Abdelhamid Benmachiche

By Abdelhamid Benmachiche and Amel Dammene Debbih

Premature ovarian insufficiency (POI) is a heterogeneous disorder, affecting approximately 1% of women before the age of 40. Heterogeneity of POI is reflected by various causes. The known causes are genetic defects, autoimmune ovarian damage, metabolic, iatrogenic following surgery, cancer therapy, and environmental factors. However, in most cases, the cause remains unknown (idiopathic POI). The main symptom is the absence of regular menstrual cycles, and the diagnosis is confirmed by the raised gonadotropins and low estradiol. The disorder usually leads to infertility and has long-term comorbidities such as cardiovascular diseases, osteoporosis, and cognitive impairments. Management includes the use of hormone replacement therapy till the age of natural menopause. In women having fertility issues, the spontaneous conception varies between 5 and 10%, and in vitro fertilization with donor oocytes remains the treatment of choice. Moreover, fertility preservation options can be offered to some patients with cancer and those at risk of early menopause, such as those with familial cases of POI. Further research is clearly needed, to identify new mechanisms which may improve the prediction of the early onset of the disease.

Part of the book: Menstrual Cycle