Primary ovarian insufficiency (POI) goes by lots of names. You might have heard of it referred to as premature ovarian insufficiency or premature ovarian failure. These all mean the same thing – when the ovaries stop working normally before the age of 40. Getting a primary ovarian insufficiency diagnosis can be worrying at first, but that doesn’t mean you don’t have options,  and luckily,  we’re here to  guide you through them.

What is primary ovarian insufficiency?

Let’s start with the basics. In short, POI is a failure of the ovaries to function properly. For you to receive a POI diagnosis, your hormones will have been tested and found to be irregular for two consecutive months. High FSH and low oestrogen levels, also seen at the onset of menopause, are indicators of POI. This is accompanied with amenorrhea, meaning loss of your period, for 3 or more months. If POI is suspected, you might also be sent for a internal ultrasound to check your antral follicle count. Antral follicles are small fluid filled sacs containing immature eggs. Your antral follicle count is an indicator of the number of eggs you have left in your ovaries, also known as your ‘ovarian reserve’. It’s important to remember, POI doesn’t always mean your reserve is depleted, rather there’s a failure to mature eggs and to ovulate every month.

Primary ovarian insufficiency vs premature menopause

POI is often confused with premature menopause.

Once you’ve reached menopause, you will have depleted your ovarian reserve and you will no longer experience menstrual periods. You will also no longer be able to conceive without the help of donor eggs. The menopausal transition begins a few years before your final menstrual period but the menopause is marked by this event. The average age of menopause is 51 with the majority of women experiencing their final menstrual period between 45 and 55. Women with early menopause experience this before the age of 45 and premature menopause is experiencing your final menstrual period before the age of 40 (1).

Primary ovarian insufficiency shares many of the symptoms of premature menopause but it doesn’t always mean a complete depletion of ovarian reserve. POI is a failure of the ovaries to function properly. Many still experience intermittent periods and although fertility is significantly reduced in people with primary ovarian insufficiency, some women do conceive spontaneously after their diagnosis.

What causes POI?

Roughly 1 in 100 people will experience primary ovarian insufficiency but despite its prevalence, the cause for many people is still unknown (2). However, there are a few risk factors known to lead to POI.

You might be more at risk of developing POI if you have a family history of it. POI can also be induced by ovarian surgery, chemotherapy or radiotherapy. Environmental toxins like cigarettes can also be a factor (3). Cigarettes can negatively affect your overall health and fertility in many ways so if you are a smoker you should consider quitting. Ask your GP or visit the NHS website for more information on relevant services.

It is possible for primary ovarian insufficiency  to happen spontaneously. Genetic disorders such as Turner’s syndrome or fragile X syndrome make people more susceptible to POI. Severe cases of the mumps, tuberculosis, or malaria are also linked to POI (3,4).

What are the symptoms of primary ovarian insufficiency?

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

– Irregular periods

– Hot flushes

– Night sweats 

– Difficulty getting pregnant

Reduced sex drive and vaginal dryness are also common.  

Other than menopausal symptoms, there are some autoimmune conditions that may indicate POI. Loss of skin pigmentation caused by vitiligo or hyperpigmentation can accompany POI as can hair loss caused by alopecia. Fatigue, and anxiety or depression are also common symptoms for you to be aware of (3).

The most common indicator is changes to your menstrual cycle, particularly missed periods. Many people will experience irregular menstrual periods in their 40s as they move through the menopausal transition. If you’re experiencing primary ovarian insufficiency, it’s common to experience reduced fertility and other symptoms before the age of 40. POI can affect people of all ages with some girls affected as early as their teens (4). If you’re missing your period for three or more months, we recommend checking in and taking a Hertility test and booking in with one of our experts. 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 check the cause of the change and rule out POI or something more serious.

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 estrogen seen in POI is known to lead to lower bone density, increased risk of bone fractures, and osteoporosis. There is also evidence that lower estrogen levels earlier in life can increase the risk of developing Alzheimer’s disease or dementia (3,4).

If you have received a primary ovarian insufficiency diagnosis, your doctor will recommend hormone therapy to you. Hormone therapy won’t just help alleviate your symptoms, it will also reduce the risk of developing the associated co-morbidities mentioned above.

What does primary ovarian insuffiency mean for my fertility?

POI comes with a compromised fertility and for many it can be a very stressful diagnosis, particularly if you haven’t started or you wish to grow your family. Although POI means your ovaries aren’t functioning at 100%, as many as 25% of people with POI do spontaneously ovulate and as many as 10% conceive and deliver after their diagnosis (5).

If you are looking to get pregnant, IVF can help. You can learn more about IVF treatment and what to expect here, but remember, IVF isn’t a guaranteed pregnancy.

If you have gone down the IVF route but you’re not happy with your response to ovarian stimulation, another option is egg donation. 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 diagnosis.

What next?

Do these symptoms sound familiar? If you’re worried you have POI, why not start with a Hertility at-home test? We don’t believe in giving you the results without the rest. Our team of experts include fertility specialists and counsellors who can create an actionable plan for your fertility future, and guide you through your journey.

(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/