Listen to our Hormones: The Inside Story podcast episode on menopause

Alternative names for premature ovarian failure

Previous terms include ‘primary ovarian insufficiency’, ‘premature ovarian failure syndrome’ or ‘premature ovarian failure’ (POF).

What is Premature Ovarian Insufficiency (POI)?

Premature ovarian insufficiency (POI) is a condition in which the ovaries run out of eggs and stop producing hormones, such that periods stop unusually early (i.e., before the age of 40 years). On average, the natural menopause occurs around the age of 51 years (usually between 45-55 years). Menopause between the age of 40-45 years is described as ‘early menopause’.

What causes Premature Ovarian Insufficiency (POI)?

Unfortunately, a cause for POI is not identified in most patients, however some causes of POI include:

• Genetic causes - such as Turner syndrome (whereby women only have one X chromosome as opposed to the usual two ‘XX’), or from changes in the gene responsible for Fragile X syndrome (called FMR1 gene premutation).
• Autoimmune diseases - whereby the body treats some of its own tissues as foreign, and the immune system attacks them inappropriately. Women with other autoimmune diseases such as type 1 diabetes mellitus, autoimmune thyroid disease, or Addison’s disease have an increased risk of POI.
• Cancer Treatments - Chemotherapy, radiotherapy, and other cancer treatments can lead to damage to the ovaries and an increased risk of POI. The ovaries may also need to be surgically removed as part of cancer treatment, which would bring on a sudden form of POI sometimes referred to as ‘surgical menopause’.
• Toxins - Exposure to toxins that harm the ovaries, which can include smoking.
• Other medical conditions – Rare inherited enzyme deficiencies e.g. galactosaemia, or infections like mumps or HIV can also increase the risk of POI.

What are the signs and symptoms of premature ovarian insufficiency?

The cessation of menstrual periods is the commonest symptom, and can be associated with other symptoms that can occur during menopause such as hot flushes, sweats, sleep disturbance and mood changes (See article on Menopause).

How common is premature ovarian insufficiency?

It is relatively uncommon, occurring in one in 1,000 women under the age of 30 years and 1-4% of women under the age of 40 years. Early menopause (40-45 years) occurs in up to 4-12% of women.

Is premature ovarian insufficiency inherited?

There may be a family history in 10-15% of women with POI, such that most women with POI do not have an inherited cause. Genes can also influence the exact timing of menopause that does not occur prematurely.

How is premature ovarian insufficiency diagnosed?

Diagnosis is made by clinical assessment, with periods having stopped for at least four months, and by blood tests measuring hormone levels that suggest decreased function of the ovaries. In particular, a blood test called ‘follicle stimulating hormone’ (FSH), would be expected to show persistently elevated levels on at least two occasions more than 4-6 weeks apart. A medical practitioner may also request tests to look for causes of POI, such as antibody or genetic tests.

How is premature ovarian insufficiency treated?

Unless contraindicated (for example in people with hormone-sensitive cancers) treatment is centred around replacing the hormones that the ovaries are no longer able to produce (in particular oestrogen, and additionally progesterone if the uterus is still present). Hormone replacement therapy (HRT, which is referred to as ‘Menopause Hormone Therapy’ or MHT when treating women with menopause) can help with relief of menopausal symptoms, prevent bone loss, and is thought to reduce the risk of cardiovascular disease in younger women. Alternatively, if contraception is needed the combined hormonal contraceptive is also an option.

Premature ovarian insufficiency (POI) is usually permanent, however depending on the cause, it can wax and wane in some women soon after diagnosis, more so than after the natural menopause. With regards to fertility, in vitro fertilisation (IVF) has a low chance of success using a woman’s own eggs as POI indicates that the ovaries are not functioning well and are unlikely to respond to hormonal stimulation, but receiving donated eggs can help facilitate pregnancy.

Are there any side-effects to the treatment?

HRT can cause breast tenderness, water retention, weight gain, nausea, headaches, and erratic vaginal bleeding. These symptoms depend on the type of HRT that is prescribed, and women should seek advice from their doctor if they have concerns about side-effects of their treatment. Changing the type of preparation or adjusting the dose of hormone treatment can reduce unwanted side-effects.

The baseline risks of breast cancer and heart disease is very low in women under the age of 40 years. Therefore, breast cancer, blood clots in the veins (known as venous thrombosis) and stroke which are risks associated with longer-term use of HRT are not increased when HRT is given in the context of POI up to the natural age of menopause (average age 51 years in the UK). Thereafter the balance of risks vs benefits can vary for each individual woman according to her medical history, the formulation and mode of administration (for more information see the Menopause page).

What are the longer-term implications of premature ovarian insufficiency?

Premature ovarian insufficiency (POI) means that the ovaries are not functioning well, and therefore the chance of conceiving is much reduced. However, the function of the ovaries can wax and wane during the early years after diagnosis of POI, more so than after the natural menopause, such that spontaneous pregnancy can still occur even after the diagnosis of POI. Pregnancy is also possible through assisted conception treatments such as ovulation induction or in vitro fertilisation (IVF) , however, the success of IVF is much reduced if the ovaries are not able to respond to hormonal stimulation very well, as is often the case in POI.

In the longer term, the loss of ovarian hormones, particularly oestrogens, if not replaced, can result in osteoporosis and an increased risk of heart disease. Regular exercise is a good, general health measure that can help maintain bone health, as well as helping to protect against heart disease and stroke. Women with POI are also encouraged to stop smoking, reduce stress, and try to maintain a healthy weight to reduce the risk of heart disease.

Listen to our Hormones: The Inside Story podcast episode on menopause

Learn more about premature/early menopause at Ask Early Menopause