Emotional Care, Often Missing from Treatment, Could Play Essential Role in Improving POI Outcomes

Published August 4, 2017 | Journal of Pediatric and Adolescent Gynecology

Treating girls who have primary ovarian insufficiency (POI), a failure of ovarian function resulting in early menopause, requires numerous approaches for physical health, including estrogen-replacement therapy.

Typically lost amid these strategies, however, are the girls’ emotional needs. Diagnosis is particularly devastating when it emerges, unannounced, in or around puberty.

That is changing, thanks in part to a retrospective chart review involving scientists and clinicians in the Divisions of Pediatric and Adolescent Gynecology, Biostatistics and Epidemiology, and Adolescent and Transition Medicine.

Led by Catherine Gordon, MD, MSc, Director, Adolescent and Transition Medicine, the team analyzed the case files of 50 females, ages 11 to 26, diagnosed with POI at Cincinnati Children’s over a 10-year period ending in 2015.

Each patient started estrogen therapy within the first two years, but only two had received mental-health support.

POI can cause infertility. Symptoms are usually subtle.

“Parents think it may be a thyroid problem. But it turns out to be early menopause, so it’s a shocking diagnosis,” says Gordon. “Our hypothesis was correct, that psychological health was important to address. Sadly, it hadn’t been.”

In 42 percent of cases, the cause was Turner syndrome, an inherited, chromosomal condition. In 36 percent, the cause was unknown. Poor bone mineral density was surprisingly common.

Researchers now want to better understand POI’s genotype and phenotype, and emphasize the value of psychological care. Strong communication between clinics and hospitals also is essential.

Last year, Gordon received a call from a Los Angeles endocrinologist who learned of Gordon’s research, and wanted more insight. “Over a year, I get about four to six calls like that,” she says. “It’s very rewarding.”