The age at which POF occurs may depend upon the number of follicles initially present and the pace of follicular atresia. It may present as primary or secondary amenorrhea. Women with primary amenorrhea are more likely to have a genetic basis for the POF, having had a smaller complement of oocytes initially. About half of women with POF have a history of infrequent or irregular menses, while about one fourth stop menstruating suddenly. Often these women also have a recent history of infertility. Although those women with primary amenorrhea have no symptoms related to low estradiol levels, the majority of those with secondary amenorrhea typically present with the complaints of hot flashes, fatigue, and mood changes. Theses symptoms may start before the complete cessation of menses.
Women with primary amenorrhea may present with signs of Turner's syndrome, while those with secondary amenorrhea usually have normal physical findings. At least one third of women with POF have ovarian follicles visible on ultrasound and many have estradiol levels over 50 pg/ml. Almost 20% may occasionally ovulate.
A recent study showed no relationship between the risk of POF and age at menarche, cycle length, and oral contraceptive use. Parity was related to a decreased risk of POF and those women with POF were more likely to have a history of infertility.
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