Premature ovarian insufficiency: from diagnosis to therapy

On average menopause occurs between 50 and 52 years of age. However, about 2-3.6% of all women are affected by premature ovarian insufficiency (POI) with cessation of ovarian function before the age of 40. Symptoms range from infertility to the classic menopausal syndrome. Causes are multifactorial and include autoimmune, iatrogenic, genetic or infectious factors. In most cases, however, the underlying genesis remains unclear. If POI is suspected, a systematic, multiprofessional diagnostic approach and subsequent comprehensive counseling of the patient regarding therapy and prognosis, especially with respect to fertility issues, is required. In the case of expected POI syndrome, for example due to oncological therapies, the affected women should be advised in advance about the option of fertility protection. For osteoprotection and reduction of cardiovascular risks, the rapid initiation of hormone replacement therapy is essential in POI patients. This should be tailored to the individual needs and risk factors of the patient and should be continued at least until the age of menopause. Psychological stress caused by the diagnosis should also be addressed and, if necessary, psychological support should be provided.