What is the risk of cardiovascular disease in POI?

• A. Decreased risk
• B. No change in risk
• C. Increased risk due to early estrogen deficiency
• D. Unknown risk

Answer: (C)

Loss of estrogen from premature ovarian insufficiency removes the protective effects estrogen has on the heart and blood vessels. Estrogen helps maintain a favorable lipid profile (higher HDL, lower LDL), supports healthy endothelial function, reduces vascular inflammation, and preserves arterial elasticity. When estrogen drops early, these protective influences are lost sooner, allowing atherosclerotic processes to begin earlier and accumulate over time. That’s why cardiovascular disease risk is increased in POI compared with women who experience menopause later, particularly if estrogen replacement is not used. Hormone therapy in POI can help mitigate this excess risk by reintroducing estrogen’s protective effects, guided by individual risk factors and contraindications.