What Is Primary Ovarian Insufficiency (POI)?

Primary ovarian insufficiency, or POI, is a medical condition in which the ovaries cease to function properly in women younger than age 40. With POI, the ovaries release too few eggs or release them unpredictably. It may also indicate a shortfall in the production of reproductive hormones, including estrogen, progesterone, and testosterone. POI is sometimes confused with premature menopause but the two conditions are not the same. Women with POI can continue to menstruate, at least occasionally. Premature menopause signals the end of monthly periods and the ability to get pregnant. Primary ovarian insufficiency can occur in women at any point from their teenage years to their thirties. It is estimated that about one in a thousand women ages 15 to 29 have POI. To learn more about primary ovarian insufficiency, make an appointment with your Baptist gynecologist. Our provider directory can help you find a provider in your area.

How Common is Premature Ovarian Failure?

Primary ovarian insufficiency (POI) is somewhat common and affects many women. The condition can only develop in women younger than age 40 and tends to occur more in a person’s 30’s rather than in their 20’s or teen years. POI can affect women who have not had children and those who have. 

Symptoms

Most females have had a normal puberty and normal menstrual periods before developing symptoms of primary ovarian insufficiency. POI exhibits similar symptoms to menopause or estrogen deficiency. The symptoms include:

• Missed or irregular periods
• Dry vagina
• Dry eyes
• Hot flashes
• Lack of focus
• Irritability
• Night sweats
• Loss of sexual appetite
• Inability to get pregnant

Girls with POI often experience a delay in undergoing puberty. They are slow to begin menstruation and develop secondary sexual characteristics, such as breasts.

Causes

There are many potential causes of primary ovarian insufficiency. The causes include:

• Genetic disorders: Certain inherited conditions, including Turner syndrome and the Fragile X mutation, can contribute to primary ovarian insufficiency.
• Autoimmune diseases: Although rare, a women’s own immune system will sometimes produce antibodies against ovarian tissue, preventing healthy egg production. Scientists are unsure of the cause.
• Toxins: Some toxins appear linked to POI. Included are pesticides, radiation, chemotherapy, cigarette smoke, and various endocrine-disrupting chemicals.
• Radiation and chemotherapy: The treatment of cancer with either radiation or chemotherapy can have the unintended consequence of damaging ovarian production.
• Chromosomal defects. Some genetic conditions contribute to the development of POI (Turner syndrome, Fragile X syndrome, or galactosemia)
• Autoimmune disease. The rare instance your body creates antibodies that attack the ovarian tissue.
• Thyroid disease
• Problems with hormones. Issues with hormones that regulate the ovaries, such as follicle-stimulating hormone (FSH).
• Eating disorders
• Other unknown factors. In many cases, the cause of POI is unknown.

Known risk factors for POI are age, family history, and ovarian surgery. Despite this, the precise cause of POI is only identified in about 25 percent of all diagnosed cases.

Risk Factors

There are several factors that may increase the risk of developing primary ovarian insufficiency. The risk factors for POI include:

• Age. Women from the ages of 35-40 are most at risk. Although it’s less common, POI can affect women in their lower 30’s, 20’s, and even teens.
• Ovarian surgeries. Surgery involving the ovaries increases the risk of developing POI.
• Family history. If anyone in your family has had POI, it increases the risk of developing the condition.
• Thyroid disease 
• Certain infections

Diagnosis

Diagnosing POI involves the following:

• A physical examination: Your physician will ask about your symptoms and record your medical history. He or she may also examine you physically, looking for additional clues as to the source of your symptoms.

Because irregular periods have a variety of causes, your physician may also conduct one or more medical tests designed to pinpoint POI, while ruling out alternatives:

• Pregnancy test: You won’t have periods during pregnancy.
• Blood test: A blood test will check the level of hormones secreted by your thyroid and pituitary glands, especially prolactin, which stimulates milk production. Certain fluctuations in these hormones can spur POI-like symptoms.
• Genetic test: This test will look for gene variations linked to POI.
• Antibody test: The presence of certain types of antibodies may indicate an autoimmune disorder.
• Bone density test: This is a test for osteoporosis. Declining bone mass may be tied to reduced estrogen output, which is one indicator of ovarian insufficiency.

Treatment

The treatment of POI typically focuses on replacing depleted levels of estrogen:

• Hormone therapy: Estrogen is the primary form of hormone treatment. It can help strengthen bones and reduce vaginal dryness. Progesterone is also utilized. You may receive hormone therapy until around age 50, when menopause typically begins.
• Vitamin D and calcium supplements: Vitamin D and calcium supplements are useful in warding off the osteoporosis caused by an estrogen deficiency.
• Infertility treatments: Women with POI often require medical assistance to overcome their obstacles to fertility. Your physician may prescribe a medication called clomiphene, which stimulates regular egg release by the ovaries. Other options for infertility include in vitro fertilization (IVF), cryopreservation of eggs prior to ovarian surgery or radiation treatment, and adoption.

Learn More about Primary Ovarian Insufficiency from Baptist Health

For more information about primary ovarian insufficiency, or to schedule an appointment with our physicians, our provider directory can help you find a provider in your area.