Premature ovarian insufficiency (POI)

Premature ovarian insufficiency (POI) is a delicate medical problem that affects young women.

It consists of light/short or missing periods before the age of 40, characterised by elevated follicle-stimulating hormone (FSH) cut-off value above 25 IU/L on two occasions more than 4 weeks apart and low oestradiol levels

It affects about 1 to 3% of women under 40

In majority of the cases cause is not known

POI is a spectrum of declining ovarian function and reduced pregnancy rates due to a premature decrease in initial follicle number but this delicate state is not permanent and unchangeable.

Intermittent or unpredictable ovarian function is present in many POI cases, and some follicles always remain as do residual egg cells capable of being recruited and fertilised

Hormone replacement therapy (HRT), i.e. oestrogen-progestogen therapy, is a crucial treatment strategy in women affected by PO especially those women who are seeking fertility.

An adequate and individualised hormone therapy not only treats the consequences of oestrogen deficiency, but also enables recovery of ovarian function.

Hormone therapy has been demonstrated to have a positive effect on folliculogenesis and subsequent pregnancy.

It is generally estimated that approximately 5-15% of POI patients are able to conceive spontaneously. Both short course and long-term oestrogen administration have been found to be useful in POI patients leading to successful pregnancy. A combined hormonal regime [oestrogen-progestogen therapy,dehydroepiandrosterone(DHEA), melatonin] could be better able to improve fertility outcome in POI patients.