Absent and Infrequent Periods: Resistant Ovary Syndrome

Some women may experience infrequent or absent periods for a while and their gonadotrophins may be elevated indicating an impending menopause. If these women are trying to conceive, treatments to encourage egg release (ovulation induction -Q10. 3) are unlikely to be successful. Their best chance of a baby is with IVF-egg donation (Q10.27).

When there is prolonged amenorrhoea and elevated gonadotrophins and subsequently periods or a pregnancy occur, we call this the resistant ovary syndrome. At one time, laparoscopy with ovarian biopsy was frequently performed for young women with apparent premature ovarian failure to establish whether the ovaries still had some eggs left. This investigation is now generally considered to have little practical value.

Even when there has been prolonged amenorrhoea, there is no absolute guarantee that there are no eggs due for later release.

A twenty-two-year old lady developed amenorrhoea. Investigation before she moved to London showed elevated gonadotrophins leading to a diagnosis of premature ovarian failure. She was advised that future spontaneous pregnancy could not be ruled out. For some years she took a cyclical hormone preparation but then felt in need of a change. Soon after her new cyclical preparation was introduced, she reported that she missed a withdrawal bleed. Her astute general practitioner arranged a pregnancy test, which to everyone's delight, proved to be positive. She went on to have a healthy son. Three months after delivery her periods had not returned and her hormone profile was again typical for ovarian failure (menopause). Cyclical HRT was reintroduced.

The forty-one year old wife of a doctor seemed to have a premature menopause on clinical and hormone assessment and she took HRT. One year later she had triplets!  

For those who do not wish to become pregnant, contraception should be used.

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