Premature Ovarian Insufficiency
Premature ovarian insufficiency (POI) refers to onset of the menopause or oestrogen deficiency under the age of 40. It has a prevalence of 1%. Genetic factors, autoimmune factors, infections and iatrogenic causes such as chemotherapy, radiotherapy and surgery are reasons why women might have POI. However, in most cases no cause is identified.
There is an increasing prevalence of childhood and young adult cancer survivors following the advancements made in cancer treatments over the past 2-3 decades. In addition, risk-reducing surgery such as bilateral oophorectomy (removal of both ovaries) to reduce the risk of ovarian cancer is on the rise following advancements in genetic testing resulting in the identification of BRCA carriers (BRCA carriers are at a very high risk of developing breast and/or ovarian cancer). Therefore, the number of women with POI is increasing.
The long-term complications of POI have been documented in the literature. These include reduced bone mineral density with resultant increased risk of developing osteoporosis and fractures, an increased risk of cardiovascular disease, reduced cognition and decreased life expectancy.
Hormone replacement has a beneficial role in maintaining bone and cardiovascular health as well as cognitive function in addition to symptom control and has been approved by the NICE guidelines as the treatment of choice for women with POI. The latest research suggests that women with POI, including those with BRCA mutation, who take HRT up until the average age at menopause, which is 51 years, are at no increased risk of breast cancer above that of their baseline genetic risk.
There is currently no national referral guideline or recommendation regarding the treatment of POI in Ireland. It is not uncommon to find a patient with longstanding POI not taking HRT nor linked with either a gynaecology or endocrinology clinic or closely monitored by their GP. It is essential that women with POI get access to the most up-to-date, evidence-based treatment and appropriate psychological support.