Trusted medical advice from the
American Academy of Family Physicians.

Primary Ovarian Insufficiency (POI)

What is primary ovarian insufficiency (POI)?

Primary ovarian insufficiency (POI) is when a woman’s ovaries stop working properly before age 40. It can affect women as early as their teenage years. It is different from premature menopause. You can still have periods and get pregnant with POI. But your ovaries don’t release eggs on a regular schedule. The condition used to be called premature ovarian failure.

Symptoms of POI

The first signs of POI are usually irregular periods and infertility. POI can also cause symptoms that are similar to those caused by menopause, including:

  • hot flashes
  • night sweats
  • irritability
  • poor concentration
  • decreased sex drive
  • pain during sex
  • vaginal dryness.

What causes POI?

In most cases, the cause of POI is unknown. Research has shown that POI can be related to problems with small sacs in the ovaries called follicles. These are where the eggs grow and mature. Problems with the follicles can be caused by:

  • Genetic or chromosomal abnormalities, such as Turner syndrome.
  • Autoimmune diseases, such as thyroiditis or Addison’s disease.
  • Chemotherapy or radiation therapy.
  • Metabolic disorders such as galactosemia.
  • Toxins, such as chemicals or pesticides.

How is POI diagnosed?

Your doctor will ask you about your medical and family history. He or she may do a pregnancy test to make sure that’s not the reason for your missed periods. They will do a physical exam to rule out other problems that could be causing your symptoms. They will also order blood tests that may be able to tell them if you have POI. Your doctor may also do a pelvic ultrasound to look at your ovaries.

Can POI be prevented or avoided?

In most cases, POI cannot be prevented or avoided. You can reduce your risk by avoiding toxins or chemicals that can cause it. These include chemicals, pesticides, and tobacco smoke.

POI treatment

There is no cure for POI. But some of the symptoms can be treated with hormone replacement therapy. This is the most common treatment for POI. It gives you the hormones that your ovaries should be making. If you have POI, this therapy can:

  • regulate your periods
  • reduce night sweats and hot flashes
  • help maintain bone health
  • possibly improve your likelihood of getting pregnant.

Living with POI

POI is usually associated with lower levels of certain hormones. This leaves women with POI at higher risk of developing several health conditions, including:

  • Osteoporosis. This is a bone disease that causes weak and brittle bones. These bones are more likely to break. This is often treated with calcium and vitamin D supplements.
  • Hypothyroidism. Low levels of hormones made by the thyroid can affect your metabolism. This can cause low energy and mental sluggishness. It can often be treated with medicine.
  • Depression and anxiety. Changes in hormones can contribute to anxiety and depression. These can be treated with counseling or medicine.
  • Heart disease. Low levels of estrogen can result in hardening of the arteries. This puts women with POI at higher risk of illness and death from heart disease. This can often be treated with medicine.

Questions to ask your doctor

  • Is POI the reason I can’t get pregnant?
  • Will I ever be able to have a baby?
  • What treatments can I go through in order to get pregnant?
  • How do I know if it’s POI or premature menopause?
  • Will I have to receive hormone replacement therapy for the rest of my life?
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