Premature Ovarian Insufficiency: Diagnosis and Treatment Options

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Premature Ovarian Insufficiency: Diagnosis and Treatment Options

Premature Ovarian Insufficiency (POI), formerly known as premature ovarian failure, is a condition characterized by the depletion of ovarian follicles before the age of 40, leading to hormonal imbalances and infertility. The ovaries stop releasing the eggs and even stop producing the hormones i.e estrogen, progesterone and testosterone. Early diagnosis is crucial for effective management and improved quality of life for affected individuals. POI is characterised by menstrual disturbance which may be amenorrhea or oligomenorrhea.

Diagnosis: Diagnosing POI involves a combination of clinical history, physical examination, and laboratory tests. The diagnosis is made by evaluating the frequency of periods which is usually over at least four months. The two key hormonal markers used in the diagnosis are Follicle-Stimulating Hormone (FSH) and Anti-Müllerian Hormone (AMH). Elevated FSH levels and decreased AMH levels are indicative of diminished ovarian reserve and are key indicators of POI.

  • FSH Levels: In POI, the ovaries fail to respond to the usual negative feedback mechanism, leading to an increase in FSH levels. Elevated FSH levels, especially when tested on different occasions i.e two measurements at least four weeks apart and both the values showing elevated levels of FSH in menopausal range (>40 IU/l) , can be a strong diagnostic clue for POI.
  • AMH Levels: Anti-Müllerian Hormone is produced by developing ovarian follicles, and its levels correlate with the ovarian reserve. Reduced AMH levels in conjunction with high FSH levels provide a comprehensive picture of ovarian function.AMH <0.9 hypoestrogenism (estradiol levels<50pg/ml)

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