Mendoza Nicolás, Juliá Ma Dolores, Galliano Daniela, Coronado Pluvio, Díaz Begoña, Fontes Juan, Gallo José Luis, García Ana, Guinot Misericordia, Munnamy Merixtell, Roca Beatriz, Sosa Manuel, Tomás Jordi, Llaneza Plácido, Sánchez-Borrego Rafael
University of Granada, Obstetric and Gynecologic, Granada, Spain.
Hospital Universitario la Fe de Valencia, Spain.
Maturitas. 2015 Feb;80(2):220-5. doi: 10.1016/j.maturitas.2014.11.007. Epub 2014 Dec 27.
While we recognise that the term premature menopause is more accepted by most non-specialist health care providers and by the general population, 'primary ovarian insufficiency' (POI) is currently considered the most apposite term to explain the loss of ovarian function, because it better explains the variability of the clinical picture, does not specify definitive failure, and highlights the specific ovarian source. Its pathogenesis involves a congenital reduction in the number of primordial follicles, poor follicle recruitment, or accelerated follicular apoptosis. However, its cause is unknown in most cases.
This guide analyses the factors associated with the diagnosis and treatment of POI and provides recommendations on the most appropriate diagnostic and therapeutic measures for women under 40 years of age who experience POI.
A panel of experts from various Spanish scientific societies related to POI (Spanish Menopause Society, Spanish Fertility Society, and Spanish Contraception Society) met to reach a consensus on these issues.
Hormonal therapy (HT) is considered the treatment of choice to alleviate the symptoms of hypoestrogenism and to prevent long-term consequences. We suggest that HT should be continued until at least age 51, the average age at natural menopause. The best treatment to achieve pregnancy is oocyte/embryo donation. If a patient is to undergo treatment that will reduce her fertility, she should be informed of this issue and the available techniques to preserve ovarian function, mainly vitrification of oocytes.
虽然我们认识到“过早绝经”一词更易被大多数非专科医疗服务提供者和普通大众所接受，但“原发性卵巢功能不全”（POI）目前被认为是解释卵巢功能丧失的最恰当术语，因为它能更好地解释临床表现的变异性，不明确界定为最终衰竭，并突出了特定的卵巢来源。其发病机制涉及原始卵泡数量的先天性减少、卵泡募集不良或卵泡凋亡加速。然而，在大多数情况下其病因尚不清楚。
本指南分析了与POI诊断和治疗相关的因素，并为40岁以下发生POI的女性提供了关于最合适的诊断和治疗措施的建议。
来自西班牙与POI相关的各个科学学会（西班牙绝经学会、西班牙生育学会和西班牙避孕学会）的专家小组开会就这些问题达成共识。
激素治疗（HT）被认为是缓解低雌激素症状和预防长期后果的首选治疗方法。我们建议HT应持续至至少51岁，即自然绝经的平均年龄。实现妊娠的最佳治疗方法是卵母细胞/胚胎捐赠。如果患者要接受会降低其生育能力的治疗，应告知她这一问题以及保留卵巢功能的可用技术，主要是卵母细胞玻璃化冷冻。
