Background: Premature ovarian failure is not uncommon in patients with polyglandular autoimmune conditions. It is rare for patients to become pregnant beyond the menopause. We present a patient with premature ovarian failure who spontaneously conceived after attaining menopausal state.
Case: We had a 41-year-old Asian lady with type1 diabetes mellitus since 30 years of age. She had widespread vitiligo, strongly positive thyroid microsomal antibody and a family history of thyroid illness. After her first pregnancy she began using a combination oral contraceptive pill (OCP). Seven months post-partum she developed thyrotoxicosis treated with block and replacement therapy. This was followed by hypothyroidism and she remained on thyroxine. She stopped the OCP 17 months later and then developed amenorrhoea. She was seen in clinic 6 months after this wishing to conceive again, but suffering from hot flushes and sweating. A diagnosis of premature menopause was made based on symptoms of oestrogen deficiency and amenorrhoea with serum LH levels of 46.6 U/L, FSH of 44.9 U/L and prolactin of 198 mu/L. HRT was commenced and the patient left the country returning six months later with suspicion of pregnancy. Ultrasound scan confirmed 20 weeks gestation. She maintained good glycaemic control during her pregnancy and remained on thyroxine 100 mcg.She successfully delivered a healthy baby at 36 weeks recently.
Conclusion: Our patient had a spontaneous pregnancy after undergoing an apparent early menopause due to autoimmune ovarian failure. We propose that as Mrs NA has a fluctuating thyroid status, she may also have fluctuating levels of ovarian antibodies that would explain her brief menopausal state. In early stages of premature menopause due to autoimmune ovarian failure there is a small risk of spontaneous pregnancy. We suggest that all women are advised to continue taking contraceptive measures to avoid unwanted pregnancy during this time.