Premature Ovarian Insufficiency (POI)

What is premature ovarian insufficiency (POI)?

POI is also known as premature ovarian failure or premature menopause.

Menopause (where you stop having periods and being fertile) usually occurs around the age of 50 for most women. POI is a condition where this happens when you are 40 years and below – this happens in 1 in 100 women.

Why does POI happen?

There isn’t an exact cause for most women, but some causes can include:

• Surgical removal of ovaries 
• Cancer treatment e.g. chemo- and radiotherapy 
• Autoimmune disease: where your immune system turns on itself e.g. thyroid disease
• Genetic conditions e.g. Turner’s syndrome (where one of the female sex chromosome is missing)
• Family history: some women have a family history of POI

What are the symptoms of premature ovarian insufficiency?

Most women either experience irregular periods or no periods at all. They may also experience symptoms related to menopause, such as hot flushes, mood changes, fatigue, low libido, insomnia, joint pains etc. Some women are not diagnosed until they present for infertility.

What tests do I need to diagnose POI?

You will need a blood test to measure your hormone levels – in particular, follicle stimulating hormone (FSH) and estradiol. In cases of POI, FSH will be high and estradiol low. Your blood tests will need to be repeated at least 4 weeks apart for confirmation.

Depending on your age, genetic tests and bone mineral density test may be advised. 

You will likely experience difficulty getting pregnant. Due to low estrogen levels, you are also more likely to develop heart disease, osteoporosis, painful sex from vaginal atrophy and depression. 

What is the treatment for POI?

Unfortunately, POI cannot be reversed. You will be advised to go on hormone replacement therapy (HRT) and continue this until the natural age of menopause i.e. 50 years old. This is to protect you against the risks described above. The risks of HRT e.g. increased risk of breast cancer, stroke etc., are related to women taking HRT after menopause and does not apply to you as you have POI. You should also maintain a healthy lifestyle with your diet and exercise.

There are many forms of HRT, and you may need to try several forms to find the one suitable for you. HRT does not act as birth control and you can still get pregnant from the occasional ovulation – so do use birth control if you are not intending to conceive. 

If you are trying for pregnancy, however, you may need to consider donor eggs as the chances of you conceiving with your own eggs through in-vitro fertilisation is low – do speak to your fertility specialist for further advice.