Premature Ovarian Insufficiency

Abstract

Genetic and environmental factors influence the quality of life and well-being. Breaking of adaptive mechanisms, induced by stressors, triggers diseases. Premature ovarian insufficiency (POI) is characterized by oligo/amenorrhea, high gonadotropin, and low estradiol levels in women younger than 40 years of age. Known etiological factors inducing POI include chromosomal abnormalities, enzyme changes, autoimmune diseases, FSH receptor gene polymorphism, inhibin B mutation, infectious disease, adnexectomy, radiotherapy, uterine artery embolization, etc. Unknown factors include stressors, inflammation, telomerase shortening, biological clock acceleration, etc. Early POI symptoms, significantly decreasing the quality of life, are hot flushes, irritability, anxiety, depression, mood swings, loss of concentration, insomnia, loss of libido, etc. Late complications include cardiovascular diseases, osteoporosis, metabolic syndrome, cognitive changes, Alzheimer’s disease, urogenital dysfunction, decreased fertility rate, etc. Diagnosis is confirmed by FSH >40 IU/L (or 25 IU/L), estradiol <50 pmol/L, and oligo/amenorrhea in women younger than 40 years of age. Also, suggested analyses are AMH, inhibin B, prolactin, dehydroepiandrosterone sulfate (DHEAS), free testosterone, free thyroxin (fT4), thyroid-stimulating hormone (TSH), cortisol, vitamin D, and oral glucose tolerance test (OGTT). Visualization methods include ultrasound examination of uterus, ovaries, and breasts and osteodensitometry. In untreated POI patients, mortality rate is increased. Therapy with estroprogestogens, and all other insufficient hormones (testosterone, fT4, DHEAS, vitamin D, etc.), has to be initiated immediately and continued without age limits, depending on individual needs, in order to achieve the best quality of life. © 2023, International Society of Gynecological Endocrinology.