Premature ovarian insufficiency (POI) is defined as menopause prior to the age of 40. Women who experience POI are at increased risk of reduced bone density, cardiovascular disease, mood disorders, cognitive impairment, sexual dysfunction and have a shorter life expectancy (1). A recent cross-sectional study has suggested women with POI may experience more severe symptoms than women who undergo natural menopause (2). Women with POI should be offered menopausal hormone replacement therapy (MHT) up to the age of 50 years for relief of symptoms resulting from low oestrogen and be counselled on the role of MHT on bone and cardiovascular protection (1,3).
We present a case of a 37-year-old who presented with irregular periods for three years prior associated with vasomotor (VSM) and genitourinary symptoms (GSM). Workup demonstrated high gonadotropins and low oestradiol. Screening investigations for known causes of POI were unremarkable. Medical history included a left middle cerebral territory infarct at 16 weeks of pregnancy (5 years prior) associated with narrowing of the left angular artery; previous migraines with visual and sensory aura; mild dyslipidemia; and a family history of venous thromboembolism and ischaemic heart disease. Post stroke the patient had been advised to avoid further pregnancies and the oral contraceptive pill.
We will review evidence and rationale for use of MHT in the context of severe menopausal symptoms and prior stroke in a young patient with POI, and the importance of collaboration with other specialties in the workup of this complex case. Finally, we will discuss alternative treatment in the form of non-hormonal based therapies.