1. PREMATURE OVARIAN INSUFFICIENCY
Prof. SVETLANA VUJOVIĆ
Medical faculty, University in Belgrade,
Institute of Endocrinology
Belgrade, S E R B I A

2. DEFINITION
Premature ovarian insufficiency is cessation of menstruation in women under the age of 40.
It may be primary or secondary.
It is characterized by hypergonadotropism (FSH>40 IU/L) and hypoestrogenism (estradiol<50 pmol/L)
(Vujovic S et al. EMAS position statement, 2010)

3. INCIDENCE
YEARS
INCIDENCE 20 1: 30
1: 1000 35
1:250 40
1:100

4. OVARIAN PHYSIOLOGY Follicle atresia starts from 15 week of gestation;
6-7 x 106 (20 week) →1-2 x 106 (at birth)
→ at puberty;
Fewer than 500 oocytes (0.007%)are released
CRITICAL PROCESS: transition
primordial ↓
primary follicles

5. AETIOLOGY I Genetic aberrations (X chromosome or autosome)
II Autoimmune ovarian damage
III Environmental factors
IV Latrogenic (surgical, radio or chemotherapy)
V Metabolic changes (galactosaemia …)
VI Defect in structure/effects of gonadotrophins
VII Idiopathic

6. PATHOGENESIS Reduced gene dosage
Non-specific chromosome effects that impair meiosis ↓
Reduced number of primordial follicles or
Increased atresia due to apoptosis or failure of follicle maturation.