Premature ovarian insufficiency

Overview

Premature ovarian insufficiency (POI) is when a woman's ovaries stop working normally before she turns 40. It means her body makes less estrogen and she stops having periods or has irregular ones. It is different from early menopause because sometimes the ovaries can still work a little, and pregnancy is still possible, though less likely without medical help.

POI is not very common. It affects about 1% of women under 40, so it is considered a rare condition.

It can affect any woman or person born with ovaries before age 40, but it is more common in those with a family history of POI, certain autoimmune diseases, or after treatments like chemotherapy or radiation.

Symptoms

Common symptoms

• Irregular or missed periods for 4 months or more
• Hot flushes and night sweats
• Vaginal dryness and discomfort during sex
• Trouble sleeping
• Mood changes, low sex drive, or feeling tired
• Trouble getting pregnant (infertility)

Symptoms in children

• Premature ovarian insufficiency does not usually happen in children. If it does, it is often because of genetic conditions or cancer treatments. Symptoms in teens may include never starting periods or very early menopause signs.

Symptoms in older adults

• This condition by definition happens before age 40, so it is not relevant to older adults. After age 40, it is considered early menopause, not POI.

Causes

Main causes

• Autoimmune disease – the body's immune system attacks the ovaries
• Genetic conditions – such as Turner syndrome or Fragile X premutation
• Cancer treatments – chemotherapy or radiation to the pelvis
• Surgery – removal of both ovaries (oophorectomy)
• In many cases, the cause is unknown (idiopathic)

Risk factors

• Family history of POI or early menopause
• Autoimmune conditions like thyroid disease or Addison's disease
• Certain genetic disorders
• Previous chemotherapy or radiotherapy to the pelvic area
• Smoking (may slightly increase risk)
• Being underweight or having an eating disorder (can affect hormone balance)

When to see a doctor

See a doctor urgently if:

• If you are under 40 and have not had a period for 4 months or more – make an appointment to see your GP or gynaecologist within a few weeks
• If you are trying to get pregnant and have irregular periods – see a fertility specialist soon

Book a routine appointment if:

• If you have mild symptoms like hot flushes or mood changes and you are under 40
• If you have a family history of POI and want to discuss checking your ovarian function

Diagnosis

Doctors diagnose POI based on your symptoms, blood tests, and sometimes an ultrasound. They look for high levels of follicle-stimulating hormone (FSH) and low estrogen.

Tests that may be done

• Blood test for FSH (follicle-stimulating hormone) – high levels mean the ovaries are not working well
• Blood test for estradiol (a type of estrogen) – low levels confirm POI
• Anti-Müllerian hormone (AMH) test – very low levels suggest low egg supply
• Genetic testing – to check for Fragile X or Turner syndrome
• Ultrasound scan of the ovaries – to see their size and number of follicles

What to expect at your appointment

Your doctor will ask about your periods, symptoms, and any treatments you’ve had. You may need to have blood tests and an ultrasound. The diagnosis can be emotional, so take someone you trust with you. Your doctor will explain the results and discuss next steps.

Treatment

Treatment focuses on replacing the hormones your ovaries no longer make enough of. This helps with symptoms and protects your bone and heart health. For fertility, options like donor eggs or IVF with your own eggs (if still viable) can be discussed with a specialist.

Self-care at home

• Keep a healthy weight – being underweight or overweight can affect hormone balance
• Exercise regularly – weight-bearing activities like walking or lifting weights help keep bones strong
• Eat a balanced diet rich in calcium and vitamin D (from dairy, leafy greens, and sunlight)
• Avoid smoking and limit alcohol
• Manage stress with relaxation techniques like yoga, meditation, or talking to a counsellor

Medical treatments

Hormone therapy (also called menopausal hormone therapy) is the main treatment. It replaces estrogen and sometimes progesterone. Your doctor will prescribe a type and dose that suits you. For women who cannot take hormones, non-hormonal options like antidepressants or gabapentin can help with hot flushes. Always discuss the risks and benefits with your healthcare provider.

When is surgery considered?

Surgery is not a treatment for POI itself. If you had both ovaries removed, that causes POI and you will need hormone therapy. Otherwise, surgery is not recommended for this condition.

Living with this condition

Living with POI means managing symptoms and staying on top of your health. You may need to take daily hormone medication. Regular check-ups with your doctor are important to monitor bone density, cholesterol, and blood pressure. If you want children, talk to a fertility specialist early.

Lifestyle tips

• Take your hormone therapy as prescribed – do not stop without talking to your doctor
• Get regular bone density scans (DEXA scan) every 1–2 years if advised
• Have a heart-healthy lifestyle – check blood pressure and cholesterol regularly
• Use lubricants or moisturisers for vaginal dryness
• Talk to your partner or a counsellor about changes in sex drive or mood

Diet and exercise

Eat plenty of calcium-rich foods (milk, yogurt, cheese, fortified plant milks, leafy greens) and get enough vitamin D (sunlight, supplements if needed). Do weight-bearing exercise like walking, jogging, or dancing for 30 minutes most days. Also include strength training twice a week.

Mental health and emotional wellbeing

POI can be emotionally tough – the loss of fertility, body changes, and hormone fluctuations can lead to anxiety or depression. It is normal to feel grief, anger, or sadness. If you have thoughts of harming yourself or feel overwhelmed, please reach out for crisis support – call your local emergency number or a helpline. Talk to a therapist who understands fertility issues.

Prevention

In most cases, POI cannot be prevented, especially if it is due to genetics or autoimmune problems. If you are about to have cancer treatment that may damage your ovaries, you can discuss options like egg freezing or ovarian tissue preservation with your oncology team before treatment starts.

Screening programmes

There is no routine screening for POI in the general population. If you have a family history, you can ask your doctor for a blood test (FSH, AMH) to check your ovarian function before you have symptoms.

Complications

If left untreated

• Weakened bones (osteoporosis) from low estrogen
• Higher risk of heart disease and stroke
• Increased risk of cognitive changes like memory problems
• Ongoing symptoms like hot flushes and vaginal dryness
• Mental health problems such as depression and anxiety

Long-term outlook

With proper treatment, most women with POI lead healthy, active lives. Hormone therapy can reduce symptoms and protect your bones and heart. Fertility options exist, such as donor eggs or egg freezing if you still have eggs. Talk to your doctor about a plan that works for you.

Find support

International organisations

• International Premature Ovarian Insufficiency Association
• Daisy Network (UK-based, offers support for POI)

Local organisations

• Look for local support groups through your country's menopause society or fertility charity · Various

Helplines

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