Premature ovarian insufficiency (POI): not identified enough or often not properly managed in young women

A couple of weeks ago I saw a 42-year-old lady in my surgery with symptoms of anxiety and palpitations. I have known her for many years but the last time I had seen her was four years ago. She was diagnosed as having premature ovarian insufficiency (POI) when she was 36 years old, after her periods stopped.

I noticed on the computer that one of the other doctors in the surgery had stopped her HRT a year ago. She had been told that she could only take hormone replacement therapy (HRT) for five years so it needed to be stopped. Since that time her symptoms of anxiety and palpitations had started. She has also become much more tired than normal and was finding her job as a policeman increasingly difficult due to this fatigue.

She had none of the "classic" symptoms of the menopause such as night sweats or hot flushes (this can be quite typical for women with POI). She was worried about having an increased risk of breast cancer with HRT, so she was relieved to no longer be taking it.

What this lady did not realise is that she actually has no increased risk of breast cancer with taking HRT when she is under 51 years of age. This is because the average age of the menopause in the UK is 51 years, so taking HRT under this age is simply replacing oestrogen her body should otherwise be making.

What is POI?

POI occurs when your ovaries no longer work properly when you are under the age of 40 years. Your ovaries no longer produce normal amounts of oestrogen and therefore may not produce eggs. This means that your periods either stop or become irregular, and you may experience symptoms of the menopause.

POI can just occur spontaneously but it can also occur after having your ovaries removed during an operation, having treatment for certain types of cancer or due to some other conditions. It can run in families for some women.

However, if it occurs spontaneously, your ovaries often do not completely fail which is different to the natural menopause when you are older. This means that the function of your ovaries can fluctuate over time, occasionally resulting in a period or even pregnancy, sometimes several years after diagnosis. This intermittent temporary return of ovarian function can result in around 5-10% of women with POI being able to conceive.

How common is POI?

POI is really common in the UK - more common than most women and also most doctors realise. It occurs in around one in a hundred women under the age of 40 years have POI and it affects around one in a thousand women under 30 years.

Women with POI have low levels of oestrogen at a much younger age than they should and this results in them having a higher risk of conditions such asosteoporosis, heart attacks and also dementia. These risks are greatly reduced by taking hormone treatment, usually in the form of HRT, until you are at least 51 years.

When you take HRT when you are young (under 51 years) then you are only replacing the oestrogen your body should otherwise be making, so there are no risks associated with it; only benefits. So it was completely wrong that this patient was being advised to stop taking her HRT after five years.

My patient was delighted to be informed of this and felt really reassured that she had no increased risk of breast cancer with taking HRT. Since her HRT has been restarted she feels wonderful, all her anxiety has gone and she has far more energy.

Many women have POI without a diagnosis ever have been made and so it is really important that if you have irregular periods or your periods have stopped then you talk to your doctor about having a blood test for this condition. Without treatment, you could really be putting yourself at risk of future illnesses which can otherwise be avoided by taking hormones.

For further POI support and information visit The Daisy Network.

Dr Louise R. NewsonBSc(Hons) MRChB(Hons) MRCP FRCGP is a GP and menopause expert, based in Solihull, West Midlands, UK.
Follow her on twitter @mymenopausedr or My Menopause Doctor on Facebook.