Primary Ovarian Insufficiency: Current Concepts

Gretchen Collins, MD; Bansari Patel, MD; Suruchi Thakore, MD; James Liu, MD

Disclosures

South Med J. 2017;110(3):147-153. 

In This Article

Abstract and Introduction

Abstract

A potential consequence of chemotherapy is the destruction of oocytes, resulting in primary ovarian insufficiency (POI) in young patients; this often results in secondary amenorrhea and necessitates hormone replacement therapy. Regardless of the etiology of POI, the chance of pregnancy is low in this patient population. Given the extent to which oocyte depletion or dysfunction is variable, there is the possibility of spontaneous ovulation on hormone replacement therapy and subsequent pregnancy, however. If pregnancy is not desired, contraception always should be discussed. In most patients, the etiology of POI will not be known, but the treatment for all patients includes estrogen and progesterone therapy, which ensures the development of secondary sex characteristics, acquisition of peak bone mass, and promotion of uterine growth and maturation. Early diagnosis, patient education, and emotional support are important to mitigate long-term sequelae.

Introduction

The fertility potential of women decreases in parallel with age, and the average age of menopause for women in the United States is 51 years.[1] Primary ovarian insufficiency (POI) is defined as gonadal failure before age 40 years (two standard deviations below the mean age of 51).[2] POI affects 1% to 2 % of women younger than 40 years and approximately 0.1% of women younger than 30 years.[3] The term primary ovarian insufficiency—not premature ovarian failure—is the preferred term for women with this condition because ovarian function is intermittent and unpredictable in many of these patients, whereas premature ovarian failure implies a permanent state of gonadal failure.[4] There are two primary causes of POI: follicular depletion through oocyte atresia or apoptosis or follicular dysfunction.[5] There are myriad causes that are implicated in this condition, including but not limited to autoimmune disorders, infections, chromosome defects (Turner syndrome [TS], fragile X syndrome) and treatment with gonadotoxic agents during chemotherapy or radiotherapy (Table 1). Unfortunately, in most patients the primary cause of POI is unknown.[6]

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