Endocrine Abstracts

Premature ovarian insufficiency (POI) is defined as hypergonadotropic oligo/amenorrhoea with FSH>40 IU/l, estradiol <50 pmol/l in women under 40 years of age. Biological aging is faster in this group of women inducing diseases and disturbing quality of life.Infertility in POI represents a special issue. Hypoestrogenism, hypoprogesteronism, hypoandrogenism, decreasing of dehydroepiandrosteron sulfate, growth hormone, and increasing insulin resistance influence all body functions knowing the fact that steroid receptors are present on all blood vessels.Central nervous system changes include depression, lack of concentration, insomnia, anxiety, lower sexual desire and increasing incidence of Alzheimer disease. Cardiovascular changes include blood vessel instability, hypertension, atherosclerotic plaque growth, myocardial infarction, arrhythmias etc. Insulin resistance increases body weight further contributing to cardiovascular disease. Osteoporosis, joint stiffnes, cartilage and connective tissue changes restricted mobility. Inflammation increase and autoimmune diseases started at that time. Dyspareunia, vulvar atrophy, lower libido ruined sexual life. All these consequences of ‘normal aging and physiological menopause process’ are not acceptable today having in mind definition of middle age until 60 years of age, according to World Health Organization. The main principle of endocrinology is to reach normal hormone concentrations. In POI estradiol has to be not only sufficient but optimal, according to the age. Adequate replacement of estradiol, progesterone, testosterone (especcialy in the artificial POI), DHEAS and all other hormones is required in POI. Modern endocrinology is responsible for helping women in reaching the optimal quality of life which is impossible without normal gonadal steroids levels.