Women with primary ovarian insufficiency at higher risk of autoimmune conditions

Women with premature ovarian insufficiency, or 'premature menopause', are two to three times more likely to develop severe autoimmune diseases during their lifetime.

When compared to controls within the general population, the chance of developing conditions such as Addison's disease, vasculitis, lupus, and inflammatory bowel disease are higher, both before and after diagnosis of premature ovarian insufficiency, researchers from Finland found. This new research, published in Human Reproduction, is one of the largest studies of its kind to date. The research analysed the relationship between autoimmune diseases and premature ovarian insufficiency by tracking nearly 20,000 women over several decades, via extensive population-based data from Finland.

Dr Susanna Savukoski, a gynaecology and obstetrics doctor from Oulu University Hospital, and the lead researcher said: 'Our findings show a two- to three-fold increased risk of autoimmune diseases around the time of premature ovarian insufficiency diagnosis, and that this elevated risk persists for several years afterward'.

Premature ovarian insufficiency itself occurs when the ovaries stop functioning properly in women under 40, which can lead to irregular or absent periods resulting in infertility. The exact cause of premature ovarian insufficiency has remained unclear, with autoimmune factors implicated as a potential cause since 1968. These results provide a stronger link that the autoimmune response could play a significant factor in the onset and progression of premature ovarian insufficiency.

The study showed that 5.6 percent of women with premature ovarian insufficiency had at least one severe autoimmune disorder before their diagnosis, compared to 2.2 percent of women in the control-matched group. The increased risk ranged between disorders, from a two-fold increase for hyperthyroidism to nearly 26-fold for polyglandular autoimmune diseases and 23-fold increased risk of Addison's disease. After premature ovarian insufficiency diagnosis, the risk remained high, with women nearly three-times more likely to develop an autoimmune disease within the first three years. Even after 12 years, their risk was still higher than in the control group.

The research also highlighted significant differences in risk between autoimmune conditions. For example, conditions like Addison's disease and vasculitis had much stronger associations with premature ovarian insufficiency than rheumatoid arthritis or hyperthyroidism.

Dr Savukoski emphasised: 'It is important to stress that most women with premature ovarian insufficiency do not develop severe autoimmune conditions, and most women with severe autoimmune diseases do not develop premature ovarian insufficiency. However, medical professionals should be aware of the increased risk, and patients should be informed about it as well.'

A limitation of the study is that it only included autoimmune diseases diagnosed in specialist healthcare settings, meaning less severe autoimmune conditions treated in primary care were not captured, this could mean that these associations would be even more prevalent. It also only included people from Finalnd, and may not be representative of people of other ancestries.

Dr Savukoski added that her team is exploring whether long-term HRT use may help reduce the risk of autoimmune diseases in women with premature ovarian insufficiency.