Primary Ovarian Insufficiency (POI)

What Is Primary Ovarian Insufficiency?

Primary ovarian insufficiency (POI) is a condition in which a woman’s ovaries do not make enough follicles or the follicles do not function properly. Because of this, there are not enough hormones produced and women stop having menses (their “period”) before the age of 40. Some women with POI do have some residual ovarian function.

What Are the Signs and Symptoms of Primary Ovarian Insufficiency?

Women with POI may have the following symptoms:

  • No menstrual period
  • Irregular menstrual periods
  • Menstrual periods that stop completely
  • Hot flushes
  • Vaginal dryness
  • Painful intercourse

What Are the Causes of POI?

There are several causes of primary ovarian insufficiency. In many cases, the cause of POI is unknown.

Common causes of POI include:

  • Chromosomal abnormalities (i.e. Fragile X mutation, Turner syndrome, gonadal dysgenesis)
  • Ovary damage from chemotherapy or radiation therapy
  • Some endocrine disorders (i.e. hypoparathyroidism, hypoadrenalism)
  • Infiltrative processes
  • Infectious processes
  • Some autoimmune conditions 

How Is Primary Ovarian Insufficiency Treated?

Your health care provider will ask questions about your health, past medical history, menstrual history, complete a physical exam, order lab work, and may order imaging (i.e. ultrasound, bone density scan).

The goal of POI treatment is to replace the hormones the ovary should be making until the natural age of menopause. Hormone replacement therapy is important for pubertal development (if this was not completed prior to the POI), symptom relief (i.e. hot flushes, vaginal dryness), bone health, cardiovascular health, and sexual health.

Women with POI should be sure to take enough calcium and vitamin D and get regular exercise. This will help optimize bone and cardiovascular health. They should avoid tobacco.

Because the diagnosis of POI can be stressful, many patients benefit from seeing a behavioral health team for emotional and psychological support.

As patients with POI grow older and start to focus on family planning, they may choose to meet with a fertility specialist to discuss fertility and family building options.

Because some women with POI may have residual ovarian function, if a woman is sexually active and does not desire pregnancy, effective contraception should be used.