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Chapters

0:00 Introduction
0:48 Causes of Primary Ovarian Insufficiency:
1:46 Symptoms of Primary Ovarian Insufficiency:
2:38 Diagnosis for Primary Ovarian Insufficiency:
3:22 Treatment for Primary Ovarian Insufficiency:

Primary ovarian insufficiency (POI) (also called premature ovarian insufficiency, premature menopause, and premature ovarian failure) is the partial or total loss of reproductive and hormonal function of the ovaries before age 40 because of folliclular (egg producing area) dysfunction or early loss of eggs.[1][4][6] POI can be seen as part of a continuum of changes leading to menopause[7] that differ from age-appropriate menopause in the age of onset, degree of symptoms, and sporadic return to normal ovarian function.[8] POI affects approximately 1 in 10,000 women under age 20, 1 in 1,000 women under age 30, and 1 in 100 of those under age 40.[6] A medical triad for the diagnosis is amenorrhea, hypergonadotropism, and hypoestrogenism.[5]

Physical and emotional symptoms include hot flashes, night sweats, dry skin, vaginal dryness, irregular or absent menstruation, anxiety, depression, mental fog, irritability, nervousness, decreased libido, and increased autoimmune disruption.[9] The sense of shock and distress on being informed of the diagnosis can be overwhelming.[1] The general treatment is for symptoms, bone protection, and mental health.[1][10] Although 5 to 10% of women with POI may ovulate sporadically and become pregnant without treatment,[11] others may use assisted reproductive technology including in vitro fertilization and egg donation[12] or decide to adopt or remain childless.[13]

The causes of POI are heterogeneous and are unknown in 90% of cases.[6] It can be associated with genetic causes, autoimmune disease, enzyme deficiency, infection, environmental factors, radiation, or surgery in 10%.[14] Two to 5% of women with POI and a premutation in FMR1, a genetic abnormality, are at risk of having a child with fragile X syndrome, the most common cause of inherited intellectual disability.[8][6]

The diagnosis is based on ages less than 40, amenorrhea, and elevated serum follicle-stimulating hormone (FSH) levels.[4] Typical serum FSH levels in POI patients is in the post-menopausal range.[2] Treatment will vary depending on the symptoms. It can include hormone replacement therapy, fertility management, and psychosocial support, as well as annual screenings of thyroid and adrenal function.[15] The signs and symptoms of POI can be seen as part of a continuum of changes leading to menopause.[7] POI contrasts with age-appropriate menopause in the age of onset, degree of symptoms and sporadic return to normal ovarian function.[8] As some women retain partial ovarian function, symptoms may not be as severe as regular menopause.[8] In others, particularly with coexistent depression, symptoms such as decreased quality of life can be severe.[9]

Hormonally, POI is defined by abnormally low levels of estrogen and high levels of FSH, which demonstrate that the ovaries are no longer responding to circulating FSH by producing estrogen and developing fertile eggs. The ovaries will likely appear smaller than normal.[medical citation needed] The age of onset can be as early as 11 years.[16] POI can be seen as part of a continuum of changes leading to menopause[7] that differ from age-appropriate menopause in the age of onset, degree of symptoms, and sporadic return to normal ovarian function.[8] A contrasting problem can be when a girl never begins menstruation due to a genetic condition causing primary amenorrhea.[14]

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