Things to Know About Primary Ovarian Insufficiency

What Is Primary Ovarian Insufficiency?

POI is a condition in which a woman’s ovaries stop functioning normally before she turns 40. It doesn’t necessarily mean that the ovaries shut down, it just means that they aren’t working as well.

Ovaries have two main jobs in reproduction. They produce eggs (called oocytes) and hormones, specifically estrogen, progesterone, and testosterone.

In the case of POI, the process of egg release and hormone production stops or becomes irregular.

It’s important to clarify that POI is not early menopause. Women who have POI can still become pregnant and may even have a period (though it can be sporadic). Symptoms of POI can begin as early as someone’s teenage years, but POI by definition only occurs in women under 40. Early menopause occurs when the menstrual cycle stops between age 40-44.

Symptoms of POI

POI symptoms can feel similar to those of early menopause. They include:

• Irritability
• Reduced libido
• Night sweats and hot flashes
• Vaginal dryness and painful intercourse
• Difficulty concentrating

What Causes Primary Ovarian Insufficiency?

The cause of about 90% of POI cases is unknown. However, research suggests that the onset of POI may have to do with a woman’s follicles, the sacs in the ovaries where the eggs grow. Specifically, POI can occur if too many of these follicles stop working normally or they run out altogether.

Other potential causes of POI include:

• Metabolic disorders
• Genetic disorders (e.g., Turner syndrome, Fragile X syndrome)
• Autoimmune disorders (e.g., Addison disease, thyroiditis)
• Cancer treatments like chemotherapy and radiation therapy
• Environmental toxins (e.g., cigarette smoke, pesticides)
• Having a low number of follicles to begin with
• Eating disorders
• Infections that damage the ovaries (e.g., mumps)

Who Is at Risk for POI?

Even though many people are unfamiliar with POI, it’s not exactly a rare condition. It’s estimated that around 1% of teenage girls and women in the United States have POI and that one in 100 women will experience POI by the time they turn 40. If you know that you have one of the disorders or conditions listed above, you may be at higher risk for POI.

Another factor that can increase your POI risk is if you have a close female relative, like your mother or sister, who experienced POI. The risk for POI also increases among women between the age of 35-40 years old.

Implications of POI

Having POI can increase your risk of developing other conditions, including depression and anxiety, heart disease, infertility, low thyroid function, dementia, and osteoporosis. All of these conditions are related to an early loss of estrogen levels.

Tell your healthcare provider if you’re experiencing hearing loss, as some genetic causes of POI can lead to deafness.

How Is POI Diagnosed?

If you’re under the age of 40 and haven’t had your period in over three months, it’s a good idea to be evaluated by your healthcare provider. Difficulty becoming pregnant is sometimes the first sign of POI leads someone to get a medical evaluation.

While you should start by visiting a primary care or women’s health provider, a gynecologist with specialized expertise in reproductive endocrinology is an excellent resource for women experiencing POI.

Your healthcare provider may order specific tests, like a pregnancy test or bloodwork to evaluate your hormone levels (e.g., estrogen and follicle-stimulating hormone) and chromosomes. A pelvic exam can check for enlarged ovaries.

POI Treatment Options

Although there is no treatment to correct POI and restore the function of your ovaries, several therapies can reduce POI symptoms and prevent secondary conditions from forming:

• In vitro fertilization (IVF) may be an option if you are experiencing POI during childbearing age and want to become pregnant.
• Menopausal Hormone Therapy (MHT) is sometimes used to increase levels of hormones like estrogen that the ovaries are not producing. It’s often recommended for women with POI who are using hormone therapy to continue it until at least age 50 to 51 for the most benefit in cardiovascular disease and osteoporosis prevention.
• Calcium and Vitamin D supplements are often prescribed to help maintain bone strength. These nutrients can also be found in certain foods, like dairy products, fortified plant milks, dark green leafy vegetables, and oranges.
• Healthy lifestyle habits are essential for everyone, but especially for people with POI. Physical activity and a healthy diet will reduce your risk for obesity and related chronic diseases that can increase naturally during perimenopausal and menopausal years.

POI is sometimes inaccurately lumped together with early menopause, but POI is an entirely different condition. That means it requires altogether different support. If you or someone you know has POI, know that you’re not alone and that there are many resources available to help you through.