas both the adrenal and thyroid function were normal. All patients were X-chromatin positive.
In 13 out of the 15 patients, in whom ovarian biopsies were obtained, the histological examination revealed a normal stroma without or with very few primordial and atretic follicles, a picture very similar to that characteristic of the postmenopausal ovary. In the last 2 patients, however, the histological examination showed a quite different picture, viz. a normal stroma with numerous primordial and primary follicles and even a few growing follicles. In spite of these morphologically normal follicles, it was not possible to stimulate the follicular development and to induce ovulation even with very high doses of human gonadotrophins. It is, therefore, concluded that the presence of a few growing follicles in the ovaries does not seem to exclude the diagnosis of premature ovarian failure.
Only 14 out of the 26 patients had the typical symptoms of the climacteric, and even in these cases the nuisance was only of a mild to moderate degree. It is generally agreed that all patients with symptoms should receive substitution therapy, but the essential risk of ischaemic heart disease and osteoporosis, together with the unquestionable psychological effect of having regular menstrual bleeding, have led us to the conclusion that this therapy is indicated in all cases of premature ovarian failure. Cyclical treatment either with a sequential preparation or with oestrogens alone is the treatment of choice.