⏱ 3 Min Read

Premature ovarian insufficiency: what it means for your health and fertility

Written by
Eleni Stefanou

Medically reviewed by
Dr Dupe Burgess, BSc, MBBS, MRCP

Updated on
5 Feb 2024

Primary ovarian insufficiency (POI) is when the ovaries stop functioning properly before the age of 40. It used to be called premature ovarian failure, but this term fell out of favour because some women with POI may still get periods. Early menopause is considered different and is when a woman stops having periods between the ages of 40 and 45.

It’s very rare. About 1% of women under the age of 40 and 0.1% of women under the age of 30 develop primary ovarian insufficiency. (1)

What are the symptoms of POI?

Someone with premature ovarian insufficiency may experience one or more of these issues:

  • Irregular or no periods

  • Difficulty conceiving

  • Hot flushes

  • Night sweats

  • Difficulty sleeping

  • Memory and concentration problems

  • Headaches

  • Vaginal dryness

  • Reduced sex drive

  • Frequent urinary tract infections

  • Stiffness in your joints

  • Heart palpitations

  • Anxiety or low mood

After ruling out other conditions that may be causing your symptoms, a doctor will look for the following criteria to diagnose primary ovarian insufficiency (2):

  • No periods for 4-6 months

  • Raised follicle-stimulating hormone (FSH)

  • Lower levels of oestradiol (one of the main types of oestrogen hormone)

PCOS

Polycystic ovary syndrome is a common hormone disorder that shares a similar symptom profile with premature ovarian insufficiency. Irregular periods and infertility are hallmarks of both conditions, which can lead to a misdiagnosis.

Poor mental health (eg anxiety, depression)

While it’s true that stress can wreak havoc on our hormones and disrupt our menstrual cycle, some doctors can be quick to conclude that a woman’s symptoms are brought on by poor mental health. (3) What complicates things even more is that mood swings, anxiety, irritability, and depression are symptoms of many gynaecological conditions. Speaking to a gynae-informed doctor who understands reproductive hormones will help you go through a thorough investigation.

A note on contraception

Hormone tests are an important part of uncovering both POI and PCOS. To get accurate results, you will need to come off birth control for three months before doing blood tests. Contraception can also mask symptoms such as irregular periods, which can further delay the diagnosis of POI.

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A POI diagnosis can be devastating because of what it means for fertility.

While rare, it is still possible to get pregnant with POI, which is why it’s important to distinguish the condition from menopause. 50% of women with POI experience infrequent ovulation and menstrual cycles after being diagnosed, while 5–10% of these women may achieve spontaneous pregnancies. (4) There have also been some cases (1) where hormone replacement therapy (HRT) has helped women with POI conceive naturally. This won’t work for everyone and some contraindications may mean HRT isn’t appropriate for you. A fertility expert can you help navigate this complex territory.

IVF is another option you can explore, just keep in mind that this path can come with its own challenges, including costs, and emotional ups and downs.

Primary ovarian insufficiency is a life-changing condition that needs long-term monitoring. Women with POI are deficient in oestrogen, which increases their risk of developing health issues later in life. (4) These complications include osteoporosis (a bone disease that can increase the risk of broken bones) and cardiovascular disease.

Hormone replacement therapy can offer women relief from the symptoms of POI and can offset some of the longer-term health conditions we mentioned above. There are also symptom-specific treatments you can explore depending on the symptoms you experience and their severity. For example, vaginal dryness can be treated with a low dose of vaginal oestrogen, which has also been shown to reduce UTIs by 50% (UTIs are a common symptom of low oestrogen). (5)

POI is a complex condition with relatively low awareness in the medical world. That’s why it’s important to speak to a healthcare professional who can identify the signs and offer a personalised care plan. Depending on your symptoms, this may mean speaking to multiple specialists, including:

  • Gynaecologist (for diagnosis and general symptom treatment)

  • Menopause specialist (for diagnosis and general symptom treatment)

  • Fertility specialist (for help with conceiving)

  • Urologist (for UTIs, vaginal dryness and other related symptoms)

1. Seek input from an expert

There are many factors that can get in the way of an early POI diagnosis. Make sure you address these with your healthcare provider and, if possible, speak to someone who understands hormones and their relationship with gynaecological conditions.

2. Natural pregnancies are difficult, but not impossible

Getting pregnant can be challenging and you may need a specialist to help you assess your options. The earlier you can seek support the better.

3. POI extends beyond fertility

Primary ovarian insufficiency should never be dismissed as early menopause and needs to be monitored and managed to lower your risk of related health conditions.

4. Emotional support matters

POI symptoms can have a huge impact on your physical and mental health and can leave you feeling isolated and depleted. It’s important to reach out to others who know what it’s like and can offer you guidance. The Daisy Network is a good place to start.

References

(1). Spontaneous pregnancy after tracking ovulation during menstruation: A case report of a woman with premature ovarian insufficiency and repeated failure of in vitro fertilization (Published: 2022 Authors: Ye He, Wanlu Wang, Chunmei Wu)

(2). Primary ovarian insufficiency (Published: 2010 Authors: Michel De Vos, Paul Devroey, Bart C)

(3). Problems in accurate medical diagnosis of depression in female patients (Published: 1997 Author: B J Floyd)

(4). Hormone Therapy in Primary Ovarian Insufficiency (Published: 2017 Author: American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice)

(5). Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women (Published: 2023 Authors: Jasmine Tan-Kim, Nemi M Shah, Duy Do)

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