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Primary and Spiractin

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Primary Symptoms and Causes

What is Primary ovarian insufficiency (POI)?

Primary ovarian insufficiency (POI), also known as premature ovarian failure, happens when a woman's ovaries stop working normally before she is 40.

Many women naturally experience reduced fertility when they are about 40 years old. They may start getting irregular menstrual periods as they transition to menopause. For women with POI, irregular periods and reduced fertility start before the age of 40. Sometimes it can start as early as the teenage years.

POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.

What are the risk factors for Primary ovarian insufficiency (POI)?

Certain factors can raise a woman's risk of POI:

  • Family history. Women who have a mother or sister with POI are more likely to have it.
  • Genes. Some changes to genes and genetic conditions put women at higher risk for POI. For example, women Fragile X syndrome or Turner syndrome are at higher risk.
  • Certain diseases, such as autoimmune diseases and viral infections
  • Cancer treatments, such as chemotherapy and radiation therapy
  • Age. Younger women can get POI, but it becomes more common between the ages of 35-40.
What causes Primary ovarian insufficiency (POI)?

In about 90 percent of cases, the exact cause of POI is unknown.

Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries. Your eggs grow and mature inside them. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be

  • Genetic disorders such as Fragile X syndrome and Turner syndrome
  • A low number of follicles
  • Autoimmune diseases, including thyroiditis and Addison disease
  • Chemotherapy or radiation therapy
  • Metabolic disorders
  • Toxins, such as cigarette smoke, chemicals, and pesticides
What are the symptoms of Primary ovarian insufficiency (POI)?

The first sign of POI is usually irregular or missed periods. Later symptoms may be similar to those of natural menopause:

  • Hot flashes
  • Night sweats
  • Irritability
  • Poor concentration
  • Decreased sex drive
  • Pain during sex
  • Vaginal dryness

For many women with POI, trouble getting pregnant or infertility is the reason they go to their health care provider.

What other problems can Primary ovarian insufficiency (POI) cause?

Since POI causes you to have lower levels of certain hormones, you are at greater risk for other health conditions, including

  • Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
  • Dry eye syndrome and eye surface disease. Some women with POI have one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If not treated, these conditions can cause permanent eye damage.
  • Heart disease. Lower levels of estrogen can affect the muscles lining the arteries and can increase the buildup of cholesterol in the arteries. These factors increase your risk of atherosclerosis (hardening of the arteries).
  • Infertility.
  • Low thyroid function. This problem also is called hypothyroidism. The thyroid is a gland that makes hormones that control your body's metabolism and energy level. Low levels thyroid hormones can affect your metabolism and can cause very low energy, mental sluggishness, and other symptoms.
  • Osteoporosis. The hormone estrogen helps keep bones strong. Without enough estrogen, women with POI often develop osteoporosis. It is a bone disease that causes weak, brittle bones that are more likely to break.
How is Primary ovarian insufficiency (POI) diagnosed?

To diagnose POI, your health care provider may do

  • A medical history, including asking whether you have relatives with POI
  • A pregnancy test, to make sure that you are not pregnant
  • A physical exam, to look for signs of other disorders which could be causing your symptoms
  • Blood tests, to check for certain hormone levels. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information.
  • A pelvic ultrasound, to see whether or not the ovaries are enlarged or have multiple follicles
How is Primary ovarian insufficiency (POI) treated?

Currently, there is no proven treatment to restore normal function to a woman's ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause:

  • Hormone replacement therapy (HRT).HRT is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. HRT improves sexual health and decreases the risks for heart disease and osteoporosis. You usually take it until about age 50; that's about the age when menopause usually begins.
  • Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day.
  • In vitro fertilization (IVF). If you have POI and you wish to become pregnant, you may consider trying IVF.
  • Regular physical activity and a healthy body weight.Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease.
  • Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

NIH: National Institute of Child Health and Human Development

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Recent Reviews

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Primary Clinical Trials and Studies

Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. People participate in clinical trials for a variety of reasons. Healthy volunteers say they participate to help others and to contribute to moving science forward. Participants with an illness or disease also participate to help others, but also to possibly receive the newest treatment and to have the additional care and attention from the clinical trial staff.
Rank Status Study
1 Recruiting Effects of Spironolactone on Collagen Metabolism in Patients With Pulmonary Arterial Hypertension
Condition: Pulmonary Hypertension
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: Change in biomarker levels in the spironolactone treated as compared to placebo treated group.;   Number of adverse events in patients treated with spironolactone as compared to placebo.;   Change in six-minute walk distance from baseline to week 8 and week 16.;   Composite end-point
2 Recruiting Acetazolamide and Spironolactone to Increase Natriuresis in Congestive Heart Failure
Condition: Heart Failure
Interventions: Drug: Combination therapy with acetazolamide and low-dose loop diuretics;   Drug: High-dose loop diuretics;   Drug: Upfront therapy with oral spironolactone
Outcome Measures: Acetazolamide arm: natriuresis 24 h;   Spironolactone arm: incidence of hypo- (serum potassium <3.5 mmol/L) or hyperkalemia (serum potassium >5.0 mmol/L);   NT-proBNP change after 72 h;   Worsening renal function;   Persistent renal impairment;   Peak plasma aldosterone concentration after 72 h;   Peak plasma renin activity after 72 h
3 Recruiting Determining the Effect of Spironolactone on Electrolyte Supplementation in Preterm Infants With Chronic Lung Disease
Conditions: Chronic Lung Disease;   Bronchopulmonary Dysplasia
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: Dose of potassium chloride in milliequivalents/kg/day;   Requirement of electrolyte supplementation;   Analyze the use of furosemide rescue doses;   Number of furosemide doses utilized;   Escalation in respiratory support
4 Unknown  Effects of Spironolactone in Dialysis
Condition: Renal Failure
Intervention: Drug: Spironolactone
Outcome Measures: Reduction of Left Ventricular Hypertrophy;   To evaluate the safety and efficacy of the use of spironolactone at a dose of 25mg in patients with chronic kidney disease on hemodialysis.
5 Unknown  Spironolactone for Paroxysmal Atrial Fibrillation
Condition: Atrial Fibrillation
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: time to a first electrocardiographically confirmed AF;   1. Response rate: Improvement of any symptom scores and/or SF36 scores more than 50 % (compared with re-randomization scores) 2. Difference of mean episodes of documented AF between the spironolactone and placebo groups.
6 Not yet recruiting L-Arginine and Spironolactone Trial in Dialysis-Dependent ESRD
Conditions: End Stage Renal Disease;   Hemodialysis
Interventions: Drug: Spironolactone;   Dietary Supplement: L-arginine;   Drug: Placebo
Outcome Measures: Change in coronary Flow Reserve (PET);   Change in left ventricular diastolic function;   Association between coronary flow reserve (CFR) and tissue doppler index (E');   Change in resting myocardial blood flow;   Change in left ventricular mass index;   Change in coronary vascular resistance;   Association between change in coronary flow reserve (CFR) and change in diastolic function-tissue doppler index (E');   Change in early diastolic function (E');   Combined cardiovascular safety;   Cardiovascular death;   Hyperkalemia;   Hypotension;   Change in early coronary flow reserve;   Change in hyperemic myocardial blood flow
7 Recruiting The Effect of Spironolactone on Pain in Older People With Osteoarthritis
Condition: Osteoarthritis, Knee
Intervention: Drug: spironolactone
Outcome Measures: Between group difference in change in WOMAC pain subscale (5 items);   Between group difference in change in WOMAC stiffness subscale.
8 Recruiting Use of Spironolactone for the Prevention of Electrolyte Abnormalities in Patients Treated With Amphotericin B
Condition: Patients With Indications for AmB Treatment
Interventions: Drug: Spironolactone 100mg;   Drug: Spironolactone 200mg;   Drug: Placebo
Outcome Measures: Incidence of hypokalemia ≤3.5mEq/L;   Average potassium supplementation;   Incidence of hyperkalemia;   Acute kidney injury;   Incidence of renal tubular damage;   Incidence of hypomagnesemia
9 Unknown  Effect of Spironolactone on Adrenal or Ovarian Androgen Production in Overweight Pubertal Girls With Androgen Excess
Conditions: Obesity;   Hyperandrogenemia;   Polycystic Ovary Syndrome
Interventions: Drug: Spironolactone;   Drug: Dexamethasone;   Drug: Cosyntropin;   Drug: r-hCG (Ovidrel)
Outcome Measures: Changes in free testosterone and 17 OH progesterone levels after ACTH and r-hCG administration respectively, before and after spironolactone administration for 12 weeks;   Changes in adrenal and ovarian steroid precursors after ACTH and r-hCG; body composition via air displacement plethysmography, BMI, and glucose tolerance testing results; baseline and after 12 weeks of spironolactone administration
10 Unknown  Effect of Spironolactone in Treating Chronic Non-resolutive Central Serous Chorioretinitis
Condition: Central Serous Chorioretinitis
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measure: Change in Central macular thickness
11 Recruiting Spironolactone in Adult Congenital Heart Disease
Conditions: Congenital Heart Disease;   Heart Failure;   Endomyocardial Fibrosis
Interventions: Drug: Spironolactone;   Other: Placebo
Outcome Measures: "Fibrosis Index" or the volume of distribution of gadolinium in the myocardium measured by MRI.;   PCIIINP, PCINP, MMP-2, TIMP-1, 6-minute walk distance, ejection fraction, and degree of diastolic function
12 Unknown  Addition of Spironolactone in Patients With Resistant Arterial Hypertension
Condition: Hypertension
Intervention: Drug: spironolactone
Outcome Measures: Average daytime systolic and diastolic blodd pressure evaluated by ABPM (ambulatory blood pressure monitoring);   changes of serum potassium, natrium, creatinine, body weight, casual blood pressure in office, treatment response for different baseline levels of aldosterone and aldosterone/PRA ratio
13 Recruiting Comparison of Effects of Eplerenone Versus Spironolactone in Heart Failure Patients With Glucose Intolerance or Type 2 Diabetes
Conditions: Heart Failure;   Type 2 Diabetes;   Glucose Intolerance
Interventions: Drug: Eplerenone;   Drug: Spironolactone
Outcome Measures: Glycated hemoglobin;   Fasting glucose and lipid profile;   Plasma insulin;   Cortisol;   Adiponectin;   NT-proBNP;   PIIINP
14 Recruiting Spironolactone for Pulmonary Arterial Hypertension
Condition: Pulmonary Arterial Hypertension
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: Change in placebo corrected 6-minute walk distance;   Clinical worsening;   Change in placebo corrected VO2 max;   Change in right ventricular function;   Biomarkers of vascular inflammation;   Rate of study drug discontinuation due to hyperkalemia, renal insufficiency, or other side effects such as breast pain and gynecomastia
15 Recruiting ALdosterone Antagonist Chronic HEModialysis Interventional Survival Trial
Condition: End Stage Renal Failure on Dialysis
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: The time to onset of the first incident :non-fatal MI or hospitalization for heart failure or nonfatal stroke or cardiovascular (CV) death;   The cumulate rate of nonfatal MI, hospitalization for heart failure, nonfatal stroke or CV death;   The time to onset of death from i) any cause and ii) from a CV event and iii) from a non CV cause;   The time of survival without a major CV event (nonfatal MI, hospitalization for heart failure, non-fatal stroke, cardiac arrest resuscitation);   Incidence of procedures related to stenosis or vascular access thrombosis for hemodialysis (HD);   Incidence of coronary or peripheral revascularizations (including lower limb amputations);   Blood pressure and its inter visit variability;   The occurrence of atrial fibrillation;   Incidence of hyperkalemia> 6 mmol/l;   Estimation of the effect of treatment on quality of life.
16 Unknown  Efficacy of Therapy With the Spironolactone Pills Compared to Minoxidil Lotion in Female Pattern Hair Loss
Condition: Female Pattern Hair Loss
Interventions: Drug: Spironolactone;   Drug: Minoxidil
Outcome Measures: hair density;   percentage of subjects who experience side effects;   subject assessment of treatment effect
17 Recruiting Mineralocorticoid Receptor Antagonists in End Stage Renal Disease
Condition: End Stage Renal Disease / Hemodialysis
Intervention: Drug: Spironolactone
Outcome Measures: Left Ventricular Mass Index;   Cardiac function parameters;   Office and 24h blood pressure;   Clinical measures of heart failure severity;   Vascular function;   Biomarkers of heart failure, inflammation and fibrosis;   Quality of Life;   Cardiac death and/or hospitalization for heart failure;   Safety measures
18 Recruiting Proteomic Prediction and Renin Angiotensin Aldosterone System Inhibition Prevention Of Early Diabetic nephRopathy In TYpe 2 Diabetic Patients With Normoalbuminuria
Conditions: Diabetic Nephropathy;   Diabetic Retinopathy
Interventions: Drug: Spironolactone;   Drug: Placebo;   Drug: Standard care
Outcome Measures: Albuminuria;   Cardiovascular disease and mortality;   Retinopathy;   Change in albuminuria;   Microalbuminuria;   Macroalbuminuria;   Change in CKD class;   Slope of estimated GFR
19 Unknown  Clinical and Therapeutic Implications of Fibrosis in Hypertrophic Cardiomyopathy
Conditions: Myocardial Fibrosis;   Hypertrophic Cardiomyopathy
Intervention: Drug: spironolactone
Outcome Measures: changes in serum markers of collagen turnover;   measures of diastolic function by echocardiography;   cardiac mass and fibrosis by cardiac magnetic resonance imaging (CMR);   exercise tolerance by exercise VO2max and Holter
20 Recruiting Eplerenone Versus Spironolactone as Treatment of Ascites Due to Liver Cirrhosis; a Study of Efficacy and Side Effects
Conditions: Ascites;   Cirrhosis
Intervention: Drug: Eplerenone
Outcome Measure: Ascites