From the Guidelines
Premature Ovarian Failure (POF), now more commonly referred to as Premature Ovarian Insufficiency (POI), is a condition where the ovaries stop functioning normally before the age of 40, resulting in decreased estrogen production and irregular or absent menstrual periods, as defined by the European Society of Human Reproduction and Embryology (ESHRE) guideline 1. This condition affects approximately 1% of women under 40 and 0.1% of women under 30. The diagnosis of POI is characterized by amenorrhea (absence of menstrual periods), elevated gonadotropin levels (FSH above 25 IU/L on two occasions at least one month apart), and low estrogen levels, as stated in the Blood Reviews study 1.
Key Characteristics of POI
- Decreased estrogen production
- Irregular or absent menstrual periods
- Amenorrhea
- Elevated gonadotropin levels (FSH above 25 IU/L on two occasions at least one month apart)
- Low estrogen levels Unlike menopause, POI is not always permanent, as about 5-10% of women with this condition may spontaneously ovulate and even become pregnant.
Common Symptoms of POI
- Hot flashes
- Night sweats
- Vaginal dryness
- Irritability
- Poor concentration
- Decreased sex drive
- Painful intercourse The causes of POI are varied and include genetic factors (such as Turner syndrome or fragile X premutations), autoimmune disorders, chemotherapy or radiation treatment, surgery, and infections, though in about 60% of cases, the cause remains unknown, as mentioned in the ESHRE guideline 1.
Management of POI
Hormonal therapy (HT) is indicated to reduce the risk of osteoporosis, cardiovascular diseases, and urogenital atrophy, and to improve the quality of life of women with POI, as recommended in the Blood Reviews study 1. Early diagnosis and treatment are crucial to manage symptoms and prevent complications like osteoporosis and cardiovascular disease, and hormonal replacement therapy should be tailored to the individual patient's needs, as suggested in the practical recommendations for hormonal replacement therapy in adolescents and young women with chemo- or radio-induced POI 1.
From the Research
Definition of Premature Ovarian Failure (POF) or Premature Ovarian Insufficiency (POI)
- Premature ovarian insufficiency (POI) is defined as loss of ovarian function in women less than 40 years 2.
- POI is characterized by the cessation of menses before the age of 40 years 3.
- Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea) 4.
- POF is also known as primary ovarian insufficiency, and is diagnosed in the event when primary or secondary amenorrhea and hypoestrogenism with high levels of gonadotropins occur in women before the age of 40 5.
Causes and Symptoms of POI/POF
- POI can be idiopathic, caused by genetic, autoimmune, or metabolic disease, or be induced by cancer therapy or surgery 2.
- POF has a strong genetic component, and X chromosome abnormalities (e.g. Turner syndrome) represent the major cause of primary amenorrhea associated with ovarian dysgenesis 4.
- Symptoms of POI/POF include those associated with the natural menopause (night sweats and vaginal dryness), and with the long-term adverse effects of estrogen deficiency (osteoporosis and cardiovascular disease) 6.
- Infertility is a common symptom of POI/POF, and the only solution presently available for the fertility defect in women with absent follicular reserve is ovum donation 4.
Treatment Options for POI/POF
- Hormone replacement therapy (HRT) is indicated to restore sex hormones to normal premenopausal levels and prevent chronic diseases, such as osteoporosis and cardiovascular disease 3.
- HRT is strongly recommended for women with POI, mainly for vasomotor and genito-urinary symptom relief, and has been shown to have a role in bone protection and probably also in primary prevention of cardiovascular disease 6.
- The diagnosis of POF is an indication for hormonal replacement therapy (HRT), which should be continued until the mean age of menopause in a given population 5.