Patient's question:
Ultrasound examination on the 6th day of the menstrual cycle, left ovary size 20x24x25mm, right 16x27x23mm, no abnormalities observed. Does this rule out premature ovarian failure? What are the differences in symptoms between premature ovarian failure and luteal phase defect? What tests should be done for luteal phase defect, and when should they be performed?Doctor's answer:
Hello! Premature ovarian failure (POF) refers to women who have established regular menstrual cycles and experience persistent amenorrhea and atrophy of sexual organs before the age of 40 due to ovarian dysfunction. It is often accompanied by elevated levels of gonadotropins and decreased levels of estrogen, along with clinical symptoms such as hot flashes, excessive sweating, vaginal dryness, and decreased libido, which are typical of menopausal symptoms.The Western medical examination for POF generally includes the following aspects:
1. Physical Examination: Basal body temperature is elevated. Gynecological examination reveals thin vaginal mucosa, reduced rugae, congestion, and atrophic uterus.
2. Laboratory Tests and Other Examinations:
- Endocrine Hormone Testing: FSH and LH levels are significantly elevated, while E2 levels are significantly decreased, reaching menopausal levels. Confirmation requires three laboratory tests. Prolactin (PRL) levels are normal.
- Vaginal Smear: Shows low estrogen levels, with predominance of basal cells or low-layer cells.
- Ultrasound: Reveals small ovaries with no visible follicles, indicating POF; normal-sized ovaries with multiple small follicles suggest the polycystic ovary syndrome (PCOS).
- Laparoscopic Examination or Laparoscopic Ovarian Biopsy: In POF, the ovaries appear small, atrophic, with no visible follicles, no primordial follicles under microscopic examination, fibrosis of ovarian stroma, and the presence of anti-ovarian antibodies. In PCOS, the ovaries are normal-sized, with multiple small follicles visible both macroscopically and microscopically, and the ovarian tissue may show anti-follicle membrane cells, anti-granulosa cells, and anti-FSH antibodies.
Premature luteal phase failure refers to insufficient progesterone secretion by the corpus luteum, leading to poor secretion of the endometrium and difficulty in implantation of the fertilized egg or early pregnancy loss. Luteal phase defects may be related to insufficient secretion of LH and FSH by the pituitary, excessive or insufficient prolactin secretion by the pituitary, or factors such as the immaturity of the fertilized egg, insensitivity to gonadotropins, insufficient progesterone synthesis by the corpus luteum, or an imbalance in the ratio of estrogen to progesterone. Long-term use of progesterone can inhibit the normal secretion of the corpus luteum, leading to endocrine disorders. It is best to identify the underlying cause before actively treating the condition.