Introduction: Primary ovarian Insufficiency (POI) occurring in youth is a devastating condition. POI is characterized by at least 4 months of disordered menses in association with menopausal follicle stimulating hormone (FSH) levels. The most common causes of POI in adolescence are iatrogenic and chromosomal abnormalities. Data are scarce regarding the incidence of POI in adolescents.
Objectives: We aimed to estimate the incidence and the distribution of etiologies of POI in a multi-center study in Israel.
Methods: Data regarding girls under age 22 years presenting with POI during the years 20002016 were collected from 14 medical centers. Iatrogenic cases were excluded. The incidence rate of new POI diagnosis was calculated based on birthrate information from the Israeli Central Bureau of Statistics (CBS).
Results: One hundred and fourteen girls met the criteria of POI, presented at a mean age of 13.6±3.8 years, 68 (60%) with primary amenorrhea. Their mean FSH level was 77.3±39.9 mUI/ml. The distribution of etiologies was: Turner syndrome/mosaicism in 50/114 (44%), idiopathic in 36/114 (32%) and other (genetic, autoimmune, etc.) in 28/114 (24%). The incidence rate of new POI diagnoses per 100,000 births doubled between the years 20092016 compared to the years 20002008 (incidence rates 3.8 and 1.8, respectively, P-value=0.0007). Moreover, the incidence rates of both idiopathic and other etiologies tripled comparing these two time periods (P-value=0.004 and P-value=0.01 respectively), contrasting with Turner syndrome, whose incidence rate remained static (P-value=0.6).
Conclusions: Over the last decade a significant increase in the rate of POI was observed among adolescents, especially among non-Turner cases. We believe the findings reflect a true increase in the risk of developing POI and not a change in awareness and identification patterns. The possible involvement of environmental and epigenetic factors in this remarkable increase should be investigated.
27 Sep 2018 - 29 Sep 2018