Primary Ovarian Insufficiency


What is primary ovarian insufficiency?

Primary ovarian insufficiency is a disorder that occurs when a woman’s ovaries stop functioning prematurely (earlier than normal). In women with this condition, the ovaries (organs that produce a woman’s eggs) stop producing eggs before age 40. The usual age for egg production to stop, known as menopause, is around 50.

When the ovaries stop functioning and stop producing eggs, they also no longer produce hormones including estrogen. Women with low estrogen levels are at an increased risk of certain health issues. Primary ovarian insufficiency is also known as premature ovarian failure. This diagnosis is currently called “insufficiency” rather than “failure” because the ovaries can intermittently (occasionally) function, begin releasing eggs, and even result in successful pregnancy.

How common is primary ovarian insufficiency?

Primary ovarian insufficiency affects about 1 out of every 1,000 women ages 15 to 29, and 1 out of 100 women ages 30 to 39.

Symptoms and Causes

What causes primary ovarian insufficiency?

In many cases, doctors don’t know what causes primary ovarian insufficiency. Known causes include:

  • Autoimmune disorders (the body’s own cells attack healthy tissue)
  • Cancer treatments such as chemotherapy and radiation treatments
  • Genetic disorders including Turner Syndrome (genetic disorder involving an abnormality in one of a female’s two X chromosomes) or Fragile X syndrome
  • Hysterectomy (operation to remove a woman’s uterus and/or ovaries)
  • Viral infections

What are the signs and symptoms of primary ovarian insufficiency?

Some women with primary ovarian insufficiency do not have any symptoms. When symptoms occur, they can include:

  • Amenorrhea (missed or irregular periods)
  • Decreased sex drive
  • Difficulty concentrating
  • Irritability
  • Hot flashes
  • Trouble getting pregnant
  • Vaginal dryness

Diagnosis and Tests

How is primary ovarian insufficiency diagnosed?

A doctor diagnoses primary ovarian insufficiency with blood tests to measure hormone levels. Other tests look for abnormalities in chromosomes. Ultrasound imaging enables doctors to see the ovaries and uterus to look for structural problems.

Management and Treatment

How is primary ovarian insufficiency managed or treated?

Treatment for primary ovarian insufficiency aims to replace the hormones the ovaries no longer produce. Hormone therapy can help reduce symptoms and the risk of complications, including bone loss.

What complications are associated with premature ovarian failure?

Primary ovarian insufficiency may reduce estrogen levels. This reduction can lead to early development of osteoporosis (fragile and brittle bones), lipid abnormalities, and heart disease. Your doctor may recommend hormone therapy to decrease these risks.

Most women with primary ovarian insufficiency are infertile (cannot get pregnant). Doctors can help some women with the condition become pregnant through treatments such as donor eggs and fertility medications.


Can primary ovarian insufficiency be prevented?

Primary ovarian insufficiency cannot typically be prevented, however women at risk can be identified in some instances and may choose to pursue fertility preservation or expedited pregnancy.

What are the risk factors for primary ovarian insufficiency?

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

  • Are over age 35
  • Have a family member with the same condition
  • Have an autoimmune disorder
  • History of prior pelvic surgery, chemotherapy, or radiation

Outlook / Prognosis

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

Most cases of primary ovarian insufficiency are permanent. Most women 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. Support groups and counseling are available. These supports can help you manage emotions associated with the condition.

Living With

When should I call the doctor?

Contact your doctor if you miss your menstrual period for three months. Your period might stop for several reasons, including pregnancy, stress, or hormonal fluctuations. Your doctor can help to determine what is causing the missed periods.

What questions should I ask my doctor?

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

  • What tests do I need?
  • How will primary ovarian insufficiency affect my overall health and wellbeing?
  • Will I need to take hormone supplements? For how long?
  • Where can I find emotional support or counseling?
  • What is my best option for fertility (if desired)?

When can I go back to my regular activities?

You won’t need to stop your usual activities. Primary ovarian insufficiency does not typically affect everyday activities.

Last reviewed by a Cleveland Clinic medical professional on 04/09/2019.


  • The American College of Obstetricians and Gynecologists. Primary Ovarian Insufficiency in Adolescents and Young Women. ( Accessed 4/11/2019.
  • American Pregnancy Association. Premature Ovarian Failure: Premature Menopause. ( Accessed 4/11/2019.
  • Komorowska, B. Autoimmune premature ovarian failure. ( Menopause Review. 2016;210–214. Accessed 4/11/2019.
  • The Society for Endocrinology. Premature Ovarian Failure. ( Accessed 4/11/2019.

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