Things to Know About Primary Ovarian Insufficiency

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As women, we hear so much about menopause because it’s something we all will eventually experience. But what about other reproductive conditions that aren’t discussed quite as much, and won’t affect all of us?

One of these conditions is called primary ovarian insufficiency (POI). This article will explain what POI is and what it can mean for women who receive this diagnosis.

What is primary ovarian insufficiency?

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

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

In POI, the ovaries will stop releasing eggs or only release them sometimes. They will also stop producing the hormones mentioned above, or just release them sometimes. The process becomes irregular.

It’s important to differentiate that POI is not early menopause. Women who have POI can still become pregnant and may even have a period (though it can become sporadic). Women with POI can start experiencing symptoms as early as during their teenage years, but a critical factor in POI is that it can only happen to women under 40. Early menopause occurs in women ages 40-44.

What are the symptoms of primary ovarian insufficiency?

POI symptoms can feel similar to those of early menopause, which can make it difficult to recognize.

Some of these symptoms can include:

  • Irritability

  • Reduced libido

  • Night sweats and hot flashes

  • Vaginal dryness and painful intercourse

  • Difficulty concentrating

What causes primary ovarian insufficiency?

Approximately 90% of POI cases have unknown causes. However, research suggests that the onset of POI may have to do with a woman’s follicles, which are 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 primary ovarian insufficiency?

Even though many people are unfamiliar with POI, it’s not exactly a rare condition. It’s estimated that around one percent 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 who has or had it, like your sister or mother. The risk for POI also increases among women between the age of 35-40 years old.

 
 

Can primary ovarian insufficiency have complications?

Having POI can increase your risk of developing other conditions. Some of these include depression and anxiety, heart disease, infertility, low thyroid function, dementia, and osteoporosis. The reason for many of these has to do with having low estrogen levels and early loss of this hormone.

Receiving a POI diagnosis can be difficult emotionally, so it’s important to pay attention to your mental health and seek support as much as needed.

How is primary ovarian insufficiency diagnosed?

If you’re under age 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 women with POI will notice that leads them to request a medical evaluation.

Your healthcare provider will likely conduct a comprehensive exam, including discussing your medical history. Specific tests may be ordered, like a pregnancy test or bloodwork to evaluate your hormone levels (e.g., estrogen and follicle stimulating hormone) and chromosomes. To check and see whether your ovaries are enlarged or have multiple follicles, a pelvic exam may be done. Your healthcare provider should also be made aware if you’re experiencing any hearing loss because some genetic POI cases can lead to deafness.

As a side note, a gynecologist with specialized expertise in reproductive endocrinology is an excellent resource for women experiencing POI.

What are the treatment options?

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

  • Hormone Replacement Therapy (HRT) is sometimes used to increase levels of hormones like estrogen that your ovaries are not producing. It’s often recommended for women with POI who are using HRT to continue it until at least age 50 to 51 for the most benefit in cardiovascular disease and osteoporosis prevention.

  • Calcium and Vitamin D are often prescribed to help maintain bone strength, as women of menopausal age are at an increased risk for osteoporosis and bone fractures. 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 to practice, like physical activity and an overall healthy diet. This can reduce your risk for obesity and related chronic diseases that can increase naturally during perimenopausal and menopausal years.

  • In Vitro Fertilization may be an option if you are experiencing POI during childbearing age and want to become pregnant.

Primary ovarian insufficiency 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.

Join us at Lisa Health to find more support for primary ovarian insufficiency and to start your personalized journey for a smoother menopause transition and lower your risk of secondary conditions. We’re in this together!

Dr. DePree is the Director of Women’s Midlife Services at Holland Hospital in Holland, Michigan, and has practiced as a board-certified gynecologist and women’s health provider for 30 years. She is a certified menopause specialist and in 2013 was named Certified Menopause Practitioner of the Year by the North American Menopause Society for “exceptional contributions” to menopause care. Dr. DePree also founded the groundbreaking website middlesexmd.com, a site focused on educating women about sexual well-being, particularly during the menopause transition, and offering curated products that support vaginal health and sexual wellness.

Related Blog: Allison’s Story of Reversing Primary Ovarian Insufficiency