Premature ovarian insufficiency (POI) is characterised by ovarian failure before the age of 40 years. Often women with POI experience severe menopausal symptoms. In addition, many adverse long term consequences, including increased risk of cardiovascular disease (CVD) and dementia. The psychological impact of POI is considerable. While research is lacking into POI, hormone replacement therapy (HRT) has been highlighted as key in helping women with POI to improve their quality of life.
The psychological effect of POI
At EMAS 2019, Dr. Nick Panay explained that women with POI often present with a number of psychological symptoms.
Low life satisfaction
A quote from one woman further demonstrated this point.
I went from 36-56 in one day! I felt unattractive, useless, different, an outsider
Dr. Panay explained that while physical symptoms of POI are more understood, healthcare professionals often struggle with providing the psychological support that women with POI need.
One meta analysis demonstrated that menopause at 40 years or older is linked to a 50% decreased risk for depression when compared with premature menopause. 
In another study, 78% women with POI said that it had resulted in a negative impact on their self image and confidence. Nearly all described the diagnosis as traumatic, even when the healthcare professional had handled the situation sensitively. 
Sexual dysfunction in POI
While very few studies have specifically investigated a link between POI and sexual dysfunction, there is evidence that POI can cause decreased sexual well-being and arousal while increasing risk of pain.  One cross-sectional study indicated that women with POI can experience a 2.8 fold increased risk of having sexual dysfunction.  Sexual wellbeing is often key to a good quality of life, therefore this sexual dysfunction can increase risk of women developing a psychopathology.
Improving the quality of diagnosis
Many women with POI may not receive a proper diagnosis for 7 years, explained Dr. Panay. In one study 53% of women with POI did not know the reason for their diagnosis, with only 55% given enough information.  There are ways to improve the quality of diagnosis, minimising the psychological impact of POI:
Maintain good communication
Improve the overall patient experience of the diagnostic process
Individualise assessment of needs
Individually tailor treatments
Effectively treat hot flushes and night sweats
A range of psychological support can be offered to POI patients. These can include:
Individualised and group therapy
Young menopause forums
Close psychiatric liaison
Treating POI with HRT
Dr. Sophia Kalantaridou discussed that HRT is a key treatment for POI, with potential benefits for symptoms and for mitigating the long term consequences. She proposed:
Give estrogen replacement equivalents continuously across 28 day cycle
Give progestin replacement equivalents for last 12 days of 28 day cycle
Evidence suggests that HRT has a role in primary prevention of cardiovascular diseases and bone protection. This is particularly important when considering that women with POI are at increased risk of osteoporosis and CVD.
While HRT may not have a direct effect on psychological effects of POI, reducing the menopausal symptoms may help to support other psychological interventions as part of a holistic treatment plan.
 Georgakis MK, Thomopoulos TP, Diamantaras A, et al. Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2016;73(2):139–149. doi:10.1001/jamapsychiatry.2015.2653
 van der Stege JG et al. Decreased androgen concentrations and diminished general and sexual well-being in women with premature ovarian failure. Menopause 2008 Jan/Feb; 15:23.
 Bueno de Almeida, Deborah Marçal MD Benetti-Pinto, et al. Sexual function of women with premature ovarian failure. Menopause: 2011; 18 (3):262-266
 D. Singer, E. Mann, M. S. Hunter, et al. The silent grief: psychosocial aspects of premature ovarian failure, Climacteric, 2011: 14:4, 428-437, DOI: 10.3109/13697137.2011.571320