Primary ovarian insufficiency (POI)

Primary ovarian insufficiency (POI) is a disorder in which the ovaries stop functioning properly in adults under the age of 40. It can often be referred to as "premature menopause."Menopause typically occurs between the ages of 45 and 55. However, it occurs early in certain people. Doctors refer to women who stopped having monthly periods between the ages of 40 and 45 as undergoing "early menopause." Menopause that occurs before the age of 40 is referred to as "premature menopause." This can happen for a variety of reasons, such as chemotherapy or radiation therapy for cancer, or in rare circumstances, the ovaries are removed (e.g., to prevent or treat cancer), resulting in "surgically induced" menopause. When monthly periods stop before the age of 40 for no apparent cause, doctors refer to this as POI.

People who are diagnosed with POI, the ovaries:

• Stop or ovulate at a very low level.
• Stop producing female hormones progesterone, and estrogen.

Given these consequences, POI makes childbirth rare, yet some people continue to have periodic intervals during which they may be able to have children. Many people experience emotional trauma when they are diagnosed with POI, especially if they intend to become pregnant in the future.

Causes

In the great majority of instances, health care professionals are uncertain of the etiology of primary ovarian insufficiency (POI). Some instances can be explained by genetic abnormalities, exposure to chemicals, or autoimmune conditions, but the vast majority are "idiopathic," meaning they have no identifiable cause.

Genetic cause: The chromosomal disorders that result in POI are:

• Turner syndrome is the most prevalent chromosomal defects in humans where females diagnosed with this syndrome only has one X chromosome instead of having two. It can induce POI and creates problems throughout the reproductive system. POI can also be caused by the absence of a critical portion of one X chromosome.
• The most frequent cause of cognitive impairment globally is fragile X syndrome. Fragile X is caused by a defective gene on the X chromosome. Moreover, this syndrome is the most prevalent heredity cognitive disorder that “passes in the family.” Individual with the faulty gene does not necessarily have cognitive disability. Females who carry this abnormality is advised to get examination prior to getting pregnant due to the increased risk of primary ovarian insufficiency (Premutation).

In addition, POI can be caused by a variety of other chromosomal and genetic disorders. Some females, for example, have Y chromosomal material, even though the Y chromosome should only occur in men.

Toxin-induced ovarian insufficiency: Mostly caused by chemotherapy and radiation therapy, both of which are used to treat cancer.

Autoimmune causes: The immune system's function is to recognize and eliminate foreign or unwanted cells that might cause infection, cancer, or other abnormalities in the body. Unfortunately, the immune system can occasionally misdirect its efforts and begin targeting the body's regular, healthy cells.

Symptoms

Prior to developing ovarian insufficiency, most patients with primary ovarian insufficiency (POI) had normal puberty and regular cycles. The most prevalent symptom that motivates individuals to seek medical attention is missed or irregular periods.

When some people quit using birth control pills, they may discover that their periods become infrequent or nonexistent; however, this does not imply that the medications caused POI. Hot flashes, sweat, and vaginal dryness are among POI symptoms since the body eventually generates little or no estrogen. As the illness develops, some women may experience vaginal dryness and weakening of the vaginal walls, making intercourse unpleasant.

Diagnosis

If you are under the age of 40 and have not had a regular period for three months or more, consult a health care practitioner for relevant health examination. Even if you do not intend to become pregnant, the illness might have repercussions on your general health. People with primary ovarian insufficiency (POI) who do not take estrogen replacement medication are at a higher risk of osteoporosis and heart disease. Signs and symptoms of estrogen deficiency, such as hot flashes, night sweats, vaginal dryness, and atrophy. To identify the reason of your irregular, missed, or abnormally light menstrual cycles, the following information should be inquired.

• Some individuals with POI have hot flashes or vaginal dryness, and these symptoms provide insight into how the ovaries are functioning.
• Ovarian surgery and history of radiation and/or chemotherapy.
• Family history of autoimmune disease.
• Adrenal insufficiency such as weight loss and decrease appetite.
• Fragile X syndrome runs in the family.

In addition to asking you detailed questions about your personal and family history and performing a physical examination, your physician should order a blood test to evaluate your hormone levels.

For a diagnosis of POI, increased levels of the hormone follicle-stimulating hormone are required (FSH). High FSH levels suggest that the brain is attempting to stimulate the ovaries, but the ovaries are not responding. That's significant because the ovaries might fail not because they're malfunctioning, but because the brain or the pituitary gland, the body's master gland, has stopped properly regulating menstrual activity.

If blood testing indicate that you have POI, your doctor should investigate for possible causes; karyotyping, which examines whether chromosomal abnormalities exist; testing for antibodies against the adrenal gland, which determines whether you have a particular form of ovarian autoimmunity.

Treatment

Self-care
The diagnosis is more than just infertility; it can have an impact on your physical and mental health. Moreover, it is crucial to be healthy before making family planning.

One of the keys aim of POI treatment is to restore the estrogen that the ovaries have stopped generating. This is significant since estrogen is required for some physiological functions especially in the bones. If estrogen deficiency is not treated, the risk of getting osteoporosis increases significantly. Additionally, there is evidence that a deficiency of estrogen before the age of 45 might raise the risk of heart disease. This can also result in menopausal symptoms such as hot flashes, night sweats, sleep difficulty, and vaginal dryness.

Most women should not take estrogen alone; they must combine it with a progestin (a kind of progesterone) to prevent a complication that can progress to uterine cancer.

Estrogen therapy
Estradiol is the most common form of estrogen produced by the ovaries. Some believed that this sort of estrogen best replicates the natural process; however, other types of estrogen are available and effective as well.
The type of estrogen medications administered will be evaluated on an individual basis. It should only be used under the supervision and prescription of a physician. Despite the advantages of the patch and ring, alternative types of estrogen replacement are as successful.

Individuals who seek to prevent pregnancy may take birth control medications. Low-dose hormone treatment is ineffective as a contraceptive. It is believed that a person with POI has a 4 percent probability of ovulating each month, as ovarian activity is frequently unpredictable and intermittent. Studies have connected the use of estrogen and progestin to an increased risk of heart attack, stroke, and breast cancer, among other conditions.

Infertility treatment
As stated previously, under 10 percent of individuals with POI are able to conceive and give birth naturally without additional therapy. There is no evidence that estrogen, fertility medications, or other hormones boost fertility. Successful treatments include in vitro fertilization (IVF) utilizing donor eggs. Before you begin attempting to conceive, you should consult with your healthcare practitioner to determine the cause of your issue. If a pregnancy is successful, various underlying causes of POI may create issues with the pregnancy or fetus. In certain circumstances, adoption is a viable alternative.