Premature Ovarian Insufficiency: Practical Management Approaches
Premature ovarian insufficiency (POI) is defined as the cessation of ovarian function before the age of 40 years. The triad of amenorrhoea, elevated gonadotrophins and estrogen deficiency is associated with long-term health consequences including increased cardiovascular disease (CVD), decreased bone mineral density (BMD), significantly reduced fertility, psychological distress, vulvovaginal atrophy, neurological effects and overall reduced life expectancy.
There are deficiencies in our understanding of the condition and subsequently the long-term health consequences associated with it. The underlying aetiology of POI and the optimum management strategies are also poorly understood. Our knowledge of long-term cardiovascular consequences specifically relating to women with POI is limited as most data on the subject are derived from studies involving women who experienced menopause at the natural age (beyond 40 years with an average age of 51).
There are however randomized controlled trials of hormone therapy planned to provide evidence for treatment, and a prospective international registry has been set up to collate multicentre data with the aim of improving care for women with POI.
KeywordsPremature ovarian insufficiency (POI) Amenorrhoea Cardiovascular disease POI registry
Conflict of Interest
In the past 5 years, Dr. John C. Stevenson has received grants/research support from Abbott, Mylan and Pfizer, consulting fees from Abbott and Pfizer and speakers’ honoraria from Abbott, Bayer, Gedeon Richter, Menarini, Mylan and Pfizer.
In the past 5 years, Nick Panay has received grants/research support from Abbott, Mithra and Mylan and honoraria/expenses for speaking/advisory work from Abbott, Bayer, Besins, Novo Nordisk, Meda, MSD, Pfizer, SeCur and Shinogi.
- 1.National Institute for Heath and Care Excellence (NICE). Menopause: diagnosis and management: NICE Guideline [NG23]. 2015. Available from: https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-pdf-1837330217413.
- 3.European Society of Human Reproduction and Embryology. Management of women with premature ovarian insufficiency. 2015. Available from: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Management-of-premature-ovarian-insufficiency.aspx.
- 12.British Menopause Society (BMS). Premature Ovarian Insufficiency. British Menopause Society Council Consensus Statement. 2017. Available from: www.thebms.org.uk.
- 13.Lethaby A, Suckling J, Barlow D, et al. Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev. 2004;(3):CD000402.Google Scholar
- 45.Popat VB, Calis KA, Kalantaridou SN, et al. Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement. J Clin Endocrinol Metab. 2014;99(9):3418–26.PubMedPubMedCentralCrossRefGoogle Scholar