Primary Ovarian Insufficiency; why is it not diagnosed enough in primary care?

Do primary care specialists know enough to diagnose and treat Primary Ovarian Insufficiency (POI)? The answer is sadly not enough. Research suggests that many GP's have not heard of the condition and may not be confident in making a diagnosis or giving their patients the right advice and support.




POI is defined as the loss of ovarian function before the age of 40, figures suggest that around 1 in 100 women under the age of 40 could have the condition. Common symptoms include infertility, irregular or absent periods and menopausal symptoms such as hot flushes, night sweats, vaginal dryness and memory problems. Women with primary ovarian insufficiency face the acute shock of the diagnosis, stigma associated with infertility and often anxiety and depression from the disruption of life plans and the future they thought they had. Devastating, shocked and confused are the most common words and feelings that women have described in time after their diagnosis.


Many women are told by their Dr's that they are to young to be menopausal or that missing periods is normal. Often other symptoms of POI are attributed to other illnesses such as depression. I have seen many women who have had to visit their GP many times before a diagnosis or relevant specialist referral has been made. Some women have left their GP's in tears unsure what to do next or who to ask for further help or advice.


For women under the age of 40, two FSH blood tests taken at least one month apart should aid the diagnosis of POI, raised FSH levels are an indicator that the ovaries are not functioning normally, a key factor of this condition. For women under 40, NICE guidelines recommend FSH blood tests when assessing a possible patient with POI. Evidence also suggests that women with POI have intermittent ovarian function rather than complete cessation of ovarian function, which mean that for many women they experience irregular and unpredictable periods, this is periods stopping all together is not a requirement of a diagnosis of POI.





Diagnosis and support are key as the right treatment and management will reduce the impact of future complications, treatment using hormone replacement therapy is usually continued until the women reaches a natural menopause age, women should be reassured that there is no increased risk of breast cancer when taking HRT at a young age as they are simply replacing the hormones they would naturally be producing. Treatment with HRT offers protection from osteoporosis and cardio vascular disease and can reduce menopause symptoms.


Support is available for those with POI, the Daisy network, a charity for women with POI has lots of information and support, you can find out more by clicking on their website https://www.daisynetwork.org/

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