POI is a condition where ovaries stop functioning before the age of 40 years ; ovulation stops and so does release of hormones – estrogen , progesterone and testosterone .
How do we diagnose POI?
Diagnosis is made by evaluating the frequency of periods ( over at least 4 months ) and by checking hormone levels ( FSH levels of more than 25IU/l at least in 2 blood samples 4 weeks apart and low estradiol levels ) It is seen in about 1 % of the population .
What are the causes of POI ?
Iatrogenic – which means those that are caused due to medical treatment like chemotherapy , radiotherapy or surgery involving removal of ovaries or a part of them for benign or malignant disease .
Non Iatrogenic –
- Genetic or chromosomal causes such as Turner’s syndrome or Fragile X syndrome . Your doctor will do a genetic testing whenever these genetic causes are suspected .
- Autoimmune diseases in which our bodies fighters the antibodies turn against our own bodies . These autoantibodies could destroy our own thyroid gland cells, adrenal gland cells or even ovarian tissue leading to POI . Your doctor will check you for some autoantibodies .
-Type 1 Diabetes
-Idiopathic – unexplained reasons leading to POI
Why is POI a big problem ?
POI if untreated leads to decreased life expectancy mainly due to cardiovascular disease owing to the deficiency of estrogen in our body .
What are the symptoms of POI?
- Amenorrhea or stopping of periods
- Oligomenorrhoea -Less frequent periods
- Hot flushes
- Irritability
- Depression
- Anxiety
- Night sweats
- Vaginal dryness
- Reduced sex drive
- Repeated UTI
- Tiredness
- Sleep disturbances
- Poor memory and concentration
How can we treat these symptoms ?
- Healthy lifestyle : regular exercise including weight bearing exercises to prevent osteoporosis or bone thinning , eating healthy and a balanced diet and stopping smoking and alcohol .
- Regular health checks including those for bone health and cardiovascular health . At least annual check ups are recommended .
What effects does POI produce on our bodies ?
- Infertility
- Reduced libido , vaginal dryness and pain during sexual intercourse.
- Increased chances of heart disease and strokes due to reduced estrogen in our bodies .
- Forgetfulness
- More chances of fractures due to reduced bone mineral density or osteoporosis .
What are the options for treating POI?
-Hormone Replacement Therapy – your doctor will take a complete history , examine you and do the relevant investigations before prescribing the same . Which HRT to use and whether oral medication or local therapy in the form of gels and patches will depend on what your doctor thinks is best for you and on your preferences . There’s no one size that fits all. There are numerous options available and every patient is different – hence the need to individualise each treatment .
- Local creams, pessaries , lubricants
- Vitamin D and Calcium supplements
Alternative therapy options like soy, black cohosh , evening primrose oil etc which may reduce symptoms in a small number of women .
