Premature Ovarian Insufficiency

Abstract

Premature ovarian insufficiency (POI) is defined as the loss of ovarian function before the age of 40 years. Secondary amenorrhea or prolonged oligomenorrhea and primary amenorrhea may be the first symptoms and are the most common complains of POI patients. Hypergonadotropic hypogonadism is the most characteristic abnormality in hormonal profile of those patients. The prevalence of POI is about 1% and is variable depending on the age: 1% of women younger than 40 years, 0.1% under 30 years, and 0.01% under the age of 20 years. Both spontaneous and iatrogenic causes may induce POI. Spontaneous causes of POI include genetic abnormalities, autoimmune disorders, infections, enzyme deficiency, metabolic diseases, or very often idiopathic causes. Induced or iatrogenic POI is often a result of oncological treatment: radiotherapy, chemotherapy, and surgery. It is necessary to highlight that POI along with associated hypoestrogenism contributes to many complications in women’s health. POI causes decrease in bone mineral density, impairment of metabolic health, and cardiovascular system functioning. Genitourinary tract, fertility, as well as emotional health and sexual life are also at influence of premature hypoestrogenism associated with POI. The mainstay of treatment of POI is hormone replacement therapy (HRT) until at least the age of natural menopause. HRT should be long term in POI patients; therefore issues of compliance as well as risk-benefit ratio are very important to maximize longer-term health.