Association between Autoimmune Conditions and Premature Ovarian Insufficiency: Human Reproduction Study

The researchers say their findings significantly strengthen the hypothesis that autoimmune processes play a “pivotal role” in the onset of premature ovarian insufficiency.

Dr Susanna Savukoski, a gynaecology and obstetrics doctor at Oulu University Hospital and University of Oulu, Finland, led the study. She said: “Estimates of the prevalence of premature ovarian insufficiency of autoimmune origin have ranged from 4% to 50%. Our study has found that autoimmune diseases were two-to-three-fold more common in women diagnosed with premature ovarian insufficiency at the time they were diagnosed, and incidence of these diseases was two-to-three-fold higher during the first years after being diagnosed with premature ovarian insufficiency, compared to a control group of similarly aged women from the general population. The incidence was higher than in the control group even more than a decade after being diagnosed with premature ovarian insufficiency.”

Dr Savukoski and her colleagues analysed health data from Finland’s comprehensive registries. From the medicine reimbursement registry maintained by the Social Insurance Institution of Finland, they identified 3972 women who had been granted the right to full reimbursement for hormone replacement therapy (HRT) because of premature ovarian insufficiency diagnosis under the age of 40 years, between the years 1988 and 2017. Each woman with premature ovarian insufficiency was matched with four women of similar ages, forming a control group of 15708 women. In both groups of women, they analysed data on severe autoimmune conditions – diseases that were diagnosed and treated in specialist health centres – between 1970 and 2017.

They found that among women who were diagnosed with premature ovarian insufficiency, 223 women (5.6%) had been diagnosed with at least one autoimmune disorder before the date when reimbursement for hormone replacement therapy because of premature ovarian insufficiency was granted, and 503 women (12.7%) were diagnosed with at least one autoimmune disorder after the date of hormone replacement therapy during the follow-up period.

Women were 2.6 times more likely to have an autoimmune disorder before a premature ovarian insufficiency diagnosis when compared to the control group. Among women with premature ovarian insufficiency, the risk of autoimmune conditions ranged from nearly double for over-active thyroid glands, to nearly 26 times for polyglandular autoimmune diseases – rare diseases of the endocrine system.

Women without existing autoimmune diseases at the time they were diagnosed with premature ovarian insufficiency were nearly three times as likely to be diagnosed with an autoimmune disease in the following three years, with the risk decreasing but still significantly higher than in the control group during the follow-up period of at least 12 years.

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