From the Guidelines
Premature ovarian insufficiency (POI), also known as premature ovarian failure, is a condition where the ovaries stop functioning normally before age 40, leading to irregular or missed periods, infertility, and other symptoms. It occurs when ovaries stop releasing eggs regularly and produce less estrogen than normal. POI affects approximately 1% of women under 40 and can develop due to genetic factors (such as Turner syndrome or fragile X premutation), autoimmune disorders, chemotherapy or radiation treatments, or surgery 1. In many cases (up to 90%), the exact cause remains unknown. Symptoms typically include:
- Irregular or missed periods
- Hot flashes
- Night sweats
- Vaginal dryness
- Irritability
- Difficulty concentrating
- Decreased sexual desire
Diagnosis involves blood tests measuring follicle-stimulating hormone (FSH) levels (elevated in POI), estradiol levels (typically low), and anti-Müllerian hormone levels, along with a karyotype test to check for chromosomal abnormalities 1.
Treatment and Management
Treatment usually includes hormone replacement therapy (HRT) with estrogen and progesterone until the natural age of menopause (around 51) to relieve symptoms and prevent complications like osteoporosis and heart disease 1. While spontaneous pregnancy occurs in about 5-10% of women with POI, fertility treatments using donor eggs are often needed for those wanting to conceive. Regular monitoring for associated conditions like thyroid disorders, adrenal insufficiency, and diabetes is important for comprehensive care 1. For adolescents and young women with chemo- or radio-induced POI, a systematic approach to hormonal therapy is recommended, including the use of 17β-estradiol and progesterone, with consideration of contraception and withdrawal bleeding 1.
The most recent and highest quality study 1 provides practical recommendations for hormonal replacement therapy in adolescents and young women with POI, including a decisional algorithm for approaching HRT in post-pubertal adolescents and young women with iatrogenic POI. The use of 17β-estradiol administered transdermally, with or without progestin, is recommended as the first choice for HRT in post-pubertal adolescents and young women with POI.
From the Research
Definition of Ovarian Insufficiency
- Ovarian insufficiency, also known as premature ovarian failure (POF) or primary ovarian insufficiency, is a condition where the ovaries stop functioning and hormone levels decrease before the age of 40 2, 3, 4, 5, 6.
- This condition is characterized by irregular or absent periods, reduced fertility, and symptoms associated with estrogen deficiency, such as night sweats, vaginal dryness, and osteoporosis 3, 4, 6.
Causes and Diagnosis
- The causes of ovarian insufficiency can be genetic, autoimmune, or environmental, leading to a decrease in the number of primordial follicles, accelerated atresia, and impaired follicular function 2.
- Diagnosis is based on the presence of primary or secondary amenorrhea, hypoestrogenism, and high levels of gonadotropins in women under the age of 40 2, 6.
Symptoms and Complications
- Symptoms of ovarian insufficiency include vasomotor symptoms, genito-urinary symptoms, osteoporosis, and cardiovascular disease 3, 4.
- If left untreated, ovarian insufficiency can lead to long-term complications, such as reduced bone density, cardiovascular disease, and decreased quality of life 3, 4.
Treatment and Management
- Hormone replacement therapy (HRT) is strongly recommended for women with ovarian insufficiency to alleviate symptoms, prevent osteoporosis, and reduce the risk of cardiovascular disease 2, 3, 4.
- HRT should be continued until the average age of menopause in the given population 2.
- For women with ovarian insufficiency who desire pregnancy, donor oocyte in vitro fertilization is a viable option 5, 6.