Autoimmune diseases are more common in women who stop ovulating before age 40.

This finding highlights the need for future research on autoimmune factors in POI to improve prevention and treatment strategies.

In a recent study published in human reproductionresearchers evaluated the relationship between autoimmune diseases and premature ovarian insufficiency (POI).

background

POI is a disease in which the ovaries stop releasing eggs before the age of 40, causing irregular periods and menopausal symptoms. According to research, autoimmune disease It accounts for 4-55% of all instances of POI. Women diagnosed with POI have a higher incidence of autoimmune antibodies, and positive thyroid antibodies make them more likely to develop POI.

Decreased anti-Müllerian hormone (AMH) levels in women of reproductive age are associated with various autoimmune diseases such as thyroid autoimmunity, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

About research

In an ongoing national registry-based study, researchers investigated whether POI increases the risk of autoimmune disease.

The study included 3,972 women diagnosed with POI (cases) and a reference group of 15,708 age-matched women from the general population (controls). The researchers selected four controls for each POI woman. Researchers identified women with POI from the Finnish Social Insurance Institute (SII) register who were under 40 years of age and were eligible for reimbursement for hormone replacement therapy (HRT) due to POI between 1988 and 2017. Identified. The index date was the date on which HRT was allowed to be redeemed. Medical reimbursement for HRT by POI was performed according to the Standards of Human Reproduction and Embryology (ESHRE).

None of the participants had cancer or had undergone bilateral oophorectomy or gender reassignment. The Hospital Discharge Registry (HDR) identified severe autoimmune diseases treated using International Classification of Diseases (ICD) codes 8, 9, and 10. The study included autoimmune diseases diagnosed and managed in specialty health centers between 1970 and 2017, excluding those primarily treated in primary care settings, such as celiac disease and hypothyroidism. It was included.

Binary logistic regression determined odds ratios (OR) for analysis. Standardized incidence ratio (SIR) indicated the ratio of observed to expected cases of autoimmune disease in women with POI during the 3-year follow-up period. The research team followed participants until December 31, 2017, when they were diagnosed with a severe autoimmune disease or died, whichever came first.

Results and discussion

The median age of participants at the time of POI diagnosis was 36 years. Among women with POI, 223 (5.6%) developed one or more severe autoimmune diseases compared to controls before the redemption date (OR, 2.6) and 503 (13%) developed one or more severe autoimmune diseases after the redemption date. I was diagnosed with an autoimmune disease. Prevalence of certain autoimmune diseases was higher in cases before the redemption date than in controls. These diseases include polyglandular autoimmune disease, Addison's disease, systemic lupus erythematosus, vasculitis, sarcoidosis, rheumatoid arthritis, hyperthyroidism, and inflammatory bowel disease, with OR values ​​of 26, 23, and 6.3, respectively. , 10, 2.3, 2.3, 1.9, 2.2. .

The prevalence of ankylosing spondylitis and type 1 diabetes was not significantly different between POI women and controls. The standardized incidence rate of severe autoimmune disease diagnosis after POI diagnosis was 2.80 for the first 3 years after POI diagnosis. At 12.0 years after POI diagnosis, the SIR gradually decreased to 1.30.

Because severe autoimmune disease and autoimmune-derived POI reflect universal susceptibility, it is realistic to expect that severe autoimmune disease will present either before or after POI diagnosis. Research has shown that the cyclic synthesis of sex hormones by the ovaries plays an important role in regulating immune function, and premature cessation of ovarian activity exposes women to autoimmune diseases like rheumatoid arthritis. It has been suggested that this is possible.

As revealed in this study, the high incidence of severe autoimmune diseases in the first few years after POI diagnosis is due to the activation of the autoimmune system in many people when POI develops. This shows that However, given that autoimmune diseases frequently occur before the diagnosis of premature ovarian insufficiency and the incidence increases in the decades after POI diagnosis, it is unlikely that women with POI will develop autoimmune diseases. The trend appears to be long-term.

conclusion

The study results showed that women who experience early ovarian failure, or who stop having their periods before age 40, are more likely to suffer from serious autoimmune diseases. Before POI diagnosis, the prevalence of severe autoimmune diseases was more than twice that of controls, and in subsequent years, the frequency of severe autoimmune diseases remained two to three times higher.

Future studies should investigate the biological mechanisms underlying the association between POI and autoimmune diseases. Identifying the molecular pathways linking POI and autoimmune diseases may aid in the development of preventive therapies for autoimmune-derived POI and other autoimmune diseases. Further investigation is needed to determine whether long-term hormone replacement therapy can prevent further disease development in women with POI.