Primary Ovarian Insufficiency

Abstract

Primary ovarian insufficiency (POI) is a syndrome of amenorrhoea, sex steroid deficiency, and elevated gonadotropins in a woman aged more than two standard deviations below the mean age for menopause estimated for her reference population. In practical terms, it occurs spontaneously in 1 % of women before the age of 40 years. Apart from idiopathic POI, many women will have impaired ovarian function by age 40 years as a consequence of surgery, chemotherapy, or radiotherapy. Of identifiable causes of POI, the most common are concurrent autoimmune diseases such as thyroid and adrenal disease, and chromosomal abnormalities such as Turner syndrome and Fragile X syndrome. Women with POI have an increased risk of heart disease, osteoporosis, stroke, cognitive impairment, and premature death. These risks appear to be greater following a surgical menopause. POI is associated with an increased prevalence of anxiety, depression, and loss of self-esteem. Whilst most women with POI will remain infertile following their diagnosis, many will menstruate again and 5 – 10 % will become pregnant. The keys to good management are a multidisciplinary approach, careful long-term follow–up, and appropriate use of hormone replacement therapy.