Premature ovarian insufficiency

• Premature ovarian insufficiency (POI) is defined as loss of ovarian activity in women <40 years.
• The cut-off age of 40 years is used because this is >2 standard deviations below the average age of menopause.
• It is characterised by menstrual disturbance (amenorrhea or oligomenorrhea) with raised FSH levels.
• Those women with oligomenorrhea may have sporadic ovarian activity and have a small chance of spontaneous pregnancy (5-10%).
• There are many causes of POI, however, the majority of cases are idiopathic.
• It is estimated to affect around 1% of women <40 years, 0.1% <30 years and 0.01% <20 years.
• As cure rates of cancers in young women improve, it is likely that the incidence of iatrogenic POI will rise.
• POI can increase the risk of adverse health sequelae including cardiovascular disease, osteoporosis and cognitive impairment due to the low oestrogen status.

• Other names often used for POI include primary ovarian insufficiency, premature ovarian failure, premature menopause, gonadal dysgenesis and hypergonadotropic hypogonadism.

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