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Premature Ovarian Insufficiency: Updating Guidelines for Primary Care

Premature Ovarian Insufficiency: Updating Guidelines for Primary Care

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Premature ovarian insufficiency (POI) (previously called premature menopause) is now the preferred terminology for a spectrum of impaired ovarian function occurring in 1% of women under the age of 40 yrs.  Recognition of POI is often delayed, particularly in adolescents, and on average, a female visits three doctors before the diagnosis is established. 

The presentation will discuss known causes of POI, and current recommendations for appropriate investigations noting in the majority of women, aetiology remains unknown.  

Estrogen deficiency in young women is associated with wide-ranging sequelae, including estrogen deficiency symptoms, mental health consequences, cardiovascular risk, osteoporosis and dementia. 

Fertility is impaired in POI, but a significant proportion of women may have some resumption of ovarian activity and 5-10% may conceive spontaneously.   If fertility is desired, oocyte donation is an established and effective option for women with POI; no reliable interventions increase natural conception rates. 

Women with known or suspected POI presenting for oocyte donation require full investigation, including thyroid and adrenal function as well as karyotype. 

Women with a history of exposure to certain chemotherapeutic agents and women with Turner Syndrome need pre-pregnancy cardiology assessment. 

Untreated, POI is associated with reduced life expectancy, mainly from cardiovascular disease. 

Hormone replacement therapy is recommended until the age of 50 years while recognizing that evidence to guide management is of moderate quality.  Smoking avoidance and focus on reducing cardiovascular risk factors are important.  Adverse opinions concerning the risks of hormone therapy derived from the WHI study should not be inappropriately applied to women with POI.