Menopause and premature ovarian insufficiency (POI) are often discussed together but they are distinctly different. Menopause is a natural consequence of ageing, which all women who have periods will go through. It occurs once the ovaries gradually stop producing oestrogen and progesterone, and releasing eggs.
In contrast, premature ovarian insufficiency occurs when the ovaries are not functioning as they should be as a result of problems with the follicles – the small sacs in the ovaries which mature and grow eggs.
Understanding POI and its symptoms can help you to get a diagnosis and the timely care you need to manage it.
What is Premature Ovarian Insufficiency (POI)?
Premature Ovarian Insufficiency (POI) is a condition that occurs when the ovaries stop functioning normally before the age of 40. This leads to a decline in oestrogen levels which can affect fertility. However, around 5% to 10% of women with POI will spontaneously conceive with infertility treatment. This is why POI is sometimes referred to as decreased ovarian reserve.
POI is estimated to affect at least 1% of girls and women below the age of 40 but is rare before the age of 30, with 0.1% of women affected. POI was previously referred to as premature ovarian failure (POF) or primary ovarian insufficiency.
Premature ovarian insufficiency is different to early menopause, which is when a woman stops having periods between the ages of 40 and 45, and menopause, which typically occurs between the ages of 45 and 55.
Causes of premature ovarian insufficiency
In over 90% of cases, the cause of POI is never identified. This is known as idiopathic POI.
Having a family history of primary ovarian insufficiency does raise the risk of getting the condition. POI is also associated with certain conditions and circumstances including:
- Genetic conditions such as Fragile X syndrome and Turner syndrome
- A low number of follicles
- Autoimmune disorders including thyroiditis and Addison’s disease
- Metabolic conditions including galactosemia
- Environmental factors and toxins such as cigarette smoke, chemicals and pesticides can speed up follicle depletion
- Medical and surgical treatment that affects the ovaries including chemotherapy and radiation
Symptoms of premature ovarian insufficiency
The symptoms of POI are similar to those of perimenopause or menopause and can be extensive. Common premature ovarian insufficiency symptoms include:
- Irregular or absent periods
- Hot flushes and night sweats
- Vaginal dryness, itching or soreness
- Difficulty conceiving
- Mood swings including anxiety, irritability and low mood
- Changes in libido
Getting a diagnosis of POI
If you are under the age of 40 years and suspect you are experiencing POI, it is important to seek help from your doctor. Diagnosis will involve discussing your medical history and carrying out blood tests.
Diagnostic blood tests
Certain hormonal blood tests are required to confirm a premature ovarian insufficiency diagnosis (unless you have had your ovaries surgically removed). These include:
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Oestradiol
Elevated FSH levels, taken on two occasions at least 4-6 weeks apart, and low oestradiol levels are indicative of ovarian dysfunction.
General blood tests
These are carried out to exclude other causes for symptoms and may include:
- Thyroid function
- Vitamin D
- Vitamin B12
- Folate
- Ferritin
- Full blood count
- Kidney, bone and liver function,
- Cholesterol and HbA1c or glucose levels
Karyotype testing
Chromosomal abnormalities can contribute to POI. Karyotype testing involves analysing a sample of your blood to examine your chromosomes. These will not be necessary for everyone with POI but are more likely to be conducted if you are in your 20s or younger.
DEXA scan
A bone density scan (DEXA scan) should be offered to anyone diagnosed with POI. This scan measures bone mineral density and is used to assess bone health and the risk of osteoporosis and bone fractures.
Treatment for premature ovarian insufficiency
While POI is not curable, symptoms can be managed. Hormone Replacement Therapy (HRT) is the most common treatment. It gives the body the hormones that the ovaries are not making, and this helps to alleviate symptoms and protect future health (to reduce the risk of osteoporosis and cardiovascular disease).
Due to POI impacting fertility, exploring avenues to parenthood is often important to those affected. While women with POI might be able to have fertility treatments using their own eggs, donor egg in vitro fertilisation (IVF) offers the best chance of successfully conceiving.
Lifestyle considerations
Alongside HRT, there are lifestyle changes and other steps that can be taken to help with the physical and emotional challenges that premature ovarian insufficiency can cause:
- Maintain a healthy lifestyle with regular, weight-bearing exercise and a balanced, fibre-rich diet.
- Quit smoking and minimise alcohol intake - these can worsen symptoms and increase the risk of osteoporosis.
- Discuss contraceptive options with your healthcare provider if you are sexually active and do not want to conceive.
- Seek psychological support to process your feelings about your diagnosis and manage your mental health
Future health risks
POI increases the risk of certain health issues, such as osteoporosis and cardiovascular diseases. Regular health check-ups and screenings with doctors who understand POI are important.
Support and resources
Living with POI can be challenging, but you are not alone. Seek support from friends, and family, or join support groups (e.g. The Daisy Network) to share experiences and coping strategies.
Some of the books we recommend are:
- The Complete Guide to POI & Early Menopause by Dr Hannah Short & Dr Mandy Leonhardt (Sheldon Press, 2022)
- Our Guide to Understanding Premature Ovarian Insufficiency by The Daisy Network (Grosvenor House Publishing, 2021)
- My Life on Pause by Dr Siobhan O’Sullivan (Olympia Publishers, 2023)
Understanding and managing POI starts with getting a diagnosis and discussing treatment options. Regular check-ups, following treatment plans, and a healthy lifestyle can help you live well with POI.
At Menopause Care, our specialist menopause doctors are experienced in helping women navigate premature ovarian insufficiency. If you’d like to take the first steps toward a diagnosis, want to find out more about treatment options, or simply need some additional support, book a consultation today.
¹Early and premature menopause | NHS inform NHS Inform (March 2023)
²Premature ovarian insufficiency - British Menopause Society British Menopause Society, Consensus Statement (March 2024)
³Primary Ovarian Insufficiency (POI) | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health (NIH), Eunice Kennedy Shriver
National Institute of Child Health and Human Development (April 2022)
⁴Primary Ovarian Insufficiency: Causes, Symptoms & Treatment Clevelan Clinic (July 2022)
⁵Premature Ovarian Insufficiency - an update on recent advances in understanding and management - PMC Torrealday et al. (November 2019)
⁶What causes POI? | NICHD National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (April 2022)
⁷Reproduction in premature ovarian insufficiency patients – from latest studies to therapeutic approach - PMC Męczekalski et al. (September 2018)
