Chronic and cumulative adverse life events in patients of premature ovarian insufficiency with unknown cause: an exploratory qualitative study

Abstract Background Premature ovarian insufficiency (POI) has serious physical and psychological consequences due to estrogen deprivation, leading to increased morbidity and mortality. However, the causes of most POI cases remain unknown (idiopathic POI). Environmental factors play an important role in the occurrence of complex diseases. To explore whether chronic and cumulative adverse life events occur in patients before POI diagnosis. Searching for the potential relative risk factors may find an intervention strategy to prevent POI in young women. Results Forty-three women (mean age=33·8 years) were recruited who were newly- diagnosed with idiopathic POI in a Chinese Ob/Gyn hospital to participate in semi-structured interviews through convenience sampling. The main questions covered by the topic guide were designed to explore adverse life events prior to POI diagnosis. Interviews were audio recorded, transcribed and analyzed thematically. Data were analyzed from June 2019 to August 2020. Among the POI patients, the mean age at diagnosis of POI was 33·8 years (range from 19 to 39 years), and the average time between the onset of irregular menstruation and POI diagnosis was 2.3 years. These patients had a relatively normal menstrual cycle before the diagnosis of POI. A number of stressful life events prior to POI diagnosis were discussed by them as important factors influencing their health and well-being. Four core themes emerged: 1) persistent exposure to workplace stress, 2) persistent exposure to family stress, 3) chronic sleep problem/disturbance existed in patients before POI diagnosis, and 4) participants' general cognition and concerns about POI. Conclusions Persistent exposures to adverse life events related to work stress, family stress and sleep disturbance exist in idiopathic POI patients. In addition, patients and their families generally have incorrect cognition of POI disease and its treatment. Future case-control studies should demonstrate whether chronic and cumulative adverse life events are risk factors of POI disease. Provision of tailored interventions (i.e. preventing or mitigating impact of adverse life events) aimed at high-risk populations is urgently needed to prevent new POI cases and promoting understanding of disease may improve health conditions of POI patients.