Primary Ovarian Insufficiency: Time to Diagnosis and a Review of Current Literature

Background: Prompt recognition of symptoms and subsequent diagnosis of primary ovarian insufficiency (POI) are critical given its consequences on quality of life and long-term health. Poor access to care in underrepresented minority women and/or low-income populations may contribute to delayed diagnosis. Our group previously demonstrated a dearth of board-certified reproductive endocrinology (RE) physicians providing care for Medicaid patients in New Jersey. Given the adverse effects of prolonged hypoestrogenism, we aimed to evaluate length of time to diagnosis of POI in a low-resource/low-income population presenting to an urban university-based RE clinic, as well as provide a review of the current literature. Methods: This retrospective case series included all new patients seen at the RE clinic at University Hospital in Newark, NJ from June 2014 through June 2018. POI was diagnosed in women with oligo/amenorrhea and menopausal levels of follicle stimulating hormone. The primary outcome was time to diagnosis from onset of symptoms. Results: Of 524 new patients seen, 19 (3.6%) were diagnosed with POI. Median time to diagnosis of POI from onset of symptoms was 48 months. 57.9% of our patients identified as Black and 31.6% as Hispanic. 13/19 (68.4%) reported hypoestrogenic symptoms at time of referral. 21.1% were diagnosed with Turner mosaicism. 14 of 19 patients completed DEXA scan, of which 35.7% were diagnosed with low bone mass or osteoporosis. Of those diagnosed prior to referral to RE (9/19, 47.4%), only 4 had initiated hormone therapy. Conclusions: Our study demonstrates a need for more aggressive evaluation of oligo/amenorrhea in underrepresented minority women. Prolonged time to diagnosis of POI has adverse effects, as reflected by hypoestrogenic symptoms and decreased bone mineral density. Delayed diagnosis and management of POI may be related to health care disparities facing these women and warrants action to improve access to care.