Premature ovarian insufficiency (POI), defined as amenorrhoea due to the loss of ovarian function before 40 years of age, can occur spontaneously or be secondary to medical therapies. POI is associated with cardiovascular morbidity, osteoporosis and premature mortality. Women with POI present in primary care with menstrual disturbance, menopausal symptoms, infertility and, often, significant psychosocial issues. General practitioners play an important role in the evaluation and long-term management of women with POI.
This article examines the diagnostic and management issues when providing care for women with POI in the primary care setting.
Diagnosis of POI requires follicle-stimulating hormone (FSH) levels in the menopausal range on two occasions, at least four to six weeks apart in a woman aged <40 years, after more than four months of amenorrhoea or menstrual irregularity. The diagnosis is often distressing and women are likely to require psychological support. Hormone replacement therapy, unless contraindicated, is required and should be continued until the age of natural menopause. Contraception is required if pregnancy is not wanted, and multidisciplinary management is necessary.
The Royal Australian College of General Practitioners 2017