Primary Ovarian Insufficiency

What is primary ovarian insufficiency?

Primary ovarian insufficiency (POI) is a condition that occurs when a person’s ovaries fail earlier than average. Your ovaries are small glands located on both sides of your uterus that produce and release eggs during ovulation. Your ovaries also make important hormones for menstruation, pregnancy and other bodily functions.

The usual age for egg production to stop, known as menopause, is around 51. For some people, POI happens abruptly, and they suddenly stop having a regular menstrual period. But, for others, a diagnosis of POI comes after months or years of irregular periods.

Primary ovarian insufficiency was previously known as premature ovarian failure. However, healthcare providers prefer “insufficiency” rather than “failure” because research has shown that people with POI can have intermittent ovulation. This means you may still release an egg and get pregnant if you have POI. In fact, around 5% to 10% of those with a diagnosis of POI will spontaneously get pregnant without treatment for infertility. For this reason, POI is often also called “decreased ovarian reserve.”

How common is primary ovarian insufficiency?

POI is rare, typically affecting about 1% of women or people assigned female at birth (AFAB) between ages 15 to 44. It can affect both those who’ve had children and those who haven’t ever had children. It’s more common in people who are older than 30.

How does primary ovarian insufficiency affect my body?

Primary ovarian insufficiency causes low estrogen levels. Losing estrogen can have side effects similar to those that occur with menopause, such as hot flashes, decreased sex drive and mood changes. It also increases your risk for osteoporosis, heart disease and other conditions.

Many people with primary ovarian insufficiency experience infertility. However, your provider may be able to help you become pregnant with treatments like donor eggs, IVF (in vitro fertilization) and/or fertility medications.

What causes primary ovarian insufficiency?

In the majority of cases, healthcare providers don’t know what causes primary ovarian insufficiency (idiopathic POI). However, research shows that up to one-third of cases may have a hereditary component.

Some other causes of POI include:

• Autoimmune disorders like Addison disease, rheumatoid arthritis or thyroid disease.
• Cancer treatments such as chemotherapy and radiation.
• Genetic disorders including Turner syndrome (genetic disorder involving an abnormality in one of a person AFAB’s two X chromosomes) or Fragile X syndrome (a genetic disorder involving changes in the gene FMR1).
• Hysterectomy (surgery to remove your uterus).
• Infections like mumps and HIV. (This is thought to happen due to antibodies that attack your ovary.)
• Prolonged exposure to chemicals, pesticides, cigarette smoke and other toxins.

What are the signs and symptoms of POI?

The most common sign of POI is irregular or missed periods. Some people with primary ovarian insufficiency don’t have any noticeable symptoms. Other symptoms can include:

• Irregular or missed periods.
• Trouble getting pregnant.
• Decreased sex drive.
• Difficulty concentrating.
• Irritability.
• Dry eyes.
• Hot flashes and night sweats.
• Vaginal dryness.
• Painful sex due to vaginal dryness.

How is primary ovarian insufficiency diagnosed?

Your healthcare provider will perform a physical exam and a pelvic exam. They’ll also ask you about your health history. Knowing about your typical menstrual cycle, previous pregnancies or use of birth control is helpful to your provider in diagnosing POI.

Next, they will likely order blood tests to measure levels of certain hormones in your body. These include follicle stimulating hormone (FSH), estrogen and prolactin.

Other tests your provider may use include:

• A blood test (karyotype testing) to look for genetic disorders.
• A pelvic ultrasound (to look at your ovaries and uterus).
• A pregnancy test.
• Antibody tests to check for autoimmune disorders.

Providers diagnose POI if you’re younger than 40 and:

• You have no periods or abnormal periods.
• Lab tests show your hormone levels are that of a person in menopause.

How do you treat primary ovarian insufficiency?

Healthcare providers treat POI in different ways. It depends on your age, symptoms and if you wish to get pregnant. Primary ovarian insufficiency treatment involves:

• Replacing hormones that your ovaries no longer produce.
• Treating symptoms or side effects of POI (like night sweats, vaginal dryness, etc.).
• Lowering your risk for conditions that POI causes.
• Treating underlying conditions that worsen POI symptoms.

Hormone replacement therapy (HRT)

Hormone therapy gives your body the hormones that your ovaries aren’t making. Hormone therapy may involve taking just estrogen or taking estrogen and progesterone. Hormone therapy can help reduce symptoms of POI like night sweats and vaginal dryness. It will also lower your risk for osteoporosis and other conditions that POI can cause. Your provider may prescribe hormone therapy in different ways, such as a pill, cream, gel, patch or vaginal ring.

If you begin HRT, you’ll continue treatment up until the age when natural menopause typically begins (age 51 to 52). Discuss the benefits and risks of HRT with your provider to make sure it’s right for you.

In addition to HRT, other treatments could include:

• Taking calcium and vitamin D to help lower your risk of osteoporosis.
• Getting regular physical exercise, lifting weights (for your bone health) and maintaining a healthy weight.
• Exploring options for fertility treatment if you wish to expand your family.

If you don’t wish to get pregnant, be sure to discuss birth control with your provider.

Can you reverse primary ovarian insufficiency?

No, primary ovarian insufficiency isn’t reversible. Healthcare providers can treat symptoms, side effects and associated conditions, but they can’t cure it.

Can your ovaries start working again?

About 25% of people with POI may experience ovulation at least once even after diagnosis. However, there isn’t treatment that can make your ovaries start to work again. Treatment for primary ovarian insufficiency helps relieve symptoms of the condition and lowers your risk of health conditions that POI may cause.

Can primary ovarian insufficiency be prevented?

You can’t usually prevent primary ovarian insufficiency. However, people at higher risk for POI may choose to pursue fertility preservation if they wish to have children. Talk to your healthcare provider if you’re concerned about POI.

What are the risk factors for primary ovarian insufficiency?

People at higher risk for primary ovarian insufficiency include those who:

• Are over 35.
• Have a biological parent with POI.
• Have an autoimmune disorder or certain genetic conditions.
• Have had pelvic surgery, chemotherapy or radiation.

What is the prognosis (outlook) for people with primary ovarian insufficiency?

Primary ovarian insufficiency is usually permanent. Most people with the condition take long-term hormone therapy to manage symptoms and reduce the risk of complications.

Primary ovarian insufficiency often causes feelings of sadness and loss, especially if you still had hopes for getting pregnant. Support groups and counseling are available. These supports can help you manage emotions and find ways to cope.

What conditions are associated with primary ovarian insufficiency?

People with POI have lower levels of estrogen. Low estrogen can put you at risk for other health conditions like:

• Osteoporosis.
• Heart disease.
• Hypothyroidism (underactive thyroid).
• Infertility.
• Anxiety and depression.

When should I see my healthcare provider?

Contact your healthcare provider if you miss your menstrual period for three months. Your period might stop for several reasons, including pregnancy, stress or hormonal fluctuations. Your provider can help to determine what’s causing you to miss your period.

What questions should I ask my provider?

If you have primary ovarian insufficiency, you may want to ask your healthcare provider:

• How will primary ovarian insufficiency affect my overall health?
• Will I need hormone replacement therapy? For how long?
• Will I need birth control?
• Where can I find emotional support or counseling?
• What’s my best option for fertility?

What is the difference between primary ovarian insufficiency and premature ovarian failure?

Providers may use these terms interchangeably to describe menopause before 40.

What is the difference between primary ovarian insufficiency and premature menopause?

Premature menopause is when your periods stop before age 40 and you can no longer get pregnant.

Can you get pregnant if you have primary ovarian insufficiency?

Yes, there’s still a chance that a person with POI can get pregnant. If you have POI and want to get pregnant, your pregnancy care provider can advise you on your options. Conversely, if you don’t wish to get pregnant, talk to your provider about options for preventing pregnancy.

A note from Cleveland Clinic

Primary ovarian insufficiency (POI) happens when your ovaries stop functioning earlier than age 40. It can cause uncomfortable symptoms and increase your risk for health conditions like osteoporosis or heart disease. Hearing you have POI can be difficult and it’s normal to have emotions about your diagnosis, especially if you hoped to become pregnant. With the right treatment and support, you can continue to live a healthy life. Discuss your concerns with your provider and lean on your partner, family and friends to help you cope.