Premature Ovarian Insufficiency: Aetiology and Long-Term Consequences.
Premature ovarian insufficiency is characterized by premature cessation of ovulation/ menstruation for 4-6 months along with raised serum gonadotropin levels especially follicle stimulating hormone on two or more occasions >4 weeks apart. POI is a heterogeneous disorder resulting from various autoimmune, iatrogenic and metabolic factors, chromosomal or genetic mutations and infections. Premature loss of ovarian function in women with POI is associated with long-term psychosocial sequelae, infertility and major health complications. It is also associated with age-specific increase in mortality due to cardio-vascular diseases. Its occurrence has increased in recent years as more and more women now-a-days attain motherhood late, also there is increase in incidence of gynaecological malignancies and its successful management leading to increased risk of POI. POI was previously known as premature menopause, but this term is a misnomer, as all women with POI do not always stop menstruating, neither do their ovaries shut down completely. In most women aged >40 years, there is a physiological decline in ovarian function with aging which is called as perimenopause/menopausal transition. Ovarian ageing resulting in ovarian failure and menopause is a continuous process and menopause is usually attained at 51 years.
The World Health Organization defines menopause as permanent cessation of menstruation due to ovarian follicular activity loss. Premature loss of ovarian function leads to significant long-term psychosocial sequelae and major health complications. It also results in age-specific increase in mortality rate.
Women Health Open J. 2017; 3(2): 45-58.doi: 10.17140/WHOJ-3-121