Premature ovarian insufficiency

Premature ovarian insufficiency (POI) is defined as the premature cessation of ovarian function before the age of 40. This leads to a decrease in the production of sex hormones, particularly oestrogen and progesterone, which can cause symptoms similar to those of menopause, such as hot flushes, menstrual irregularities and infertility. POI can have a significant impact on the quality of life of affected women, affecting not only their physical health but also their emotional and psychological well-being.

• Genetic factors : certain chromosomal abnormalities, such as Turner syndrome, or mutations in specific genes, may predispose individuals to POI.
• Medical treatments : gonadotoxic treatments (i.e. toxic to the reproductive organs), such as chemotherapy or radiotherapy used to treat cancers, may damage the ovaries.
• Ovarian surgery : repeated surgical procedures on the ovaries, for example to treat endometriosis or ovarian cysts, may reduce the ovarian reserve.
• Infections : certain viral or bacterial infections may also affect ovarian function.
• Autoimmune diseases: conditions such as Hashimoto’s thyroiditis or lupus may be associated with ovarian damage.

Prevalence of premature ovarian insufficiency

Premature ovarian insufficiency affects 1 to 3.7% of women worldwide. A significant proportion of women may be affected by this condition, often without being aware of it. Precise data on the prevalence of POI are limited, but studies suggest that young patients receiving cancer treatment should be particularly closely monitored for this condition.
 

Diagnosis

The diagnosis of premature ovarian insufficiency involves several steps:

• Clinical assessment: a thorough medical examination and a history of symptoms, including menstrual cycles and medical history, are necessary.
• Hormonal tests: blood tests to measure hormone levels, particularly oestrogen and follicle-stimulating hormone (FSH), may indicate impaired ovarian function.
• Ultrasound: an ultrasound examination may be performed to assess the presence of follicles, the anatomy of the ovaries and uterus, and to detect abnormalities such as cysts or lesions.

Treatment options

• Oocyte retrieval and freezing: before starting gonadotoxic treatment, patients may consider having their oocytes retrieved and frozen to preserve their fertility.
• Hormone replacement therapy (HRT): this therapy may help relieve symptoms associated with early menopause, such as hot flushes and mood disturbances. Non-hormonal therapies are also available in the event of contraindications.
• Psychological support: psychological support is often necessary to help women cope with the emotional aspects of POI.

Required medical follow-up

Regular medical follow-up is essential for patients with POI. This may include endocrinology consultations to monitor hormone levels and assess whether hormone therapy needs to be adjusted. Fertility consultations may also be recommended to discuss conception options and assisted reproductive techniques.
 

Services involved in the management of POI at Brussels University Hospital:

• Gynaecology: gynaecologists are often the first healthcare professionals involved in the diagnosis and management of POI.
• Endocrinology: endocrinologists may be involved in overall management.
• Oncology: oncologists play a crucial role in monitoring patients who have undergone cancer treatment and are at risk of developing POI.
• Psychology: psychologists or psychiatrists can provide emotional and psychological support to women facing the challenges of POI.
• Fertility Clinic: fertility specialists are involved in managing fertility preservation options and assisted reproductive techniques.
• Endometriosis Clinic: gynaecologists specialising in endometriosis can refer young patients at risk to discuss fertility preservation strategies with specialists.