Premature Ovarian Insufficiency (POI) is when the ovaries stop working normally before the age of 40. Getting a diagnosis can be worrying at first, but there are options available. Let’s take a look at what you need to know about POI including symptoms and treatments. 

Quick facts:

• POI is when the ovaries stop functioning properly before the age of 40.
• Symptoms can include irregular or absent periods and menopausal symptoms. 
• The causes are often unknown but there are factors which increase your risk.
• POI can significantly reduce your fertility.
• It’s important to get tested if you think you may have any symptoms.

What is Premature Ovarian Insufficiency?

In short, Premature Ovarian Insufficiency (POI) is when the ovaries stop functioning properly before the age of 40. It can significantly reduce your fertility. 

This doesn’t always mean that you don’t have any eggs left in your ovaries or that you couldn’t carry a baby. It means your body is failing to mature eggs or to ovulate each month.
You may have heard of Premature Ovarian Insufficiency (POI) being referred to as premature ovarian failure. It is also referred to as Primary Ovarian Insufficiency, gonadal dysgenesis, and hypergonadotropic hypogonadism.

Premature Menopause

Premature Menopause is when someone before the age of 40 experiences menopause. This means they will not have any more periods and are permanently no longer able to become pregnant. 

This is different to POI, where although fertility becomes significantly reduced, there is a chance of spontaneous ovulation, and hence a period might still occur. Some people are still able to conceive spontaneously after their diagnosis.

However, POI and Premature Menopause do share many of the same symptoms.

What are the symptoms of POI ?

POI symptoms are similar to menopause and low oestrogen. You’re likely to experience:

• Irregular periods
• Hot flushes
• Night sweats 
• Difficulty getting pregnant
• Reduced sex drive 
• Vaginal dryness

Other than menopausal symptoms, loss of skin pigmentation caused by vitiligo or hyperpigmentation can accompany POI. As can hair loss caused by alopecia. 

Fatigue, anxiety, and depression can also be common symptoms as a result of other symptoms or a diagnosis (3).

If you’re missing your period for three or more months, it’s important to get your hormones tested to try and decipher what’s going on. 

You can miss your periods for a number of reasons, including increased stress, changes to your diet or exercise routine. Some people might even like the idea of not getting a period every month, but sudden changes should always be investigated to check the cause of the change and rule out POI or something more serious.

What causes POI ?

Roughly 1 in 100 people will experience POI and it can affect people up to the age of 40, with some affected as early as their teens (4). But despite its prevalence, the causes, like for many female-reproductive health conditions, are still relatively unknown (2). 

POI can happen spontaneously. However, there are a few known risk factors that may increase your risk of developing POI. These include:

• A family history of POI 
• Ovarian surgery
• Chemotherapy or radiotherapy 
• Environmental toxins like cigarettes (3)
• Genetic disorders like Turner’s or Fragile X syndrome
• Some autoimmune conditions like Hashimoto’s
• Severe cases of mumps, tuberculosis or malaria (3,4).

How is POI diagnosed?

To receive a POI diagnosis, you’ll need to get a hormone test. High FSH (greater than 25) and low oestrogen levels, also seen at the onset of menopause, are indicators of POI. This is accompanied by absent, unpredictable or irregular periods for at least two consecutive months. 

If POI is suspected, you might also be sent for an internal ultrasound to check your antral follicle count (AFC). Antral follicles are small fluid-filled sacs in your ovaries containing immature eggs. An AFC count is an indicator of the number of eggs you have left in your ovaries, also known as your ovarian reserve.

What does POI mean for my overall health?

POI can increase the risk of other illnesses or health problems if left untreated. People with untreated POI have an increased risk of developing heart disease and stroke. 

Also, because oestrogen plays such an important role in bone health, low oestrogen seen in POI is known to lead to lower bone density, increased risk of bone fractures, and osteoporosis. 

There is also evidence that lower oestrogen levels earlier in life can increase the risk of developing Alzheimer’s disease or dementia (3,4).

If you have received a POI diagnosis, your doctor will likely recommend hormone therapy to you. This could be in the form of HRT or taking some form of hormonal contraception. 

Hormone therapy can help to alleviate symptoms and reduce the risk of developing the associated conditions mentioned above.

Does POI affect fertility?

Often, yes, POI can reduce your fertility significantly. This can mean getting a diagnosis can be stressful and upsetting, particularly if you want to start or grow your family. 

Although POI means your ovaries aren’t functioning properly, as many as 25% of people with POI do spontaneously ovulate. Another 10% do conceive and deliver after their diagnosis (5).

If you are looking to get pregnant, there are treatment options available if you have POI—including In Vitro Fertilisation (IVF). 

Egg donation is also an option for some people. POI is a condition that affects the ovaries, not the uterus. This means egg implantation and your ability to carry a pregnancy are not greatly affected by a POI.

Think you might be experiencing POI symptoms?

If you suspect POI symptoms, like irregular or absent periods, it’s important to get checked. Our at-home Hormone and Fertility Test can give you a better insight into your hormones and any symptoms you might be experiencing. 

Our team of experts will help you understand whether your symptoms are related to POI or other underlying health conditions. We can also support you with follow-up fertility treatments and fast-track you to specialists for tailored care plans.

References:

1. https://www.nhs.uk/conditions/menopause/
2. https://www.nhs.uk/conditions/menopause/#:~:text=Sometimes%20they%20can%20stop%20suddenly,before%2040%20years%20of%20age.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710309/
4. https://patient.info/womens-health/menopause/premature-ovarian-insufficiency
5. https://pubmed.ncbi.nlm.nih.gov/19461434/