Abstract
PurposePremature ovarian insufficiency (POI) is defined as the cessation of the ovarian function before the age of 40 years. POI aetiology may be related to iatrogenic or endogenous factors and in many cases remains unclear. The aim of this review was to characterize the long-term consequences of POI.MethodsThe available literature regarding the long-term consequences of POI from MEDLINE has been reviewed.ResultsLack of ovarian steroids synthesis has serious consequences for women’s health. The short-term effects are similar to spontaneous menopause and refer mainly to the climacteric syndrome. In a longer perspective, POI affects a variety of aspects. It obviously and drastically reduces the chances for spontaneous pregnancies. Oestrogen loss leads also to urogenital atrophy. The most common urogenital symptoms include vaginal dryness, vaginal irritation and itching. The urogenital atrophy and hypoestrogenism interferes also with sexual functioning. Patients with POI are threatened by a decrease in bone mineral density (BMD). POI women also experience psychological distress and some studies have shown an increased risk of neurodegenerating diseases. Overall, POI women have a shortened life expectancy, mainly due to cardiovascular disease. Some studies have reported a reduced risk of breast cancer in this group of patients.ConclusionsIn conclusion there are several well-characterized health risks in POI women. With every patient, an individualized approach is required to properly recognize and prevent these risks.
Highlights
Premature ovarian insufficiency (POI) is defined as an ovarian insufficiency before the age of 40 years [1]. It is characterized by a cessation of menstruation for at least 4 months associated with the elevation of serum follicle-stimulating hormone (FSH) concentration (FSH >40 IU/l) [2]
When sexual function was evaluated in both groups, women with POI showed worse sexual performance, with more pain and poorer lubrication than women in the control group [23]. These findings suggest that hormonal therapy in POI patients successfully reestablishes the epithelium cells, vaginal pH and microflora, but is not effective enough to improve complaints of lubrication and pain
In the same study, POI has been associated with an increased risk of cancer mortality, and this increase was independent of hormonal replacement therapy [31]
Summary
Premature ovarian insufficiency (POI) is defined as an ovarian insufficiency before the age of 40 years [1]. Cumulative pregnancy rates of oocyte donation treatment are very high and after four cycles reach 70–80 % [14]. Ameratunga et al [15] reported following complications in 36 pregnancies after oocyte donation in POI patients: three cases of preterm labour, five gestational hypertensions, two gestational diabetes mellitus and one intrauterine growth retardation case. Cryopreservation of embryos and mature oocytes is the clinically established method, with pregnancy rates and livebirths reaching 25 % [18, 19] All remaining options, such as retrieving immature oocytes aiming at maturing them later in vitro, freezing of gonadal tissue or novel methods using ovarian stem cells, are very promising but still considered experimental
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