Women with premature ovarian insufficiency, whose periods stop before 40, are at much higher risk for serious autoimmune diseases, according to research.
Premature ovarian insufficiency (POI) occurs when women under 40 no longer produce eggs because their ovaries have stopped working properly. Periods become irregular and then stop, and some women experience menopausal symptoms. It affects 1% of women worldwide.
A study found that women with POI are two to three times more likely to develop serious autoimmune conditions such as type 1 diabetes, overactive thyroid, lupus, and inflammatory bowel disease, compared to the general population.
The researchers say the findings significantly strengthen the hypothesis that autoimmune processes play an “important role” in the onset of POI.
The study, published in Human Reproduction, is the largest to investigate the link between autoimmune conditions and POB.
Finnish academics followed nearly 20,000 women for at least 12 years. They analyzed health data from Finland’s comprehensive registries and identified nearly 4,000 women under 40 with a POB diagnosis between 1988 and 2017.
Each was matched with four women of similar ages. They then studied how many serious autoimmune conditions developed between 1970 and 2017. They found that 5.6% of women with POI were diagnosed with at least one autoimmune disorder before their diagnosis and 12.7% after diagnosis with POI.
Overall, women were 2.6 times more likely to have an autoimmune disease before a POI diagnosis compared to the control group. These risks ranged from nearly double for overactive thyroid glands and rheumatoid arthritis to nearly 26 times for polyglandular autoimmune diseases.
Women with POI who did not have a pre-existing autoimmune condition were almost three times as likely to be diagnosed with one in the next three years.
These links are likely an underestimate, say the authors, because the study only included autoimmune disorders diagnosed in specialist health centres: less serious conditions such as celiac disease and underactive thyroid are often diagnosed and treated in primary health care, so the overall prevalence of autoimmune -immune disorders in women with POI are higher.
Dr Susanna Savukoski, a gynecology and obstetrics doctor at Oulu University Hospital and the University of Oulu, Finland, who led the study, said: “It is important to emphasize that most women with POI do not have severe auto- immune conditions do not develop, and most women with severe autoimmune diseases do not develop POI. However, medical professionals should be aware of the increased risk, and patients should also be informed.”
Since POI threatens fertility, women at increased risk of the condition should consider trying to conceive when they’re young, she says, although some autoimmune diseases can significantly increase the risk of pregnancy complications and should be considered.
The authors want to study the biological mechanisms of POI and autoimmune diseases to aid the development of preventive treatments. Savukoski said: “We are investigating whether long-term use of [hormone replacement therapy] may prevent other conditions from developing among women with POI.”
Commenting on the findings, Louise Kenny, a professor of maternal and fetal health at the University of Liverpool, said: “POI is poorly understood and devastating. It limits the ability of young women to carry their own biological child , as well as increasing their risk of menopause-related complications such as osteoporosis.”
New research was needed to confirm the role of the immune system, she added.
Bassel Wattar, an associate professor of reproductive medicine at Anglia Ruskin University, said the research highlights the need for multidisciplinary and holistic care for women with POI due to the increased risk of long-term health complications.
He added: “This study does not help us to understand the causation of POI and therefore it remains to be answered whether it is a result of autoimmune disorders or if the lack of ovarian activity is an autoimmune reaction under affected women may exaggerate.”
