Study on Premature Ovarian Insufficiency and Autoimmune Disorders

A new study published in the journal of Human Reproduction showed that women confirmed to have premature ovarian insufficiency (POI) have an elevated frequency of certain particular autoimmune disorders. 1% of women have spontaneous premature ovarian insufficiency, which is characterized as the loss of ovarian function before the age of 40. The autoimmune processes affecting the ovaries that cause POI might appear alone. Autoimmunity has been proposed as a key player in the pathophysiology of POI. The proportion of POI patients with an autoimmune etiology has been estimated to be between 4% and 50%. Thus, this study by Savukoski and colleagues was to investigate any potential link between severe autoimmune illnesses and early ovarian insufficiency, both before and after the diagnosis of POI.

This community-based registry investigation included both case-control and cohort analysis, where 3972 women with spontaneous POI diagnoses between 1988 and 2017 were involved, along with 15,708 female population controls. Diagnoses of autoimmune diseases were assessed from childhood till the end of 2017. The Finnish Social Insurance Institution's reimbursement registry data was used to identify women with POI based on their eligibility for hormone replacement treatment (HRT). For every POI instance, 4 female population controls who were matched based on age and place of residence were looked for in order to create a reference cohort. Women who had had a bilateral oophorectomy or a history of malignancy were not eligible. Diagnoses for severe autoimmune disorders from 1970 to 2017 were retrieved from the Hospital Discharge Registry.

When compared to population controls, the frequency of at least one serious autoimmune illness in women with POI was 5.6%, with an OR of 2.6. The women with POI had higher rates of several specific autoimmune diseases like:

• Hyperthyroidism
• Inflammatory bowel diseases
• Addison's disease
• Systemic lupus erythematosus
• Vasculitis
• Sarcoidosis
• Rheumatoid arthritis
• Polyglandular autoimmune diseases

prior to the index date.

Also, there was no difference in the prevalence of diabetes type 1 and ankylosing spondylitis between the POI and the reference cohort. Following a diagnosis of post-traumatic inflammation (POI), the odds ratio (SIR) for receiving a new diagnostic of a severe autoimmune illness was 2.8 during the first three years following the diagnosis, and it progressively dropped to 1.3 after 12 years.

Overall, this study gives new evidence at the population level on the relationship between severe autoimmune illnesses and POI. Overall, women with POI have a more than 2-fold higher frequency of serious autoimmune disorders, and this prevalence persists for more than a decade following diagnosis when compared to female population controls.

Reference

Savukoski, S. M., Silvén, H., Pesonen, P., Pukkala, E., Gissler, M., Suvanto, E., Ollila, M.-M., & Niinimäki, M. (2024). Excess of severe autoimmune diseases in women with premature ovarian insufficiency: a population-based study. In Human Reproduction. Oxford University Press (OUP). https://doi.org/10.1093/humrep/deae213