Menopausal symptoms associated with premature ovarian insufficiency

The cross-sectional study in the journal Menopause found that the most striking differences related to psychological and sexual domains.

Women with POI were also more prone to distressing menopausal symptoms like sexual problems.

A total of 293 Chinese women with POI (mean age 33.76 years) from an outpatient clinic at Gynecological Endocrinology at Women’s Hospital, Zhejiang University School of Medicine, were recruited between June 2014 and January 2019.

The criteria for diagnosing POI were the presence of oligo/amenorrhea for at least 4 months in women younger than aged 40 and an increased serum concentration in the follicle-stimulating hormone (FSH) of at least 25 IU/L on two occasions spaced more than 4 weeks apart.

The modified Kupperman Menopausal Index (mKMI) total score, which is widely used in the Chinese population, indicated that 70.6% of women with POI exhibited menopausal symptoms and 32.4% had moderate-to-severe menopausal symptoms.

The five most prevalent menopausal symptoms among women with POI were mood swings (73.4%), insomnia (58.7%), sexual problems (58.7%), fatigue (57.3%) and hot flashes/sweating (49.5%).

“Sexuality in women with POI warrants special attention, considering the young age and the negative impact of sexual dysfunction on intimate relationships,” wrote the authors, noting sexual symptoms can be alleviated, but not entirely reversed, by hormone therapy (HT).

Therefore, nonhormonal alternatives such as lubricants, vaginal moisturizers and focused counseling should be combined with tailored HT to enhance sexuality, according to the authors.

However, Chinese POI women may be less willing to seek medical help for sexual symptoms compared to their Western counterparts, due to cultural differences, thus leaving these symptoms untreated.

Nonhormonal alternatives such as lubricants, vaginal moisturizers and focused counseling should be combined with tailored HT to enhance sexuality, according to the authors.

The study also found that among women with POI, there were moderate-to-severe symptoms of mood swings (23.9%), formication (17.4%) and hot flashes/sweating (17.1%).

In addition, compared with women with natural menopause, women with POI were nearly 50% more likely to report fatigue or insomnia, and more than three times as likely to report melancholia or mood swings.

The psychological impact of ovarian insufficiency on young women is probably largely due to the diagnosis of infertility and lack of perceived psycho-social support rather than hormone deficiency.

But women with POI were more than 50% less likely to report moderate-to-severe sexual problems or moderate-to-severe muscle/joint pain versus women with natural menopause.

However, living in urban areas and higher gravidity were independently associated with menopausal symptoms in women with POI. The authors speculated that women in large cities are challenged by more pressure, have higher expectations about life and pay more attention to health issues. Likewise, high gravidity is related to poor health condition.

Because women with POI were much more likely to have profound menopausal symptoms compared with women with natural menopause, it is important that healthcare providers “recognize the possible presence of psychological complications and sexual dysfunctions and offer relief from short-term distress, as well as improve a women’s mental and sexual well-being,” wrote the authors. “Collectively, effective management based on a biopsychosocial perspective warrants a comprehensive evaluation of symptomatology, tailored hormone therapy, and concerted counseling of women with POI.”

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Huang Y, Qi T, Ma L, et al. Menopausal symptoms in women with premature ovarian insufficiency: prevalence, severity, and associated factors. Menopause. Published online January 18, 2021. doi:10.1097/GME.0000000000001733