Premature ovarian insufficiency: an International Menopause Society White Paper

Abstract

The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.

Premature ovarian insufficiency: a toolkit for the primary care physician

“…Primary or secondary amenorrhea are the pathognomonic symptoms which characterize the diagnosis of POI. The initial presentation may be with oligomenorrhea (menstrual irregularity), but it is important that POI is not over-diagnosed in those with regular cycles and no history of menstrual disturbance 1 . Although amenorrhea is not officially diagnosed unless menstruation has been absent for 6 months, there is general agreement that it is justified to commence investigations if menstruation has been absent for 3-4 months.…”

“…Nulliparity and low parity are therefore associated with POI. Symptoms may be more severe in POI than natural menopause, particularly in the case of iatrogenic POI due to the rapid loss of ovarian hormones and fertility; this can have profound psychosocial and psychosexual effects 1,2 .…”

“…POI occurs due to a reduction in the primordial follicle pool. This can be due to accelerated follicular atresia or destruction, or due to problems in the support, recruitment or maturation of primordial and/or growing follicles ( Table 2 and Figure 1) 1 . 'Resistant ovary syndrome' is a rare disorder in which levels of FSH and luteinizing hormone (LH) are elevated despite normal AMH and antral follicle counts.…”

“…In cases of a low-trauma fracture or a continuous decline in BMD despite optimal HRT, referral to a specialist is advisable 27,111 . The optimal decision for the choice of the appropriate agents, such as anti-diabetic medications, statins and anti-osteoporotic therapies, must derive after taking into consideration the various metabolic, cardiovascular and bone health effects of these agents in the context of personalized medicine 1,112 .…”

“…It is therefore important that the diagnosis is correct and that it is made in a timely manner. There is often a delay in the diagnosis and therefore the effective treatment of POI, but it is also vitally important that such a profound diagnosis is not made erroneously as this can also have a devastating impact on the woman's emotional well-being 1 . There are a number of steps which facilitate a correct, timely diagnosis and these will be outlined in the next section.…”