61. Colorado Reproductive Endocrinology Introduction Premature ovarian failure (POF) is defined by most that there may besome ovarian follicles remaining The two primary concerns of the woman and the http://www.coloradofertility.com/physician_prem_failure.htm

resources Premature Ovarian Failure Introduction Presentation of the Woman With POF Causes of Premature Ovarian Failure Iatrogenic ... Therapy Introduction Premature ovarian failure (POF) is defined by most authors as the loss of ovarian function before the age of 40. It is characterized by amenorrhea, hypoestrogenemia, and elevated serum gonadotropin levels. This occurs in about 1.9% of women before age 40 and in 0.1% of women before age 30. Menopause normally occurs at an average age of 50, at which time ovulation ceases and symptoms of hypoestrogenemia typically appear as a result of ovarian follicular depletion. The mean age of menopause is over 45 in 88% of women and under 45 in 9.7% of women. When POF occurs, it has been shown that there may be some ovarian follicles remaining, menses may return, and pregnancies may occur. The two primary concerns of the woman and the clinician include the woman's fertility potential and the long-term consequences of hypoestrogenemia. This lecture will present the currently understood causes of POF, a reasonable diagnostic approach to the problem, the long-term health consequences of POF, and therapeutic considerations. Return to top of page next page Suggested Reading home ... Legal Notices Webmaster: webmaster@outsourceit.com

62. WHAT CAUSES AMENORRHEA? Anorexia and Bulimia. The eating disorders anorexia and bulimia may bea primary factor in many cases of FHA. Premature ovarian failure. http://www.ucdmc.ucdavis.edu/ucdhs/health/a-z/101Amenorrhea/doc101causes.html

WHAT CAUSES AMENORRHEA? Delayed Puberty The most common cause of primary amenorrhea is delayed puberty due to some genetic factor that delays physical development. Being short is the most common sign of this, although sometimes a family history of delayed menstruation can indicate this situation. Time usually resolves the problem. Functional Hypothalamic Amenorrhea (FHA) and Eating Disorders Functional hypothalamic amenorrhea (FHA) is the absence of menstruation due to disturbances in the thyroid gland and hypothalamus-pituitary-adrenal (HPA) system. FHA may be due to different factors, most unknown. The hypothalamus and the pituitary gland regulate the reproductive hormones. It triggers the production and release of steroid hormones ( glucocorticoids ), including the primary stress hormone cortisol . The HPA system manages appetite and mood as well. Anorexia and Bulimia. The eating disorders anorexia and bulimia may be a primary factor in many cases of FHA. Both weight loss and changes of appetite may cause hormonal abnormalities. Such changes may be due to a primitive protective biologic mechanism, which was designed to prevent potentially harmful pregnancies during times of famine. Hormonal changes to extreme weight loss and reduced fat stores include low thyroid levels (hypothyroidism) and excessive stress hormone levels (hypercortisolism), which in turn reduce reproductive hormones. Reducing stress hormones, in one study, helped elevate reproductive hormones in women with FHA.

63. COCHRANE MENSTRUAL DISORDERS AND SUBFERTILITY GROUP Nonsteroidal antiinflammatory drugs for primary dysmenorrhoea (Cochrane Review); inductionin women with spontaneous premature ovarian failure (Cochrane Review http://www.cochrane.org/cochrane/revabstr/g180index.htm

COCHRANE MENSTRUAL DISORDERS AND SUBFERTILITY GROUP Abstracts of Cochrane Reviews The Cochrane Library Issue 1, 2003 The full text of these reviews and protocols is available in [The Cochrane Library] indicates the review is new in the current release of the Library. indicates the review has been substantially amended since the last issue of the Library. Note: 'Protocols' are the introduction, objectives, materials and methods for reviews currently being prepared. Reviews "Coasting" (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome (Cochrane Review) Androgens versus placebo or no treatment for idiopathic oligo/asthenospermia (This review has been withdrawn by the editorial group. Abstract not available) Antifibrinolytics for heavy menstrual bleeding (Cochrane Review) Barrier agents for preventing adhesions after surgery for subfertility (Cochrane Review) Bromocriptine for idiopathic oligo/asthenospermia (This review has been withdrawn by the editorial group. Abstract not available) Bromocriptine for unexplained subfertility in women (Cochrane Review) Cleavage stage versus blastocyst stage embryo transfer in assisted conception (Cochrane Review) Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea (Cochrane Review) Clomiphene citrate for unexplained subfertility in women (Cochrane Review) Clomiphene or tamoxifen for idiopathic oligo/asthenospermia (This review has been withdrawn by the editorial group. Abstract not available)

64. COCHRANE MENSTRUAL DISORDERS AND SUBFERTILITY GROUP Abstracts Nonsteroidal antiinflammatory drugs for primary dysmenorrhoea (Cochrane Protocol); inwomen with spontaneous premature ovarian failure (Cochrane Protocol); http://www.update-software.com/abstracts/g180index.htm

See also Italian COCHRANE MENSTRUAL DISORDERS AND SUBFERTILITY GROUP Abstracts of Cochrane Reviews The Cochrane Library Issue 1, 2003 The full text of these reviews and protocols is available in The Cochrane Library indicates the review is new in the current release of the Library. indicates the review has been substantially amended since the last issue of the Library. Note: 'Protocols' are the introduction, objectives, materials and methods for reviews currently being prepared and do not therefore have abstracts What's new in this issue Search abstracts Browse by Review Group Browse alphabetical list of titles ... About The Cochrane Library Reviews "Coasting" (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome (Cochrane Review) Androgens versus placebo or no treatment for idiopathic oligo/asthenospermia (This review has been withdrawn by the editorial group. Abstract not available) Antifibrinolytics for heavy menstrual bleeding (Cochrane Review) Barrier agents for preventing adhesions after surgery for subfertility (Cochrane Review) Bromocriptine for idiopathic oligo/asthenospermia (This review has been withdrawn by the editorial group. Abstract not available)

65. Nature Publishing Group cause arrest of primary follicle development 8 . Mice lacking Foxl2 should providea means to better understand the pathogenesis of ovarian failure in type I http://www.nature.com/cgi-taf/DynaPage.taf?file=/ng/journal/v27/n2/full/ng0201_1

66. Nature Publishing Group lines as well as in some primary colon cancers. common with over 40% of serous ovariancancers showing Our failure to identify any somatic alteration among our http://www.nature.com/cgi-taf/DynaPage.taf?file=/onc/journal/v18/n46/full/120307

67. P53 Overexpression Is Not An Independent Prognostic Factor For Patients With Pri other wellknown prognostic variables in multivariate analysis, and failure to account ofp53 overexpression in patients with primary ovarian epithelial cancer http://www.slip.net/~mcdavis/database/p53_21.htm

Cancer 80:892-8, 1997 American Cancer Society . All rights reserved. Published by p53 Overexpression Is Not an Independent Prognostic Factor for Patients with Primary Ovarian Epithelial Cancer Gamal H. Eltabbakh, M.D. , Jerome L. Belinson, M.D. , Alexander W. Kennedy, M.D. , Charles V. Biscotti, M.D. , Graham Casey, Ph.D. , Raymond R. Tubbs, D.O. , Leslie E. Blumenson, Ph.D. Department of Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio. Department of Anatomic and Clinical Pathology, the Cleveland Clinic Foundation, Cleveland, Ohio. Department of Cancer Biology, the Cleveland Clinic Foundation, Cleveland, Ohio. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York. ABSTRACT BACKGROUND. The clinical significance of p53 overexpression in patients with ovarian carcinoma is uncertain. Previous studies have yielded conflicting results and have been hampered by small patient populations, failure to account for other well-known prognostic variables in multivariate analysis, and failure to account for the grade of p53 overexpression. The aim of this study was to investigate the independent prognostic significance of p53 overexpression in patients with primary ovarian epithelial cancer (POEC). METHODS.

68. SWEHSC - Faculty Research Pages These pools of primordial and primary follicles can not be regenerated. Therefore,once they are destroyed, ovarian failure (menopause) results. http://swehsc.pharmacy.arizona.edu/people/faculty/summary/Hoyer.html

SWEHSC Research Cores Facility Cores Pilot Projects About the SWEHSC Southwest Environmental Health Sciences Center Faculty Research Page Patricia B. Hoyer Adjunct Professor, Animal Science; Professor, Physiology; Investigator, Center for Toxicology Ovarian physiology and toxicology SWEHSC Center for Toxicology University of Arizona TOP Southwest Environmental Health Sciences Center University of Arizona College of Pharmacy, Room 244 PO Box 210207, Tucson, AZ, USA 85721-0207 swehsc-info@pharmacy.arizona.edu 520-626-6944(FAX) The Southwest Environmental Health Sciences Center is funded by NIEHS grant # ES06694 Questions/ Feedback Last update: November 6, 2000 Page Content: SWEHSC Web Master: Mike Kopplin

69. Menstrual Cycle Disorders that lead to secondary amenorrhea can also cause primary amenorrhea. these conditionsinclude polycystic ovary syndrome and ovarian failure (early menopause). http://www.uptodate.com/patient_info/topicpages/topics/Endo_hor/9299.asp

Menstrual cycle disorders CAUSES OF MENSTRUAL CYCLE DISORDERS Causes of primary amenorrhea Causes of secondary amenorrhea Causes of oligomenorrhea ... WHERE TO GET MORE INFORMATION Kathryn A Martin, MD Ann E Taylor, MD UpToDate performs a continuous review of over 290 journals and other resources. Updates are added as important new information is published. The literature review for UpToDate version 11.1 is current through December 2002; this topic was last changed on October 25, 2000. These materials are for your general information and are not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment, or care. Do not contact UpToDate or the physician authors of these materials. Amenorrhea refers to the absence of menstrual periods, and is classified as primary (absence of the onset of menstrual periods by age 16) or secondary (absence of menstrual periods for more than three to six months in a woman who previously had periods). Oligomenorrhea refers to infrequent menstrual periods (fewer than six to eight periods per year). The causes, evaluation, and treatment of amenorrhea and oligomenorrhea are similar, and will be considered together.

70. Diseases Database Disease, Symptom, Sign, Etc Alphabetical Index : O Diseases Da see Idiopathic premature ovarian failure ovarian hyperstimulation deficiency ovariantorsion ovarian tubal ligation type 1 see Hyperoxaluria, primary type 1 http://www.diseasesdatabase.com/sieve/disease_index_o.asp

Diseases Database [Previous page] [Search] [Index] [Feedback] Diseases Database disease, symptom, sign, etc alphabetical index : O O'Brien's granuloma see Actinic granuloma O'nyong-nyong fever O-chlorobenzylidine malononitrile see CS gas O-methyldihydroartemisinine see Artemether see Oxygen OA see Osteoarthritis Oasthouse urine disease see Methionine malabsorption OAT deficiency see Ornithine ketoacid transaminase deficiency Obesity Obliterative bronchiolitis see Bronchiolitis obliterans Obnubilation see Brain failure Obstetric Obstetric shock see Puerperal shock Obstructive jaundice see Cholestatic jaundice Obstructive nephropathy see Hydronephrosis Obstructive sleep apnoea Obturator hernia Occult blood in stools see Faecal occult blood positive Ochoa syndrome Ochronosis see Alkaptonuria Ockelbo disease see Sindbis virus Octapressin see Felypressin Octopressin see Felypressin Octreotide see Somatostatin Octylcyanoacrylate Ocular albinism type 1 Ocular cicatrical pemphigoid see Cicatricial pemphigoid Ocular hypertelorism see Hyperteliorism, ocular Ocular hypertension see Raised intraocular pressure Ocular larva migrans Ocular movement abnormality Oculoauricular vertebral dysplasia see Goldenhar syndrome Oculoauriculovertebral syndrome see Goldenhar syndrome Oculobuccogenital syndrome see Behcet's disease Oculocerebral syndrome see Lowe's syndrome Oculocerebrocutaneous syndrome Oculocutaneous albinism (tyrosinase negative) Oculocutaneous albinism (tyrosinase positive) Oculocutaneous albinism type 1 see Oculocutaneous albinism (tyrosinase negative) Oculocutaneous albinism with leukocyte defect

71. Gyn-A130 primary amenorrhea affects only approximately one in onethousand women pituitarygland and other parts of the brain, and premature ovarian failure or premature http://www.obgyngroup.com/Library\gyn-A130.html

Medical Articles of Interest AMENORRHEA Amenorrhea Amenorrhea is defined as the absence of menses during the reproductive years. It can be either physiologic or pathologic. Physiologic causes would include not having a menstrual period during the time of pregnancy and in the postpartum period, especially while nursing. Pathologically, it can be caused by a variety of different types of disorders, including hormonal abnormalities and anatomical abnormalities. Amenorrhea can be primary amenorrhea, which includes the absence of a menstrual period by the age of sixteen and one-half years, and secondary amenorrhea, the absence of menses for usually approximately six months in a person who has had spontaneous menstrual periods previously. The evaluation for secondary amenorrhea usually includes the administration of progesterone, either in an oral form or via an intramuscular injection, and then waiting to see if a menstrual period occurs. If a menstrual period occurs, then further hormonal evaluation via blood testing is necessary. If a menstrual period does not occur, then evaluation of a specific hormone called follicle stimulating hormone would be necessary to determine if premature ovarian failure has occurred, or if there has been failure of release of hormones from deep within the brain. Treatment of secondary amenorrhea can simply be removing medications, quitting street drugs, decreasing exercise, minimizing stress, and increasing weight. Other problems such as certain identified, or specific types of brain tumors, such as a prolactinoma, may be treated simply with oral medication and most often results in resumption of menstrual periods. Other conditions such as Polycystic Ovarian Syndrome may require treatment with birth control pills or cyclic progestational medications.

72. Clinical Study: 00-CH-0045, Hormone Replacement In Young Women With Premature Ov Vitamin D deficiency, Paget's disease, primary hyperparathyroidism, hyperthyroidism Wewill include patients with premature ovarian failure on antidepressant http://clinicalstudies.info.nih.gov/detail/A_2000-CH-0045.html

Protocol Number: 00-CH-0045 Title: Hormone Replacement in Young Women with Premature Ovarian Failure Number: 00-CH-0045 Summary: The human ovary produces male sex hormones (androgen) and female sex hormones (estrogen). Currently, androgen is not included in hormone replacement therapy for women with premature ovarian failure. Present hormone replacement therapy (HRT) was designed to treat women who experience ovarian failure at menopause (around the age of 50). However, 1% of women will experience premature failure of the ovaries before the age of 40. There have been no studies conducted to determine proper hormone replacement therapies for these younger women. Some research suggests that the usual menopausal hormone replacement therapy is not adequate to protect young women with premature ovarian failure from developing osteoporosis. Women with premature ovarian failure have abnormally low levels of androgens circulating in their blood. This may contribute to the increase risk for osteoporosis. This study will compare two treatment plans for women with premature ovarian failure. Treatment plan one will be physiological estrogen hormone replacement. Treatment plan two will be physiological estrogen hormone replacement plus androgen. The study will attempt to determine which plan is more beneficial to women in relation to osteoporosis and heart disease.

73. Premature Ovarian Failure -- POF This site provides women with POF (Premature ovarian failure) with information about ongoing studies/treatment at the NIH (National Institutes of Health) Do you have Premature ovarian failure? Doctors at the National Institutes of Health (NIH) are young women with spontaneous premature ovarian failure (POF). These studies will also http://dir2.nichd.nih.gov/nichd/deb/geuPOF/geupofpg.htm

Do you have Premature Ovarian Failure? Doctors at the National Institutes of Health (NIH) are conducting a clinical research program whose goal is to develop improved treatments for young women with spontaneous premature ovarian failure (POF). These studies will also help doctors and patients learn more about POF. More Information Frequently Asked Questions Contact Information Printable Information Patient Recruitment Office (toll free) 1-866-411-1010 (TTY) prpl@mail.cc.nih.gov http://www.cc.nih.gov/ccc/prrc/

74. Premature Ovarian Failure (POF) Interview with Catherine Corp from POF Support on the less common infertility cause of premature ovarian failure helpful websites regarding premature ovarian failure. Her response of Premature ovarian failure (POF), sometimes referred to Incidence of Premature ovarian failure, which has since http://infertility.about.com/library/weekly/aa100398.htm

zfp=-1 About Infertility Search in this topic on About on the Web in Products Web Hosting Infertility with Apply Now Your Guide to one of hundreds of sites Home Articles Forums ... Help zmhp('style="color:#fff"') Subjects ESSENTIALS Answers to Frequently Asked Questions How Tos Center for Resolutions to Infertility ... All articles on this topic Stay up-to-date! Subscribe to our newsletter. Advertising Free Credit Report Free Psychics Advertisement Premature Ovarian Failure (POF) Dateline: 10/03/98 Talking with Catherine Corp of the non-profit group POF Support , I asked if she knew of any particularly helpful websites regarding premature ovarian failure . Her response of "Sorry, (but) no; that's why we started POF group!", convinced me further that this is an important topic to feature. Premature ovarian failure (POF), sometimes referred to as " premature menopause ", is a loss of ovarian function in women under 40 years of age. Periods stop, estrogen is low, and the follicle-stimulating hormone (FSH) level is elevated. Generally, an accurate diagnosis requires at least four months without a period and two FSH tests, taken at least one month apart, with results greater than 40 mIU/ML. In 1986

75. - Help On , Ovarian Antibodies Back. ovarian Antibodies. Found in 1520% of patients with primaryovarian failure. ovarian antibodies are almost always present in http://www.chl.govt.nz/chlabs/help/6850hlp.htm

76. Member Sign In Terminal deletions at Xp11 result in 50% primary amenorrhea and 50% prematureovarian failure. Deletions at Xq13 usually produce primary amenorrhea. http://www.medscape.com/viewarticle/444686_4

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

77. NIH News Release--Women With Premature Menopause At Increased Risk For Potential Premature ovarian failure occurs when the ovaries stop producing eggs and Primaryautoimmune adrenal insufficiency, also known as Addison's disease, occurs http://www.nih.gov/news/pr/aug2002/nichd-30.htm

NATIONAL INSTITUTES OF HEALTH National Institute of Child Health and Human Development FOR IMMEDIATE RELEASE Friday, August 30, 2002 Contact: Marianne Glass Duffy Robert Bock Women with Premature Menopause at Increased Risk for Potentially Fatal Adrenal Condition Early Diagnosis Can Lead to Effective Treatment Women with spontaneous premature ovarian failure (POF) are three hundred times more likely than members of the general population to develop a serious condition in which the body attacks the adrenal glands, according to a study by researchers at the National Institute of Child Health and Human Development (NICHD). The study also reports that a test measuring immune system proteins known as antibodies is an effective way to diagnose the adrenal condition in women with spontaneous POF. The researchers published their findings in the August issue of Human Reproduction Premature ovarian failure occurs when the ovaries stop producing eggs and reproductive hormones well in advance of natural menopause. An estimated one percent of American women develop the condition by age 40. Primary auto-immune adrenal insufficiency, also known as Addison's disease, occurs when the body's own immune system makes antibodies that attack and destroy the adrenal glands. Antibodies ordinarily bind to disease-causing organisms, tagging them for later destruction by the immune system. The adrenal glands produce hormones (cortisol and aldosterone) that regulate salt metabolism and the body's response to stress. Addison's disease is easily treated with medication that replaces the hormones that the adrenal glands are not making. However, if a person with untreated adrenal insufficiency experiences a stressful event, like a severe illness, injury, or surgery, he or she can die from the condition. Despite the fact that adrenal insufficiency can be life threatening, there has been ongoing debate in the medical community as how to best detect this condition in the early stages.

78. Primary Amenorrhea Premature ovarian failure (10%); Oophoritis (rare) Chemotherapy or Radiation; http://www.fpnotebook.com/GYN70.htm

Home About Links Index ... Editor's Choice Paid Advertisement (click above). Please see the privacy statement Gynecology Menses Assorted Pages Primary Amenorrhea Secondary Amenorrhea Abnormal Uterine Bleeding Causes Anovulatory Bleeding ... Uterine Fibroid Primary Amenorrhea Book Home Page Cardiovascular Medicine Dental Dermatology Emergency Medicine Endocrinology Gastroenterology General Medicine Geriatric Medicine Gynecology Hematology and Oncology HIV Infectious Disease Jokes Laboratory Neonatology Nephrology Neurology Obstetrics Ophthalmology Orthopedics Otolaryngology Pediatrics Pharmacology Prevention Psychiatry Pulmonology Radiology Rheumatology Sports Medicine Surgery Urology Chapter Gynecology Index Breast Cervix Contraception Dermatology Endocrinology Examination Hematology and Oncology Infectious Disease Laboratory General Menses Obstetrics Pharmacology Prevention Procedure Psychiatry Radiology Surgery Symptom Evaluation Uterus Vagina Vulva Page Menses Index Amenorrhea Primary Amenorrhea Secondary DUB Causes DUB Management Anovulatory DUB Management Anovulatory Metrorrhagia DUB Management Ovulatory DUB Management Ovulatory Menorrhagia Dysmenorrhea Primary Dysmenorrhea Secondary Definition No menstrual period by: Sixteen years old or One year beyond Family History No secondary sexual characteristics by 14 years old Causes Axis 1: Hypothalamus or Central Anovulation (10%) Post-hormonal contraceptive Amenorrhea Constitutional (6%): Family history Anosmia Axis 2: Pituitary Pituitary Tumor (8%) Pituitary Adenoma (hormone producing) Pituitary Null Cell Tumor (No hormone produced)

79. 121 - BONE MASS MEASUREMENTS 256.3. Other ovarian failure includes premature menopause and primaryovarian failure (9/7/99). 256.31, Premature menopause (10/01/2001). http://www.gamedicare.com/policies/121.htm

BONE MASS MEASUREMENTS Contractor's Policy Number: Contractor Name: Cahaba GBA Contractor Number: Contractor Type: Carrier LMRP Title: Bone Mass Measurements CMS National Coverage Policy: Title XVIII of the Social Security Act, section 1862(a)(7). This section excludes routine physical checkups. Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered medically reasonable and necessary. Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Title IV of the Balanced Budget Act of 1997, section 4106. This section includes language providing for Medicare coverage of bone mass measurement procedures, and coverage of FDA-approved bone mass measurement techniques and equipment. These procedures are covered only when medically necessary. The intent of this bone mass measurement policy is to clarify rules for determining medical necessity. Primary Geographic Jurisdiction: Georgia Secondary Geographic Jurisdiction: N/A CMS Region: Region IV CMS Consortium: Southern Original Policy Effective Date: Original Policy Ending Date: Revision Effective Date:

80. Bone Mass Measurements 256.3, Other ovarian failure ( includes premature menopause and primaryovarian failure). 627.2, Menopausal or female climacteric states. http://www.ahsmedicare.com/medical_review_appeals/provider/LMRP/archived/FI-R-06

Associated Hospital Service To Archived Policies POLICY NUMBER: FI-R-0600-04ac TITLE: Bone Mass Measurements BEGINNING EFFECTIVE DATE SYSTEM: June 1, 2000 DESCRIPTION: POLICY TYPE: INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY: The term "qualified individual" means an individual who meets the medical indications for at least one of the five categories listed below: A woman, who has been determined by the physician or a qualified nonphysician practitioner treating her, to be estrogen-deficient and at clinical risk for osteoporosis, based on her medical history and other findings. An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass), or vertebral fracture; An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 7.5 mg of prednisone, or greater, per day, for more than 3 months; An individual with primary hyperparathyroidism; or An individual being monitored to assess the response to or efficacy of a FDA-approved osteoporosis drug therapy.

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