Premature Ovarian Insufficiency (POI)

Can menopause happen at 25 or 38 years old?

• Yes, it can. 
• When periods stop before the age of 40, it is called primary ovarian insufficiency (POI). 

 

Why does POI happen?

• When there is cessation of ovarian function below the age of 40.

• It affects 1% of the female population.
• This could be due to an unknown cause, genetic predisposition, medical illness, chemotherapy or radiotherapy for the treatment of cancer, or surgical intervention.

Causes of POI
Idiopathic	Turner’s Syndrome
	Fragile X
Autoimmune Causes (20%)	Autoimmune hypothyroidsm
	Addison’s Disease
	Type 1 diabetes mellitus (DM)
	Coeliac Disease
Inborn errors of metabolism
Environmental causes	Smoking
Iatrogenic causes	Post chemotherapy
Radiotherapy
Surgical causes	Removal of both ovaries / removal of uterus and both ovaries

What are the signs and symptoms of POI?

• Given the diverse causes of POI, symptoms may differ from one woman to another.
  Most common presentation is cessation of periods. Some woman may even experience primary amenorrhea (when a girl did not start to have periods by the age of 16 years old)
• Menopausal symptoms may be more severe in woman with POI compared to women undergoing natural menopause.
• The diagnosis of POI may bring about depression and other mental health
  issues. A psychological consult is advised along with the regular gynaecological visits

What should you expect when you are suspected of POI?

• Blood tests for hormones (Folicullar Stimulating Hormone, FSH) are carried out and repeated 6-8 weeks later.
• Other investigations to screen for autoimmune diseases or genetic problems
  Ultrasound examinations may be done to exclude pregnancy.
• Women with POI can still get pregnant due to intermittent ovarian activity (5–15% chances).
• Hormonal therapy is strongly recommended due to long-term health risks including osteoporosis, cardiovascular disease, and dementia.

What are the treatments for POI?

• The low dose combined oral contraceptive pill (COC) is recommended for women with premature ovarian insufficiency till the age of menopause (50 years). It acts both as a hormone replacement and a contraceptive.
• Menopausal hormone therapy (MHT) may be used as an alternative to the combined oral contraceptive (COC) pill in women with premature ovarian insufficiency. Additional measures should be advised if contraception is required.