Premature ovarian failure

To diagnose premature ovarian failure a detailed and full general examination is mandatory in the assessment of all patients, particularly seeking signs of other organ specific auto-immune diseases.

In children and young adults it is useful to plot growth against standardised charts to aid pubertal staging. Extremes of height or weight should raise the suspicion of possible alternative diagnoses.

These should all be normal in patients with premature ovarian failure. Increased carrying angles tend to occur in Turner’s syndrome, and shortened metacarpals and metatarsals may be seen in pseudopseudohypoparathyroidism.

This should be assessed in both upper and lower limbs to screen for coarctation of the aorta in Turner’s syndrome.

This should be assessed thoroughly in patients with suspected hypogonadism to seek evidence of heart failure and for possible complications of Turner’s syndrome.

Full pubertal staging should be performed in any patient presenting with amenorrhoea. 

Nipple spacing tends to be increased in Turner’s syndrome.

Galactorrhoea suggests that hyperprolactinaemia is present. Serum prolactin levels may increase after breast examination and so should always be tested before this is performed.

Secondary sexual hair should be assessed as part of pubertal staging and in all adults presenting with suspected hypogonadism.

Fine vellus hair is seen in patients with very low body mass and may be associated with hypothalamic hypogonadism.

Secondary sexual characteristics should be assessed as part of pubertal staging.

Clitoromegaly and ambiguous genitalia should also be assessed.

Poor muscle bulk may indicate gonadotropin deficiency.

Muscle wasting may also occur in glucocorticoid deficiency.

Proximal myopathy and slow relaxing reflexes may occur with loss of thyroid function.

Specifically seek signs of thyroid dysfunction in all cases, since this is associated with auto-immune premature ovarian failure.