Premature Ovarian Failure - is there Hope?

Premature ovarian failure (POF), also known as premature ovarian insufficiency, represents a continuous decline of the ovarian function found in fertile women before the age of 40, and it manifests itself through hypoestrogenemia, hypergonadotropism, secondary amenorrhea and infertility [1]. It is believed that POF is most frequently idiopathic but may also occur due to autoimmune disorders, genetic diseases, infections or metabolic syndromes [2]. Epidemiological studies indicate that POF affects approximately 1% of the female population. Women with POF have low oestrogen levels in their serum, which leads to an increased risk of low bone density, osteoporosis and fractures [3] and earlier onset of coronary heart disease [4, 5]. However, the psychosocial effects due to infertility must be mentioned, as women with POF have been reported to experience more anxiety and depression [4, 6]. Studies show that in approximately 20-30% of cases, POF is associated with autoimmune diseases and endocrinopathies such as Addison's disease or autoimmune thyroid diseases [7]. The therapeutic approach to POF usually consists of oestrogen therapy in order to substitute the low levels of this hormone found in patients' serum (also known as HRT hormone replacement therapy), which can be used for both prophylactic and symptomatic purposes, in the latter case to try to diminish the symptoms caused by hormonal deficiency. In addition to oestrogen therapy, it is advisable to add progestogen to protect the endometrium, the proliferative and malignant effects of oestrogen left alone being well documented. The most recommended therapy in this case is oral contraceptive pills [8].