Advertisement

Approach to Evaluation and Comprehensive Care for Primary Ovarian Insufficiency

Published:November 01, 2022DOI:https://doi.org/10.1016/j.nurpra.2022.09.023

      Highlights

      • Individuals with primary ovarian insufficiency commonly present with menstrual irregularity ranging from oligomenorrhea to amenorrhea.
      • Long-term sequelae include increased mortality risk, infertility, depression, and psychosexual and sexual dysfunction
      • Patients with primary ovarian insufficiency often experience a “diagnostic odyssey” that contributes to impaired health-related quality of life.
      • The constellation of physical and psychosocial sequelae of primary ovarian insufficiency necessitates an interdisciplinary and patient-centered approach to management.

      Abstract

      Idiopathic primary ovarian insufficiency (POI) is a reproductive endocrine disorder defined as the loss of ovarian function before age 40. The condition is characterized by infertility, estrogen deficiency, and premature menopause. POI has significant long-term physical and psychosocial sequelae. Because POI is underrecognized and challenging to diagnose, patients often experience a “diagnostic odyssey” that contributes to impaired health-related quality of life. This review provides a state-of-the-science overview of POI, approach to diagnosis and management, and interprofessional aspects of care. We highlight unanswered questions and future directions and underscore the nurse practitioner’s role in providing holistic care for women with POI.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Li X.T.
        • Li P.Y.
        • Liu Y.
        • et al.
        Health-related quality-of-life among patients with premature ovarian insufficiency: a systematic review and meta-analysis.
        Qual Life Res. 2020; 29: 19-36https://doi.org/10.1007/s11136-019-02326-2
        • Eskenazi S.
        • Bachelot A.
        • Hugon-Rodin J.
        • et al.
        Next generation sequencing should be proposed to every woman with “idiopathic” primary ovarian insufficiency.
        J Endocr Soc. 2021; 5: bvab032https://doi.org/10.1210/jendso/bvab032
        • Maciejewska-Jeske M.
        • Szeliga A.
        • Męczekalski B.
        Consequences of premature ovarian insufficiency on women’s sexual health.
        Prz Menopauzalny. 2018; 17: 127-130https://doi.org/10.5114/pm.2018.78557
        • Moukhah S.
        • Ghorbani B.
        • Behboodi-Moghadam Z.
        • Zafardoust S.
        Perceptions and experiences of women with premature ovarian insufficiency about sexual health and reproductive health.
        BMC Womens Health. 2021; 21: 54https://doi.org/10.1186/s12905-021-01197-5
        • Tao X.Y.
        • Zuo A.Z.
        • Wang J.Q.
        • Tao F.B.
        Effect of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis.
        Climacteric. 2016; 19: 27-36https://doi.org/10.3109/13697137.2015.1094784
        • Welt C.K.
        Primary ovarian insufficiency: a more accurate term for premature ovarian failure.
        Clin Endocrinol (Oxf). 2008; 68: 499-509https://doi.org/10.1111/j.1365-2265.2007.03073.x
        • Bogart K.
        • Hemmesch A.
        • Barnes E.
        • Blissenbach T.
        • Beisang A.
        • Engel P.
        Healthcare access, satisfaction, and health-related quality of life among children and adults with rare diseases.
        Orphanet J Rare Dis. 2022; 17: 196https://doi.org/10.1186/s13023-022-02343-4
        • Coulam C.B.
        • Adamson S.C.
        • Annegers J.F.
        Incidence of premature ovarian failure.
        Obstet Gynecol. 1986; 67: 604-606
        • Lagergren K.
        • Hammar M.
        • Nedstrand E.
        • Bladh M.
        • Sydsjö G.
        The prevalence of primary ovarian insufficiency in Sweden; a national register study.
        BMC Womens Health. 2018; 18: 175https://doi.org/10.1186/s12905-018-0665-2
        • Nelson L.M.
        Clinical practice. Primary ovarian insufficiency.
        N Engl J Med. 2009; 360: 606-614https://doi.org/10.1056/NEJMcp0808697
        • Maclaran K.
        • Panay N.
        Current concepts in premature ovarian insufficiency.
        Womens Health (Lond). 2015; 11: 169-182https://doi.org/10.2217/whe.14.82
        • Luborsky J.L.
        • Meyer P.
        • Sowers M.F.
        • Gold E.B.
        • Santoro N.
        Premature menopause in a multi-ethnic population study of the menopause transition.
        Hum Reprod. 2003; 18: 199-206https://doi.org/10.1093/humrep/deg005
        • Golezar S.
        • Ramezani Tehrani F.
        • Khazaei S.
        • Ebadi A.
        • Keshavarz Z.
        The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis.
        Climacteric. 2019; 22: 403-411https://doi.org/10.1080/13697137.2019.1574738
        • Mishra G.D.
        • Chung H.F.
        • Cano A.
        • et al.
        EMAS position statement: predictors of premature and early natural menopause.
        Maturitas. 2019; 123: 82-88https://doi.org/10.1016/j.maturitas.2019.03.008
        • Davis S.R.
        • Lambrinoudaki I.
        • Lumsden M.
        • et al.
        Menopause. Nat Rev Dis Primers. 2015; 1: 15004https://doi.org/10.1038/nrdp.2015.4
        • Richard-Eaglin A.
        Male and female hypogonadism.
        Nurs Clin North Am. 2018; 53: 395-405https://doi.org/10.1016/j.cnur.2018.04.006
        • Lambrinoudaki I.
        • Paschou S.A.
        • Lumsden M.A.
        • et al.
        Premature ovarian insufficiency: a toolkit for the primary care physician.
        Maturitas. 2021; 147: 53-63https://doi.org/10.1016/j.maturitas.2020.11.004
        • Torrealday S.
        • Kodaman P.
        • Pal L.
        Premature ovarian insufficiency—an update on recent advances in understanding and management.
        F1000Res. 2017; 6: 2069https://doi.org/10.12688/f1000research.11948.1
        • Rahman R.
        • Panay N.
        Diagnosis and management of premature ovarian insufficiency.
        Best Pract Res Clin Endocrinol Metab. 2021; 35: 101600https://doi.org/10.1016/j.beem.2021.101600
        • Ryan J.
        • Scali J.
        • Carrière I.
        • et al.
        Impact of a premature menopause on cognitive function in later life.
        BJOG. 2014; 121: 1729-1739https://doi.org/10.1111/1471-0528.12828
        • Lenton E.A.
        • Sexton L.
        • Lee S.
        • Cooke I.D.
        Progressive changes in LH and FSH and LH:FSH ratio in women throughout reproductive life.
        Maturitas. 1988; 10: 35-43https://doi.org/10.1016/0378-5122(88)90129-6
        • Younis J.S.
        • Iskander R.
        • Fauser B.
        • Izhaki I.
        Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis.
        Hum Reprod Update. 2020; 26: 904-928https://doi.org/10.1093/humupd/dmaa013
        • World Health Organization
        International statistical classification of diseases and related health problems.
        10th ed. 2019
        https://icd.who.int/browse10/2019/en#/
        Date accessed: September 12, 2022
        • Hagerman R.J.
        • Berry-Kravis E.
        • Hazlett H.C.
        • et al.
        Fragile X syndrome.
        Nat Rev Dis Primers. 2017; 3: 17065https://doi.org/10.1038/nrdp.2017.65
        • Davies K.
        • Dwyer A.A.
        Genetic competencies for effective pediatric endocrine nursing practice.
        J Pediatr Nurs. 2019; 48: 127-128https://doi.org/10.1016/j.pedn.2019.06.006
        • Committee Opinion No
        698: hormone therapy in primary ovarian insufficiency.
        Obstet Gynecol. 2017; 129: e134-e141https://doi.org/10.1097/aog.0000000000002044
        • Webber L.
        • Davies M.
        • et al.
        • European Society for Human Reproduction and Embryology (ESHRE) Guideline Group on POI
        ESHRE Guideline: management of women with premature ovarian insufficiency.
        Hum Reprod. 2016; 31: 926-937https://doi.org/10.1093/humrep/dew027
        • Stuenkel C.A.
        • Davis S.R.
        • Gompel A.
        • et al.
        Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline.
        J Clin Endocrinol Metab. 2015; 100: 3975-4011https://doi.org/10.1210/jc.2015-2236
        • Burgos N.
        • Cintron D.
        • Latortue-Albino P.
        • et al.
        Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review.
        Endocrine. 2017; 58: 413-425https://doi.org/10.1007/s12020-017-1435-x
        • Podfigurna-Stopa A.
        • Czyzyk A.
        • Grymowicz M.
        • et al.
        Premature ovarian insufficiency: the context of long-term effects.
        J Endocrinol Invest. 2016; 39: 983-990https://doi.org/10.1007/s40618-016-0467-z
        • Groff A.A.
        • Covington S.N.
        • Halverson L.R.
        • et al.
        Assessing the emotional needs of women with spontaneous premature ovarian failure.
        Fertil Steril. 2005; 83: 1734-1741
        • Golezar S.
        • Keshavarz Z.
        • Ramezani Tehrani F.
        • Ebadi A.
        An exploration of factors affecting the quality of life of women with primary ovarian insufficiency: a qualitative study.
        BMC Womens Health. 2020; 20: 163https://doi.org/10.1186/s12905-020-01029-y
        • Yela D.A.
        • Soares P.M.
        • Benetti-Pinto C.L.
        Influence of sexual function on the social relations and quality of life of women with premature ovarian insufficiency.
        Rev Bras Ginecol Obstet. 2018; 40: 66-71https://doi.org/10.1055/s-0037-1615289
        • Driscoll M.A.
        • Davis M.C.
        • Aiken L.S.
        • et al.
        Psychosocial vulnerability, resilience resources, and coping with infertility: a longitudinal model of adjustment to primary ovarian insufficiency.
        Ann Behav Med. 2016; 50: 272-284https://doi.org/10.1007/s12160-015-9750-z
        • Schmidt P.J.
        • Luff J.A.
        • Haq N.A.
        • et al.
        Depression in women with spontaneous 46, XX primary ovarian insufficiency.
        J Clin Endocrinol Metab. 2011; 96: E278-E287https://doi.org/10.1210/jc.2010-0613
        • Marsh W.K.
        • Bromberger J.T.
        • Crawford S.L.
        • et al.
        Lifelong estradiol exposure and risk of depressive symptoms during the transition to menopause and postmenopause.
        Menopause. 2017; 24: 1351-1359
        • Pearce M.
        • Garcia L.
        • Abbas A.
        • et al.
        Association between physical activity and risk of depression: a systematic review and meta-analysis.
        JAMA Psychiatry. 2022; 79: 550-559https://doi.org/10.1001/jamapsychiatry.2022.0609
        • Johnston-Ataata K.
        • Flore J.
        • Kokanović R.
        Women’s experiences of diagnosis and treatment of early menopause and premature ovarian insufficiency: a qualitative study.
        Semin Reprod Med. 2020; 38: 247-255https://doi.org/10.1055/s-0040-1721463
        • Jones A.R.
        • Tay C.T.
        • Melder A.
        • Vincent A.J.
        • Teede H.
        What are models of care? A systematic search and narrative review to guide development of care models for premature ovarian insufficiency.
        Semin Reprod Med. 2020; 38: 323-330https://doi.org/10.1055/s-0041-1726131
        • Martin L.A.
        • Porter A.G.
        • Pelligrini V.A.
        • et al.
        A design thinking approach to primary ovarian insufficiency.
        Panminerva Med. 2017; 59: 15-32https://doi.org/10.23736/S0031-0808.16.03259-6
        • Gameiro S.
        • Sousa-Leite M.
        • Vermeulen N.
        Dissemination, implementation and impact of the ESHRE evidence-based guidelines.
        Hum Reprod Open. 2019; 2019: hoz011https://doi.org/10.1093/hropen/hoz011
        • Rudnicka E.
        • Kruszewska J.
        • Klicka K.
        • et al.
        Premature ovarian insufficiency–aetiopathology, epidemiology, and diagnostic evaluation.
        Prz Menopauzalny. 2018; 17: 105-108

      Biography

      Elizabeth A. Weyman, BA, Doctor of Nursing Practice Student, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Isabella R. McDonald, BS, Doctor of Nursing Practice Student, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Elizabeth S. Blocker, BA, Doctor of Nursing Practice Student, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Corrine K. Welt, MD, Professor of Internal Medicine, University of Utah, Salt Lake City, UT; Chief of Endocrinology, Metabolism & Diabetes, University of Utah, Salt Lake City, UT; Investigator, Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Boston MA. Andrew A.

      Biography

      Dwyer, PhD, FNP-BC, FAAN, Associate Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; Investigator, Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Boston MA, and can be contacted at [email protected] .