Primary ovarian insufficiency is not early menopause

NAMS Annual Meeting

CHICAGO — The terms primary ovarian insufficiency and menopause are often used synonymously, but the two conditions are not equivalent, indicating that a team science approach for health care professionals to care for women with primary ovarian insufficiency is necessary, Lawrence M. Nelson, MD, said during a presentation at the North American Menopause Society 21st Annual Meeting.

Primary ovarian insufficiency (POI) is characterized by amenorrhea, hypoestrogenism and elevated serum gonadotropin levels in women aged 40 years and younger, and those with POI have potentially functional ovarian follicles remaining in the ovary for many years and, unlike menopausal women, may become pregnant.

Using the ‘right’ term

Terms other than POI used to describe this condition, such as premature ovarian failure or premature menopause, are “problematic,” both from a mechanism perspective and in creating confusion for health care professionals and patients, said Nelson, of the NIH’s Child Health and Human Development, Intramural Research Program on Reproductive and Adult Endocrinology.

“The term POI has the ability to include a spectrum of impaired ovarian function, which is more accurate to the clinical situation,” he said.

Fuller Albright “had it right” in 1942 when he first reported a syndrome in young women characterized by amenorrhea and estrogen deficiency in association with menopausal follicle-stimulating hormone (FSH) levels, Nelson said. Albright termed the condition POI to make clear that ovarian function was the primary defect rather than failure of FSH secretion by the pituitary.

Issues in diagnosis, management

Women with POI commonly have a delay in diagnosis, according to Nelson.

“More than half typically see three different doctors before a simple FSH level test is done,” he said. “This is all that is needed to make a diagnosis earlier and more accurately — a lower threshold at which to take a history and do the appropriate lab evaluation to find out why women are having oligomenorrhea.”

In addition, there are different aspects in the management of POI, including reproductive health, endocrine health, genetic health and emotional health.

“In our experience, too much attention is paid to reproductive health, and not enough to these other aspects,” Nelson said.

An oft ignored issue in the management of POI is the emotional health of the women, he said.

“Patients tell us that premature menopause and premature ovarian failure are stigmatizing. Data show that the more stigma women feel, the more symptoms of anxiety and depression they exhibit,” Nelson said. “Here we have evidence suggesting that we should try to relieve the stigmas associated with this condition.”

Previously published data demonstrate that women with POI had significant reductions in bone mineral density at the femoral neck, total hip and lumbar spine. In addition, approximately 50% have vitamin D deficiency, inadequate calcium intake and no regular exercise program.

“These are simple things to help patients with POI,” Nelson said. – by Katie Kalvaitis

Nelson addresses an important issue in patients with POI: The emotional aspects of this condition which is often as devastating as a death. Patients see a loss of their future and need careful counseling and support.

– Michelle P. Warren, MD
Endocrine Today Editorial Board member

For more information:

• Nelson LM. NAMS/Pfizer Wulf H. Utian Endowed Lecture. Presented at: North American Menopause Society 21st Annual Meeting; Oct. 6-9, 2010; Chicago.

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