POF/POI is defined as menstruation ending before a women reaches the age of 40 years 129.
Studies estimate that between 0.9-1.2% of women will have POF/POI 130,131.
There are limited data on the cost burden of POF/POI, aside from the costs associated with VMS listed above.
Hispanics and Blacks have the highest risk of POF/POI, and Japanese-Americans the lowest. Table 16 lists the demographic differences associated with POF/POI 129.
|Premature menopause (<40 years)|
|% in ethnic group||1.0||1.4||1.4||0.14||0.5||1.1|
|Early menopause (age 40-45 years)|
|% in ethnic group||2.9||4.1||3.7||0.8||2.2||3.1|
|Menopause (>45 years)|
|% in ethnic group||13.0||16.1||12.5||10.5||9.1||12.9|
|% in ethnic group||83.0||78.3||82.4||88.6||88.2||82.9|
Source: Luborsky et al. 2003 129
5.4 LIFE EXPECTANCY AND MORTALITY
Women with POF/POI may be at higher risk of early onset of heart disease 132,133 and mortality 16. In addition, women with POF/POI are likely to spend more years in an estrogen-deficient state, and thus might be at higher risk for osteoporosis and fracture 16,134.
A study by Luborsky et al. reported that there appear to be ethnic variations in the prevalence of and health factors associated with POF/POI. However, the cross-sectional design of the study made it impossible to clarify possible cause and effect relationships. We likely need more studies on the health risks of POF/POI 129.
Among Caucasian women there were significant associations between POF/POI and hormone use, severe disability, smoking, and osteoporosis. However, among African Americans, POF was not associated with osteoporosis, but was associated with female hormone use and higher BMI (Table 17) 129.
|OR||(95% CI)||P‐value||OR||(95% CI)||P‐value||OR||(95% CI)||P‐value|
|Hormone (not birth control pills)||2.9||(1.9-4.3)||0.00001||3.0||(1.7-5.2)||0.0001||4.5||(2.3-9.1)||0.0001|
Source: Luborsky et al. 129
Clinicians should prescribe hormone therapy for women with premature ovarian failure/premature ovarian insufficiency (POF/POI) up to the age of natural menopause, at which point, clinicians should follow the standard guidelines for age-appropriate menopausal women 135,136.
Hormone therapy can confer an excess risk of mortality in women older than 60 years. Estrogen and progestin in combination can increase the risk of breast cancer in women aged 50-59, but this combination also has been associated with a decrease in overall mortality risk. Those women with prolonged menopausal symptoms who are 60-69 years old can have increased cardiovascular risk with continued hormone therapy. Furthermore, there is an increased risk of stroke in women who have had hysterectomies who take estrogen alone 135,136.