Zusammenfassung
Der Begriff „prämature Ovarialinsuffizienz“ (POI) bezeichnet den vorzeitigen Verlust der Ovarialfunktion vor dem 40. Lebensjahr mit dem konsekutiven kombinierten Auftreten eines hypergonadotropen Hypogonadismus und einer primären/sekundären Amenorrhoe. Die Diagnostik beinhaltet eine detaillierte Anamnese (Chemotherapie, Radiotherapie, Operationen) sowie die Abklärung genetischer Ursachen und eines polyglandulären Autoimmunsyndroms. Bei Diagnosestellung wird die Durchführung eines DXA-Scans zur Bestimmung der Basisknochendichte empfohlen. Die prämature Ovarialinsuffizienz hat nicht nur einschneidende Auswirkungen auf die Fertilität, sondern geht auch mit negativen Langzeitfolgen u. a. auf die Knochengesundheit, das kardiovaskuläre System und die kognitive Funktion einher. Eine Hormonersatztherapie (HRT) zumindest bis zum durchschnittlichen regelrechten Menopausenalter wird zur Primärprävention östrogenmangelbedingter Langzeitfolgen empfohlen. Die Risiko-Nutzen-Analyse einer HRT, wie wir sie aus Daten von Frauen mit regelrechter Menopause kennen, darf nicht uneingeschränkt auf das Kollektiv der Patientinnen mit POI extrapoliert werden. Bei Patientinnen mit POI wiegt der Nutzen einer HRT deutlich schwerer als die potenziellen Risiken.
Résumé
Le terme »insuffisance ovarienne prématurée« désigne l’épuisement prématuré de la fonction ovarienne avant la 40e année de vie, avec développement consécutif d’un hypogonadisme hypergonadotrope associé à une aménorrhée primaire/secondaire. Le processus de diagnostic comprend une anamnèse détaillée (chimiothérapie, radiothérapie, interventions chirurgicales) ainsi que la vérification de causes génétiques et d’un éventuel syndrome polyendocrinien auto-immun. Si le diagnostic est établi, on recommande de faire un scan DXA pour déterminer la densité minérale osseuse de base. En plus de ses conséquences décisives pour la fertilité, l’insuffisance ovarienne prématurée a d’autres conséquences négatives à long terme, entre autres sur la santé des os, le système cardio-vasculaire et la fonction cognitive. Un traitement hormonal substitutif poursuivi au moins jusqu’à l’âge normal de la ménopause est recommandé pour la prévention primaire des conséquences à long terme du déficit œstrogénique. L’analyse connue du rapport avantages-risques du THS, établie d’après les données des femmes ménopausées à l’âge normal, ne peut pas être extrapolée sans restriction au collectif des patientes atteintes d’une IOP. Chez les patientes ménopausées prématurément, les avantages d’un THS prédominent nettement par rapport aux risques potentiels.
Abstract
The term “premature ovarian insufficiency” (POI) describes the premature loss of ovarian function before the age of 40 years and is accompanied by a combination of hypogonadotropic hypogonadism and primary/secondary amenorrhea. The diagnostic process includes a detailed anamnesis (chemotherapy, radiation therapy, operations) and the exclusion of genetic causes as well as polyglandular autoimmune syndrom. At diagnosis measurement of bone density is recommended. POI not only has an adverse impact on fertility but is also associated with negative long-term effects on bone health, the cardiovascular system and cognitive function. To prevent estrogen deficiency-related long-term consequences hormone replacement therapy (HRT) at least until the average natural menopause age is recommended. The benefit-risk profile of HRT in naturally postmenopausal women may not be unrestrictedly extrapolated to the collective of patients with POI. In patients with POI the benefits of HRT far outweigh the potential risks.
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Weidlinger, S. Prämature Ovarialinsuffizienz. J. Gynäkol. Endokrinol. 21, 51–57 (2018). https://doi.org/10.1007/s41975-018-0045-1
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DOI: https://doi.org/10.1007/s41975-018-0045-1