Premature Ovarian Insufficiency: Practical Management Approaches

Premature ovarian insufficiency (POI) is defined as the cessation of ovarian function before the age of 40 years. The triad of amenorrhoea, elevated gonadotrophins and estrogen deficiency is associated with long-term health consequences including increased cardiovascular disease (CVD), decreased bone mineral density (BMD), significantly reduced fertility, psychological distress, vulvovaginal atrophy, neurological effects and overall reduced life expectancy. There are deficiencies in our understanding of the condition and subsequently the long-term health consequences associated with it. The underlying aetiology of POI and the optimum management strategies are also poorly understood. Our knowledge of long-term cardiovascular consequences specifically relating to women with POI is limited as most data on the subject are derived from studies involving women who experienced menopause at the natural age (beyond 40 years with an average age of 51). There are however randomized controlled trials of hormone therapy planned to provide evidence for treatment, and a prospective international registry has been set up to collate multicentre data with the aim of improving care for women with POI.