[Premature failure of the ovaries]

The premature ovarian failure syndrome has been reviewed on the basis of existing data. The frequency, clinical picture and diagnostic procedures of premature ovarian failure are discussed. The disorder is characterized by secondary amenorrhea with constant estrogen deficiency and elevated gonadotropin levels in the post-menopausal range. Differential diagnosis is to be made with pituitary adenomas secreting gonadotropin, circulating gonadotropin antibodies, and biological profiles typical of the peri-menopausal years. Histopathology distinguishes two principal forms of premature ovarian failure: the premature menopause with complete follicular depletion of the ovaries, and the insensitive ovary syndrome. A correct ovarian biopsy is important for this diagnosis and can also help to point toward an immunological etiology. The following causes of premature menopause are analysed: chromosomal abnormalities, autoimmune disorders, viral infections and galactosemia. The toxic and iatrogenic causes are not developed. The factors eventually implicated in the insensitive ovary syndrome are discussed: deficient biological activity of gonadotropins, the presence of inhibitor substances preventing hormone action and the presence of antibodies toward FSH receptors. In the management of premature ovarian failure, a possible autoimmunization has to be considered. When an immunological disorder is suspected, other autoimmune glandular failures, that may develop secondarily, have to be detected. From the 26 pregnancies reported after a diagnosis of the insensitive ovary syndrome, only two occurred after a correct ovarian biopsy. Those cases seem to indicate that reducing endogenous gonadotropins to normal levels is important before considering induction of ovulation.