Premature ovarian insufficiency (POI) is a condition that impacts around 1 in 100 women in the UK and happens when a woman’s ovaries stop working normally before she is 40.
This blog post looks at the symptoms, causes, diagnosis and treatment of POI and explores its impact on fertility and long-term health.
Whether you or someone you know has been diagnosed with POI, you can find out more here.
What is premature ovarian insufficiency?
Premature ovarian insufficiency is a female reproductive hormone disorder that affects women under the age of 40 and occurs when the ovaries stop functioning correctly.
This can lead to reduced fertility and premature menopause, which means that women may stop having periods and experience menopause symptoms earlier than expected.
While there is no cure for POI, there are several treatment options available that can help manage its symptoms.
What are the symptoms of POI?
Symptoms of POI can vary, but they typically include:
- Infrequent or absent periods
- Hot flushes (sudden feelings of heat)
- Night sweats
- Low mood and decreased energy levels
- Body aches and joint pains
- Brain fog and lack of concentration
- Poor sleep quality
- Decreased libido
- Vaginal dryness and painful sexual intercourse
Some women may not experience any symptoms at all, while others may have them more severely. The symptoms are similar to that of natural menopause (which usually happens around the age of 50) so the condition can sometimes be difficult to diagnose without proper investigations.
What causes POI?
There are several different reasons behind why this condition may develop — there isn’t one single cause. For the majority of women, the underlying cause is unknown.
Some potential causes of POI include:
- Chromosome or gene problems – Chromosome or gene abnormalities, such as Turner Syndrome or Fragile X chromosomes, can be identified in around one in 20 women with POI.
- Autoimmune diseases – Autoimmune factors may cause the immune system to attack and damage the ovaries mistakenly. In these cases, fertility and ovary function can fluctuate over time.
- Metabolic conditions and infections – Certain metabolic conditions, such as galactosaemia, and infections like mumps or tuberculosis, can be associated with POI.
- Idiopathic or unexplained POI – In most cases (80%), the cause of POI cannot be identified. In these cases, the ovaries may continue to function intermittently, and women may experience a return of menstrual cycles or even become pregnant years later, though this is rare.
- Chemotherapy or radiotherapy – Exposure to these treatments can cause damage to the ovaries and result in premature menopause. This can cause either temporary or permanent ovarian damage, depending on the dose, duration and type of drugs used.
- Ovarian removal – Removal of the ovaries during an operation, either due to cysts, tumours, or in conjunction with a hysterectomy, can lead to an abrupt menopause.
It’s important to note that the exact cause of POI can vary from person to person, and a combination of factors may contribute to the condition.
What does diagnosis look like?
POI is diagnosed through blood tests that measure hormone levels as well as an assessment of your symptoms.
The blood tests specifically measure the levels of follicle-stimulating hormone (FSH) and oestradiol (oestrogen). In women with POI, the levels of oestradiol are low because the ovaries are not producing normal levels of the hormone. As a result, the pituitary gland from the brain produces more FSH in an attempt to stimulate the ovaries to produce oestradiol.
Blood tests are usually performed twice, at least four to six weeks apart, to confirm the diagnosis. If a woman is not having periods, the blood test may be performed on any day, but if periods are still occurring, the blood test must be done during the period, as FSH levels rise later in a normal cycle.
Another hormone test, known as anti-Müllerian hormone (AMH), may also be performed to assess ovarian reserve (store of eggs), but it should be interpreted with caution as it does not accurately predict the chance of natural pregnancy.
How is POI treated?
Treatment for POI usually includes hormone replacement therapy (HRT) or the combined oral contraceptive pill. HRT (replacement of oestrogen, progesterone and where necessary testosterone) is typically the first treatment offered for women with POI, in the form of oestrogen replacement therapy.
HRT aims to replenish the low oestrogen levels — alleviating symptoms experienced with POI. Boosting oestrogen levels can also help protect from low bone density and changes to heart and blood vessels, and prevent conditions that develop as a result, such as osteoporosis or coronary heart disease.
It’s important to note that women have the option to choose whether or not they want to take oestrogen replacement therapy, as well as which form of treatment they prefer.
While some women may choose to use alternative medicines, dietary supplements, or herbal and homoeopathic remedies, it’s important to remember that these treatments do not necessarily protect against heart disease and low bone density.
How is POI different from natural menopause?
POI is different from menopause in several ways. Firstly, menopause is a permanent cessation of periods due to lower hormone levels which typically occurs between the ages of 45 and 55 — the average age for natural menopause is 51 in the UK.
In contrast, POI affects women before the age of 40 and will result in the cessation of periods or irregular periods due to reduced ovarian function.
The balance of benefits versus risks from hormone replacement therapy is different (more favourable) for POI as compared to natural menopause after the age of 45.
Can you get pregnant when you have POI?
Yes, it is possible, but there is a lot more to it as women with this condition do not ovulate regularly. There is a 5-10% chance of natural pregnancy with POI and HRT is not contraceptive.
This happens because some women with unexplained or immune-related POI may occasionally ovulate, so they can possibly become pregnant. Unfortunately, there is currently no way to predict which women may fall into this group.
Women who resume ovulation and menstruation following chemotherapy and recovery from cancer treatments may regain fertility and conceive naturally, and HRT does not affect the chances of becoming pregnant.
Fertility treatments such as in vitro fertilisation (IVF) using donated eggs and hormone therapy to prepare the womb lining can be offered to women with POI in fertility clinics. In these cases, hormone therapy will be continued for the initial weeks of pregnancy.
Are there any long-term effects of POI?
POI can have significant long-term effects on women’s health. One of the most common long-term effects is osteoporosis, which can lead to bone fractures. Women with POI are at an increased risk of osteoporosis due to low oestrogen levels in their bodies. To monitor their bone strength, women with POI are often offered a DEXA scan, which is a simple and painless X-ray test that can be repeated every few years.
POI may also increase the risk of cardiovascular diseases, such as heart attack or stroke, due to deficiency of oestrogen. Other factors such as smoking, diet, exercise, and weight can also contribute to this risk. Additionally, POI has been linked to cognitive decline, raised cholesterol levels, and an increased risk of diabetes.
Receiving a diagnosis of POI can be difficult, but it doesn’t have to be. It is common to experience feelings of anxiety or low mood. But seeking support through talking to friends and family or having counselling can help to manage these feelings and develop a positive outlook towards life with POI.
Speak with London Medical about POI
If you’re struggling with symptoms that you think might be related to POI, don’t hesitate to get in contact with our experts in women’s health at London Medical.
Our team will advise you on testing and treatment options to help you manage your symptoms. With the right support, treatment and care, your POI symptoms could be alleviated and your long-term health protected.