Premature ovarian insufficiency (POI) is a condition that affects ovarian function before the age of 40, with implications for your fertility and long-term health.
While POI can make conception more difficult, support and treatment options are available. Understanding the condition and receiving appropriate care can help you make informed decisions about your reproductive health and family-building options.
Premature ovarian insufficiency, sometimes called primary ovarian insufficiency, occurs when the ovaries stop functioning normally before the age of 40, and affects up to 4% of women around the world.
The ovaries are responsible for storing eggs and producing important reproductive hormones, including oestrogen. In women with POI, ovarian function declines earlier than expected so the window where it is possible to conceive is smaller. Individuals with POI have hormonal changes which can lead to lower oestrogen levels, irregular ovulation, and reduced fertility. The drop in oestrogen may also increase the risk of long-term health conditions, such as heart disease, dementia, reduced muscle strength, and osteoporosis.
These reproductive and hormonal effects are similar to what is seen during normal menopause, however, in POI, ovarian function may fluctuate. This does mean that it is still possible to conceive naturally despite a POI diagnosis.
Symptoms of POI are often related to reduced oestrogen levels and changes in ovarian function. Common symptoms may include:
Some women first become aware of POI when investigating fertility concerns, while others seek medical advice because of noticeable changes to the regularity of their menstrual cycles.
As irregular or missing menstrual periods are symptoms shared with several other conditions, Dr Anna’s assessment will involve confirming that your menstrual disturbances are not caused by something else.
A diagnosis of POI can be made if:
During your consultation, Dr Anna will discuss your medical history, including your recent menstrual patterns, symptoms that may indicate POI, whether your family history includes relatives with POI, and your general health. As pregnancy can cause missed periods, you will have a pregnancy test to exclude this possibility.
In addition to a blood test for FSH, you may undergo some additional investigations to understand the cause of the premature ovarian insufficiency. This may include:
Confirming the underlying cause of POI is not necessary to make a diagnosis, but can be beneficial for excluding other causes of abnormal periods, and also for understanding your own body. For women where testing reveals a genetic cause of POI, this information can be used to counsel your daughters and other female relatives, who may be at an increased risk of POI themselves.
Currently there is no cure for POI or treatment to restore ovarian function. Treatment for POI focuses on managing your symptoms, restoring quality of life, protecting long-term health, and supporting your fertility goals.
Treatments such as hormone replacement therapy (HRT) and the combined oral contraceptive pill can manage symptoms caused by low oestrogen, such as hot flushes and night sweats. This treatment also helps to reduce the long-term risks of heart disease, dementia, and osteoporosis. Each type of hormone therapy for POI has its own advantages and disadvantages. Finding the right one for you will be based on shared decision-making, considering your personal preferences, symptoms, and fertility goals.
Supporting your psychological wellbeing is important – a diagnosis of POI can have a significant impact on your sexual wellbeing and function, so access to psychological therapy may be appropriate. Vaginal dryness causing discomfort or painful intercourse may be managed with vaginal oestrogen creams or pessaries, moisturisers, or lubricants. Non-hormonal topical treatments can be used alongside hormone therapies or a standalone treatment for specific symptom relief.
A diagnosis of POI can be extremely distressing, especially if you are still planning to grow your family. As hormone levels and ovarian function can still rise within normal range intermittently despite POI, there is potential to fall pregnant naturally if you have not had both ovaries surgically removed. However, immediately after a diagnosis has been made is the optimal time to discuss your options for fertility preservation to safeguard your future reproductive potential.
For women with immediate plans to have children but are having difficulty falling pregnant, in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) with donor eggs may help.
Donor eggs may be accessed through an egg donor program or provided by a family member, friend, or someone else within your social network. These eggs are fertilised with your partner’s sperm (if conceiving as a couple) in a laboratory, either by combining the eggs and sperm in a dish as in IVF, or injecting a single sperm into each egg as in ICSI. The fertilised egg is developed in an incubator for 5-6 days, then the embryo transferred to your uterus for pregnancy.
