Premature Ovarian Insufficiency

Premature ovarian insufficiency refers to the transient or permanent loss of ovarian function before 40 y/o.

Some other closely related terms:

Premature ovarian insufficiency can occur spontaneously with no underlying cause.

Identifiable cause / risk factors include:

• Genetic factors
  • Strong family history
  • Galactosaemia
  • Chromosomal abnormalities (e.g. Turner syndrome)
• Autoimmune diseases (e.g. T1DMType 1 diabetes mellitus, Addison’s disease, thyroid disorders)
• Infections (e.g. TB, mumps)
• Iatrogenic causes
  • Bilateral oophorectomy
  • Gonadotoxic medications (e.g. GnRH agonist)
  • Pelvic radiotherapy
  • Chemotherapy

Clinical features of premature ovarian insufficiency overlap significantly with those of menopause (see the Menopause article)

Some key differences:

• Premature ovarian insufficiency occurs in <40 y/o women
• Infertility is often a prominent presenting complaint
• There aren’t always permanent immediate amenorrhoea

Complications are largely similar to those of menopause:

• Osteoporosis and associated fragility fractures
• Cardiovascular diseases
• Cerebrovascular disease (stroke and TIATransient ischaemic attack)

If a <45 y/o woman presents with menopause symptoms → measure serum FSH level (take 2 samples, 4-6 weeks apart)

• Persistently elevated FSH indicates reduced ovarian function
• The exact diagnosis depends on the age of the patient:
  • <40 y/o → premature ovarian insufficiency
  • 40-44 y/o → early menopause

Offer sex steroid replacement to all patients:

• Form: HRTHormone replacement therapy or COCPCombined oral contraceptive pill
• Duration: continue until at least the age of natural menopause (usually 51 y/o)