POI is the loss of ovarian activity before age 40y resulting in the disappearance of menstruation for more than 4 months and symptoms of low estrogen levels. It occurs in 1-3% of women.
It is characterised by FSH levels ≥25 mIU/ml on 2 occasions that are at least 4 weeks apart, and low estrogen levels.
No obvious cause of POI is found in most women. Some known causes are listed below:
- Autoimmune disease
- Surgery that removes portions of or a whole ovary
- Some treatments for cancer such as chemotherapy and radiotherapy
- Genetic conditions such as Turner’s syndrome (lack of an X chromosome or a portion of it) and Fragile X syndrome, etc.
- Toxins such as some chemicals and pesticides. Cigarette smoking is associated with earlier age at menopause when compared to non-smokers.
- Infections such as mumps, tuberculosis and HIV.
- Uterine artery embolization.
Consequences of POI
- Loss of oocytes (eggs) resulting in infertility
- Low estrogen levels which may result in:
- Hot flushes, night sweats and poor sleep.
- Low bone density (osteoporosis) which predisposes to bone fractures.
- Cardiovascular disease associated with increased risk of a heart attack.
- Sexual dysfunction for example low sexual desire or painful intercourse due to vaginal dryness and thinning.
- Depression and anxiety.
- Loss of memory and lack of concentration.
- Associated disorders eg- autoimmune hypothyroidism, adrenal disease and diabetes mellitus.
It is important to be evaluated by a specialist Reproductive Endocrinologist who will exclude other causes of similar symptoms such as thyroid disease, hyperprolactinemia and hyperandrogenism; search for a possible cause for POI and offer relevant treatment.
Premature ovarian insufficiency is not reversible because a woman is born with all the eggs she will ever have. There is currently no technology to make new eggs.
Prevention
Premature ovarian insufficiency is not entirely preventable in all cases. Women at high risk for POI may consider the following before POI occurs:
- Early childbearing, especially those with a family history of POI
- Fertility preservation for example oocyte (egg) or ovarian tissue cryopreservation before therapy or GnRH agonists during therapy in women due to undergo chemotherapy or surgery for treatment of cancer.
- Avoid known toxins.
Treatment
5-10% of women may experience a spontaneous pregnancy especially in the early years post occurrence of POI. However most women who desire pregnancy will require egg donation coupled with invitro fertilisation.
Hormone replacement till the age of natural menopause is recommended to alleviate the health risks due to low estrogen. It is important to visit your Reproductive Endocrinologist who will guide you regarding the best medication and supplements for you. Calcium and vitamin D supplementation will help to maintain bone health.
Maintaining a healthy diet and exercise regimen will mitigate health risks.
