Endocrine Abstracts

Case: A 20 year old female was referred for further evaluation of ovarian function. She has a history of beta thalassemia and bone marrow transplant in 2009 at age 11. Her menarche started in 2008 and she continued having regular periods until shortly after her bone marrow transplant. She was subsequently started on Loestrin oral contraceptive pill. Examination showed a height of 164 cm and weight of 57 kg. She had well developed secondary sexual characteristics. Her OCPs was stopped and hormonal panel was requested. Investigation included two sets of hormonal panel confirmed premature ovarian insufficiency with elevated LH 23 & 34 IU/l, elevated FSH 54 and 72 IU/l, low estradiol <70 pmol/l and AMH<0.2 pmol/l.

Management: With results confirming premature ovarian insufficiency, the patient was started on HRT with Elleste Duet 2 mg (contains Norethisterone Acetate). On follow up visit, she reports feeling unwell with anxiety and sleep disturbance for one to two weeks prior to having the withdrawal bleed and then symptoms will ease. Therefore HRT was changed to Femoston 2 mg (contains Dydrogesterone) which she tolerated well. Also, she was concerned regarding her future fertility options. She was informed that she had sustained damage to her ovaries following her treatment for beta thalassemia (probably as a result of the cytotoxic agents especially the alkylating agent Busulphan used in the conditioning regimen for her bone marrow transplantation). She was informed that egg donation is the only current available option in such cases.

Discussion points: • Types and forms of Hormone Replacement Therapy.

• Fertility preservation in patients prone to iatrogenic POI (e.g. Oncology, transplant)