Insuficiência ovariana precoce: causas, diagnóstico e estratégias de manejo – revisão de literatura
DOI:
https://doi.org/10.34119/bjhrv8n6-310Keywords:
insuficiência ovariana primária, menopausa precoce, terapia hormonalAbstract
A insuficiência ovariana primária (IOP) é um distúrbio endócrino complexo caracterizado por falência ovariana antes dos 40 anos, resultando em hipoestrogenismo e infertilidade, com repercussões clínicas sistêmicas que afetam ossos, sistema cardiovascular, metabolismo e saúde mental. Representa um desafio relevante para a saúde da mulher, especialmente pela diversidade etiológica - genética, autoimune, iatrogênica ou idiopática - e pela dificuldade frequente no diagnóstico precoce. Este estudo teve como objetivo revisar de forma integrativa as características etiológicas, clínicas, diagnósticas e terapêuticas da IOP, reunindo evidências atualizadas sobre sua fisiopatologia, impacto na qualidade de vida e estratégias contemporâneas de manejo. A busca bibliográfica foi realizada nas bases PubMed e SciELO, utilizando descritores relacionados a insuficiência ovariana, menopausa precoce, saúde reprodutiva e terapia hormonal. Foram incluídos artigos completos publicados entre 2015 e 2025, em português, inglês ou espanhol, que abordassem aspectos clínicos, diagnósticos ou terapêuticos da IOP, resultando inicialmente em 1684 estudos identificados, dos quais 33 preencheram os critérios metodológicos para análise detalhada. Os resultados demonstraram que a avaliação combinada de manifestações clínicas, níveis hormonais (FSH e estradiol) e exclusão de causas secundárias constitui o eixo central do diagnóstico, enquanto a terapia de reposição hormonal é a intervenção mais eficaz para controle sintomático e prevenção de complicações ósseas e cardiovasculares. Estratégias de preservação da fertilidade, como criopreservação de oócitos e transplante de tecido ovariano, bem como terapias emergentes com células-tronco, também foram destacadas como perspectivas promissoras. Conclui-se que o manejo adequado da IOP exige abordagem multidisciplinar, protocolos bem estruturados e educação continuada, além do incentivo a pesquisas multicêntricas que aprofundem o entendimento etiológico e ampliem as opções terapêuticas reprodutivas e hormonais disponíveis.
References
AI, G. et al. Adipose-derived stem cells promote the repair of chemotherapy-induced premature ovarian failure by inhibiting granulosa cells apoptosis and senescence. Stem Cell Research & Therapy, v. 14, p. 75, 2023.
BEN-NAGI, J.; PANAY, N. Premature ovarian insufficiency: how to improve reproductive outcome? Climacteric, v. 17, n. 3, p. 242–246, 2014.
BRENT, S.; CHRISTAKIS, M.; SHIRREFF, L. Primary ovarian insufficiency. CMAJ, v. 195, n. 28, p. E956, 2023.
CHEN, J. et al. A review of autoimmunity and immune profiles in patients with primary ovarian insufficiency. Medicine, Baltimore, v. 101, n. 51, e32500, 2022.
CHEN, M.; JIANG, H.; ZHANG, C. Selected genetic factors associated with primary ovarian insufficiency. International Journal of Molecular Sciences, v. 24, n. 5, p. 4423, 2023.
COULAM, C.; ADAMSON, S.; ANNEGERS, J. Incidence of premature ovarian failure. Obstetrics and Gynecology, v. 67, n. 4, p. 604–606, 1986.
DENG, Z.-H. et al. A bibliometric analysis of primary ovarian insufficiency from 2010 to 2020. Climacteric, v. 25, n. 5, p. 497–503, 2022.
FEDERICI, S. et al. Primary ovarian insufficiency: update on clinical and genetic findings. Frontiers in Endocrinology, Lausanne, v. 15, e1464803, 2024.
FU, Y.-X. et al. Human mesenchymal stem cell treatment of premature ovarian failure: new challenges and opportunities. Stem Cell Research & Therapy, v. 12, p. 161, 2021.
GAO, H.; GAO, L.; WANG, W. Advances in the cellular immunological pathogenesis and related treatment of primary ovarian insufficiency. American Journal of Reproductive Immunology, v. 88, e13622, 2022.
GARCÍA-GARCÍA, M. et al. Analysis of Mexican young women with primary ovarian insufficiency induced by gynaecological and haematological cancer management. Journal of Obstetrics and Gynaecology, v. 43, n. 1, e2112026, 2023.
GOSWAMI, D.; CONWAY, G. Premature ovarian failure. Human Reproduction Update, v. 11, n. 4, p. 391–410, 2005.
HEDDAR, A.; MISRAHI, M. Genetics of primary ovarian insufficiency: a careful step-by-step approach based on solid foundations to bring new knowledge. Fertility and Sterility, v. 118, n. 2, p. 421–424, 2022.
HONG, T.; PU, D.; WU, J. The correlation between primary ovarian insufficiency, sex hormones and immune cells: a two-step Mendelian randomization study. Frontiers in Endocrinology, Lausanne, v. 16, e1456273, 2025.
HUANG, Q.-Y. et al. Therapeutic options for premature ovarian insufficiency: an updated review. Reproductive Biology and Endocrinology, v. 20, n. 28, p. 1–16, 2022.
KUANG, X. et al. The evaluation of ovarian function recovery following treatment of primary ovarian insufficiency: a systematic review. Frontiers in Endocrinology (Lausanne), v. 13, e941842, 2022.
LAVEN, J. S. E.; LOUWERS, Y. V. Can we predict menopause and premature ovarian insufficiency? Fertility and Sterility, v. 122, n. 4, p. 795–803, 2024.
MARISTANY, S. et al. Primary ovarian insufficiency secondary to chemotherapy with inotuzumab ozogamicin and other agents. Journal of Assisted Reproduction and Genetics, v. 39, p. 1733–1738, 2022.
MCGLACKEN-BYRNE, S. M.; CONWAY, G. S. Premature ovarian insufficiency. Best Practice & Research Clinical Obstetrics and Gynaecology, v. 81, p. 98–110, 2022.
NASH, Z.; DAVIES, M. Premature ovarian insufficiency. BMJ, v. 384, e077469, 2024.
NELSON, L. M. Clinical practice. Primary ovarian insufficiency. New England Journal of Medicine, v. 360, n. 6, p. 606–614, 2009.
OPEN-ACCESS. Increased oxidative stress markers may be a promising indicator of risk for primary ovarian insufficiency. Open Access Journal, 2024.
OPEN-ACCESS. Reality of premature ovarian failure in Argentina. Open Access Journal, 2023.
OPEN-ACCESS. Criopreserved ovarian tissue transplantation and bone restoration metabolism in castrate models. Open Access Journal, 2024.
OPEN-ACCESS. Função ovariana em mulheres lúpicas submetidas ao uso de ciclofosfamida em dois grandes centros. Open Access Journal, 2023.
PANAY, N. et al. Premature ovarian insufficiency: an International Menopause Society White Paper. Climacteric, v.23, n.5, p.426–446, 2020.
PARK, H. et al. Comparison of the therapeutic potential of stem cells and various drugs for the treatment of primary ovarian insufficiency. Stem Cell Research & Therapy, v.14, n.1, p.1–14, 2023.
POTEET, B. et al. The diagnostic experience of women with fragile X–associated primary ovarian insufficiency (FXPOI). Journal of Assisted Reproduction and Genetics, v.40, p.179–190, 2023.
RAHMAN, R.; PANAY, N. Diagnosis and management of premature ovarian insufficiency. Best Practice & Research Clinical Endocrinology & Metabolism, v.35, 101600, 2021.
REBAR, R.; KEATOR, C. Expanding our knowledge of premature ovarian insufficiency. Fertility and Sterility, v.116, n.2, p.228–229, 2021.
SIQUEIRA, M. F. et al. Síndrome X frágil y otras patologías asociadas a insuficiencia ovárica primaria. Revista Latinoamericana de Genética Humana, v.12, p.45–53, 2023.
TAKAHASHI, A.; YOUSIF, A.; HONG, L.; CHEFETZ, I. Premature ovarian insufficiency: pathogenesis and therapeutic potential of mesenchymal stem cells. Journal of Molecular Medicine, Berlim, v.99, p.1615–1642, 2021.
TOURAINE, P. et al. Premature ovarian insufficiency. Nature Reviews Disease Primers, v.10, art.63, 2024.
VERRILLI, L. et al. Primary ovarian insufficiency has strong familiality: results of a multigenerational genealogical study. Fertility and Sterility, v.120, n.1, p.127–133, 2023.
WANG, V. et al. Autoimmune disease is increased in women with primary ovarian insufficiency. Journal of Clinical Endocrinology & Metabolism, 2025.
YATSENKO, S.; WITCHEL, S.; GORDON, C. Primary amenorrhea and premature ovarian insufficiency. Endocrinology and Metabolism Clinics of North America, v.53, n.2, p.293–305, 2024.
