Primary ovarian insufficiency

Primary ovarian insufficiency (POI) is a condition where the ovaries stop working as expected before age 40. This may make it difficult to become pregnant, cause symptoms of low estrogen, and raise certain health risks. For many people, POI can be emotionally challenging as well.

Your healthcare provider can answer questions, help you manage POI, and explore family-building options. Let’s go over the basics together.

What is POI?

With POI, your ovaries stop working before age 40. (If this happens between 40 and 45, it’s known as early menopause.) When the ovaries stop working, they stop producing the hormones estrogen and progesterone. The ovaries also stop ovulating (releasing eggs).

Rarely, people with POI may still produce these hormones or release eggs intermittently, and pregnancy may be possible. Unfortunately, however, pregnancy is less likely for most people with the condition.

POI affects about 1% of women in their 30s and is less common in younger ages. For most people, the cause is never known, but it may happen due to:

• Family history
• Genetic disorders such as Turner syndrome or fragile X syndrome
• Chemotherapy or radiation
• Autoimmune and metabolic disorders

How is it diagnosed?

People with POI often notice that their periods stop or become irregular, although this may be masked if you’re on hormonal birth control.

Other symptoms caused by low estrogen may include:

• Vaginal dryness
• Hot flashes
• Night sweats
• Mood swings
• Trouble sleeping

To diagnose POI, your provider will learn about your health history and symptoms, do a pelvic exam, and likely perform blood tests.

If a blood test shows high follicle-stimulating hormone (FSH), this may indicate POI.

• The role of FSH is to tell the ovary to create a follicle (a small, fluid-filled sac in the ovary that may release and nourish an egg).
• FSH levels become high when your body is working extra hard to stimulate the ovaries and release an egg.
• Low estrogen in addition to high FSH may help confirm the diagnosis.

Your provider will also work with you to rule out other possible causes of your missing or irregular periods.

How is POI managed?

Unfortunately, there are no treatments to restore ovarian function. And POI can be emotionally difficult, raising the risk for depression and anxiety.

Your provider can help connect you with emotional support, counseling, and specialists who may help you pursue family-building goals if desired. For example, you may consider paths to parenthood including in vitro fertilization (IVF) with donor eggs.

Your provider will work with you to develop a management plan that also takes into account your health as a whole. This may include:

• Symptoms from low estrogen
• Emotional well-being
• Fertility concerns
• Sexual function
• Bone health
• Heart health
• Risk for endocrine problems, such as diabetes or thyroid conditions

Talk with your provider to find out if hormone therapy is an appropriate treatment option for you. It may help lower risks associated with low estrogen, such as:

• Osteoporosis
• Heart disease
• Sexual health problems
• Overall quality of life

Calcium and vitamin D supplements may also help lower the risk of osteoporosis.

You have support.

A diagnosis of POI can be challenging. Your provider is there to answer any questions you have. Your Progyny Care Advocate is also here for you. We can help provide resources, answer questions, and support you on your journey.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.