Premature ovarian failure (POF), or premature ovarian insufficiency (POI), is a rare condition that occurs when a person’s ovaries stop producing eggs regularly before they reach the age of 40. This can make it difficult for someone to become pregnant.
This definition comes from the American Society for Reproductive Medicine.
While both POF and POI describe the same condition, the National Institutes of Health (NIH) prefer to use POI because the word failure does not accurately describe what happens to the ovaries in people with POI. Additionally, the word failure can create stigma, and most healthcare professionals choose not to use it.
This article looks at what POI is, its symptoms, causes, complications, treatments, and other strategies that may help someone manage the physical and emotional impact of the condition.
When a person has POI, the ovaries start to run out of eggs before they enter menopause. A person with POI may ovulate much less often or in a stop-start pattern, as a result.
According to The National Infertility Association, POI affects around 1 in 1,000 females between the ages of 15–29. It affects 1 in 100 females between the ages of 30–39. Early-onset POI can begin at an average age of 27.
According to the NIH, some practitioners call POI early menopause. However, this does not accurately reflect what happens to people with POI.
After menopause, a person will never have another period and cannot get pregnant. A person with POI may still have periods, and in some cases, can still get pregnant.
A person with POI who does not want to get pregnant must continue to use birth control. The American College of Obstetricians and Gynecologists (ACOG) recommend barrier methods, such as condoms or an intrauterine device (IUD).
According to Cedars-Sinai, common symptoms of POI include:
- night sweats
- hot flashes
- trouble becoming pregnant
- painful sex due to thinning of the vaginal lining
- a decrease in sex drive
- irregular periods
- no periods (amenorrhea)
The American Society for Reproductive Medicine indicate that a person with POI may also experience:
- vaginal dryness
- few or no signs of puberty as a teenager
While some people with POI have noticeable symptoms, many do not. People may not realize that they have POI until they try to get pregnant or stop using hormonal birth control. When they do, they may notice irregular or absent periods or some of the other symptoms listed above.
- autoimmune disease
- thyroid disease
- infections that can damage the ovaries, such as mumps
- surgery on the ovaries
- toxins from radiation or chemotherapy
- genetic conditions, such as Turner syndrome or Fragile X syndrome
Some of the underlying conditions that can cause POI improve with treatment or management. However, it is not possible to reverse POI itself.
A person with POI has a higher risk for some health conditions, such as osteoporosis. Osteoporosis is a condition that causes weaker bones, increasing a person’s risk of experiencing a fracture or breakage.
People with POI are also more at risk for:
- cardiovascular disease
- impaired cognition
According to the American Society for Reproductive Medicine, doctors use a person’s medical history and the results of hormone tests to diagnose POI. This may include blood tests for:
- follicle-stimulating hormone (FSH)
- antimüllerian hormone (AMH)
A doctor will also carry out a physical examination. If appropriate, they may order genetic testing to see if a person has a mutation that could cause POI, such as Fragile X syndrome or Turner syndrome.
A doctor may also perform a pelvic ultrasound to look at the ovaries and for other potential causes of absent periods.
Once a person receives a POI diagnosis, there are several ways a doctor can approach treatment depending on a person’s goals.
Firstly, a doctor will investigate the cause of POI. Finding and treating any underlying causes may improve the symptoms of POI. However, this does not reverse the loss of eggs.
A doctor may recommend hormone replacement therapy (HRT) to reduce the symptoms of POI. If a person with POI wants to become pregnant, doctors can discuss several options with them.
For some, medications that stimulate the growth or release of eggs, such as clomiphene citrate or gonadotropins, may be an option. However, it is often difficult for someone POI to conceive using their own eggs. In these cases, a person may wish to use an egg donor instead.
ACOG recommend that people seek advice from fertility specialists to discuss the best options for a person’s unique situation and goals.
There are some steps a person can take to treat their POI symptoms and reduce their associated health risks.
Some lifestyle and dietary changes can reduce the symptoms of POI and the risk of complications. According to the NCH Healthcare System, these include:
- Keeping bones strong: This may mean taking a calcium and vitamin D supplement, consuming foods that contain these nutrients, and performing weight-bearing exercises to strengthen the bones.
- Avoiding smoking and toxins: Cigarette smoke, pesticides, and some viruses may exacerbate POI. Stopping smoking and getting vaccinations for viruses, such as mumps, may help someone avoid further damage to the ovaries.
- Emotional support: A POI diagnosis can change someone’s plans to conceive, which may cause significant distress and feelings of grief. Online or offline support groups, and counseling or therapy from someone with experience helping people with fertility concerns, can help.
There is some limited evidence that certain herbs may reduce the symptoms of POI. A 2014 study found that Chinese herbal medicine could reduce POI symptoms when compared to HRT. However, scientists need to carry out more research on this to determine safety and efficacy.
A person should talk to their doctor before using any herbal remedy, particularly if they are taking other medications.
A person should speak to their doctor if they notice symptoms, such as hot flashes, night sweats, or loss of periods below the age of 40.
They can also consult a doctor if they have had difficulty getting pregnant for more than 6–12 months or notice that their period has not returned to normal after stopping hormonal birth control, cancer treatment, or following surgery.
If a person requires cancer treatment, they may wish to preserve fertility by freezing their eggs so that they have an opportunity to conceive after treatment.
POI occurs when a person’s ovaries produce fewer eggs. Often, doctors do not know what causes it, but it is often the result of an underlying condition.
A doctor can diagnose POI based on a person’s medical history and blood tests. The treatment they prescribe will depend on the individual and whether they want to try to conceive.
If they do, a doctor may prescribe hormones or medication to increase the chances of pregnancy, but many people will require donor eggs. Support groups or counseling may help someone cope with the emotional impact of this condition and its affect on fertility.