Primary ovarian insufficiency (POI) is a condition that causes your ovaries to stop working as well as they should before age 40.
As a result, your body doesn’t produce a normal amount of the hormone estrogen, causing your periods to become irregular or stop. People with POI often have a hard time becoming pregnant.
In this article, we’ll define POI and explain its symptoms, treatment, and more.
POI is sometimes also called premature ovarian failure, although this term is falling out of favor.
It happens when your ovaries no longer produce the typical amount of estrogen. Your periods may become harder to predict or stop altogether. Your body also may not release eggs regularly, which can lead to infertility or difficulty becoming pregnant.
If you have POI, you may still have some periods and you can still become pregnant with your own eggs. In fact, 5 to 10 percent of women with POI become pregnant naturally.
The symptoms of POI are similar to the those you’d expect with menopause or perimenopause. They include:
- irregular periods
- difficulty getting pregnant
- hot flashes
- night sweats
- difficulty staying focused
- lower sex drive
- vaginal dryness
- dry eyes
- painful intercourse
Fertility problems are common with POI. That’s because the disorder can drastically reduce your body’s ability to produce and release eggs.
Low levels of reproductive hormones mean that many of your follicles — the structures in your reproductive system that mature into eggs — won’t get the signal to start egg production, or won’t respond normally to that signal.
Egg production may not stop altogether, though. Around
These symptoms can be caused by a number of conditions, so a healthcare professional will want to rule out more common causes before diagnosing you with POI. Here’s what to expect during your diagnostic appointment:
- The healthcare professional, often a gynecologist, will probably ask you questions about your menstrual cycle, your exposure to environmental toxins, medications and supplements you take, any surgeries you’ve had, and your family’s medical history.
- You may undergo tests that check your hormone levels, especially follicle stimulating hormone (FSH), which is the hormone that causes your follicles to develop and release an egg, and prolactin, the hormone that causes you to produce milk. Anti-Müllerian hormone (AMH) levels may be checked as well to assess your egg count. Understanding the hormonal activity in your body can help your doctor rule out other conditions.
- You may also need genetic tests, especially karyotype test and tests for the FMR1 genetic difference. These tests help identify genetic conditions that can lead to POI.
- The doctor may also test your bone density. Since estrogen reduction can cause your bones to weaken, they may want to look for signs of osteoporosis.
- An ultrasound may be performed to count your antral (ovarian) follicles, which contain your immature egg cells.
Tips for your medical appointment
If you’ve missed three or more periods, it’s a good time to visit a gynecologist, even if fertility isn’t on your mind right now. Missed periods can be caused by a number of conditions, and some of them are serious medical issues.
Before your visit, make a list of the symptoms you’re experiencing — even the ones that may not be related to POI. You also may want to jot down a few questions for the doctor. Here are a few to consider:
- If POI isn’t the cause of my symptoms, what could be causing them?
- Should I change my birth control method?
- Do I even need birth control if I have POI?
- Are there treatments I can use to help me sleep better?
- What can I do about night sweats and hot flashes?
- Do I need to take calcium supplements?
- What can I do about the depression I’m feeling?
- Why am I so anxious?
- Do I want to be come pregnant in the future?
- What fertility methods should I consider?
- How do I explain this condition to my family and friends?
Your gynecologist may not be able to determine exactly what’s caused your ovaries to stop working properly.
- Genetic differences. Around
28 percentof the time, POI is caused by variations in your chromosomes. People with Turner syndrome (one normal X chromosome and one X chromosome that’s different) and Fragile X syndrome (delicate, breakable X chromosomes) have a greater chance of developing POI.
- Exposure to toxins. You’re most likely to develop POI if you’ve been exposed to:
- radiation therapy
- cigarette smoke
- certain chemicals, like pesticides
- certain viruses
- Autoimmune disorders. In some cases, your body treats your ovaries like it would an invader or an infection — by attacking them. In the process, your ovaries, eggs, and follicles can become damaged.
People between ages 35 and 40 are at a higher risk of developing POI than younger people, but the condition does sometimes occur at younger ages. People who’ve had ovarian surgery or cancer treatments are also at a higher risk of POI, as are those with a family history of POI.
A diagnosis of POI can be really hard to process. If you’ve just been told you have this condition, you may be dealing with a whirlwind of emotion — sadness, anger, anxiety, dread — or you may be experiencing a sense of numbness that often follows difficult health news.
Although this is a difficult diagnosis, there is some good news: Treatments can help raise your hormone levels to relieve some of your symptoms, and if you want to become pregnant, there are treatment options available to help you, like hormone replacement therapy (HRT) and counseling.
Treatments may vary on a case-by-case basis, taking into account the severity of your symptoms and how many eggs you may have left.
Whether you want to become pregnant right now or not, your gynecologist may recommend treatment with estrogen, or estrogen and progesterone together, if you still have your uterus. Replacing these hormones can relieve some of your symptoms, including:
- hot flashes
- night sweats
- period issues
Although there are some risks associated with HRT, the potential benefits generally outweigh the risks for younger women. HRT can help to prevent bone loss and cardiovascular problems in younger people as well.
Therapy or counseling
It’s completely normal to notice emotional swings with POI. It’s not uncommon for people to experience depression and anxiety, especially if you were planning to become pregnant at some point.
Even without fertility complications, the symptoms of POI closely mimic menopause symptoms, including depression and anxiety. It may be helpful to share your experiences either with a therapist or a group of others with similar diagnoses.
Tips for coping with primary ovarian insufficiency
- A POI diagnosis may leave you feeling isolated, but the reality is that you aren’t alone. Finding a support group may help you work through some of the hard parts.
- A patient assistance organization can help you deal with some of the practical difficulties, like insurance coverage, that this disorder can pose.
- If you smoke, this is a really good time to quit. Admittedly, you have a lot on your plate if you’re coping with a POI diagnosis. But smoking can cause some
serious health complicationsfor people with low estrogen. You may want to talk with a healthcare professional about ways to quit.
- Because low estrogen can affect your bone and heart health, building an exercise habit will be especially important for you going forward.
It’s important to be aware that POI can cause some complications down the line. You may want to talk with a healthcare professional about these possible outcomes:
- Endocrine disorders. Around 20 percent of people with POI also have hypothyroidism, so you may want to be tested for thyroid disease every year or so. A potentially life-threatening adrenal condition called Addison’s disease has also been associated with POI.
- Osteoporosis. If your body isn’t producing enough estrogen, your bones can become weaker and more brittle. This condition, called osteoporosis, can make you vulnerable to bone breaks and fractures.
- Cardiovascular disease. Low levels of estrogen are also linked to a higher risk of heart disease and stroke.
- Other associated conditions. When an autoimmune disorder has caused POI, you may be at greater risk for the following conditions:
POI is a condition that changes your body’s ability to produce estrogen, which leads to irregular periods, lower egg production, and fertility difficulties.
This condition is most often caused by genetic differences, autoimmune conditions, or exposure to toxins, like chemotherapy and radiation for cancer treatment.
The menopause-like symptoms of POI can be treated with HRT, but replacing estrogen and progesterone won’t necessarily resolve fertility issues.
If you have POI, you may need to talk with your gynecologist or an infertility specialist about in vitro fertilization (IVF) or other ways to conceive, like with donor eggs.
If you’ve been diagnosed with POI, you’ll need to take good care of your overall health, as a number of other conditions — some of them serious — can develop alongside this disorder.
You may also experience some emotional upheaval with this diagnosis, so look for sources of support as you decide on a treatment plan and a path forward.