Primary Ovarian Insufficiency

Natural menopause is defined as the permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious pathological or physiological cause. It occurs at a median age of 51.4 years in normal women. Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years [1]. The term premature menopause, premature ovarian failure is no longer preferred because ovarian function is intermittent or unpredictable in many cases. POI (premature ovarian insufficiency) is characterized by menstrual disturbance (amenorrhea or oligomenorrhea) with raised gonadotropins and low estradiol. The prevalence is affected by population characteristics like ethnicity [2]. The incidence of POI is approximately 1% of women under 40 years old and 0.1% of women under 30 years old [3]. POI is a result of deficiency of ovarian sex hormones and decreased ovarian follicles which leads to early onset of menopausal symptoms [4]. There is hypoestrogenism which causes subfertility, infertility, menstrual irregularities, and pregnancy failures. There are myriad of menopausal symptoms like hot flashes, night sweats, insomnia and the long-term risk of skeletal fragility, cardiovascular, and neurocognitive disorders. In spontaneous POI with XX karyotype, there may be intermittent resumption of ovarian activity in approximately 25% of women [5]. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for the sufferer and her family. The diagnosis must be correct and in a timely manner for not only 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 [6].