| Abstract | Prijevremena menopauza predstavlja disfunkciju ili prestanak rada jajnika prije 40. godine života. Nije ireverzibilan poremećaj, te u 50% slučajeva može doći do intermitentne spontane remisije, a u 5-10% i do uspješno iznijete trudnoće. Pojavljuje se u 0.01% žena mlađih od 20 godina, 0.1% žena mlađih od 30 godina, te u 1% žena mlađih od 40 godina.
Idiopatska prijevremena menopauza čini 50-90% svih slučajeva, dok se ostatak može obrazložiti genetskim, metaboličkim, autoimunim, ijatrogenim, infekcijskim ili okolišnim uzrocima. Definirana je trijasom kojeg čine amenoreja ili oligomenoreja 4 ili više mjeseci, te hipergonadotropni hipogonadizam, odnosno povišena razina FSH (>40 IU/L) te deficit estrogena (<50 pg/mL).
Uz normalne menopauzalne simptome, postoji i povišen rizik za razvoj dugoročnih zdravstvenih posljedica koje uključuju kardiovaskularne bolesti, osteoporozu, neurokognitivna oštećenja, poremećaje raspoloženja, seksualnu disfunkciju i neplodnost, koje smanjuju kvalitetu života te povećavaju rizik za preuranjenu smrtnost.
Hormonsko nadomjesno liječenje (HNL) predstavlja osnovu terapije kod PM-e. Trajanje terapije je individualno, ali se preporuča do dobi nastupa prirodne menopauze, odnosno 50. godine života. Tipičan režim primjene je ciklički, a uključuje 100 μg/dan 17β-estradiola transdermalno i 10 mg/dan medroksiprogesteron acetata oralno zadnjih 12 dana mjesečno. Za liječenje neplodnosti poglavito se koriste metode medicinski potpomognute oplodnje, od kojih je najuspješnija IVF/ET nakon donacije oocita. |
| Abstract (english) | Premature menopause represents the dysfunction or cessation of ovarian function before 40 years of age. It is not an irreversible disorder, because in 50% of cases there may be an intermittent spontaneous remission of ovarian function, and in 5-10% women can successfully conceive. It affects 0.01% of women under 20 years of age, 0.1% of women before the age of 30, and 1% of women under 40 years of age.
Idiopathic premature menopause accounts for 50-90% of all cases, while the rest may be explained by genetic, metabolic, autoimmune, iatrogenic, infectious or environmental causes. It is defined by a trias consisting of amenorrhea or oligomenorrhoea of 4 or more months, and hypergonadotropic hypogonadism, which includes an increase of FSH levels (> 40 IU/L) and estrogen deficiency (<50 pg/mL).
Along with normal menopausal symptoms, there is an increased risk for developing long-term health effects that include cardiovascular diseases, osteoporosis, neurocognitive impairment, mood disorders, sexual dysfunction and infertility, which reduce the quality of life and increase the risk of early mortality.
Hormone Replacement Therapy (HRT) is the basis of management for premature menopause. The duration of the treatment is individual but it is recommended up to the age of natural menopause, usually 50 years of age. Typical application regime is cyclic and includes 100 μg/day 17β-estradiol (transdermal) and 10 mg/day medroxyprogesterone acetate (oral) for the last 12 days each month. For infertility treatment, the most commonly used are assisted reproductive technology procedures, and the most successful one is IVF/ET after oocyte donation. |
