What is premature ovarian insufficiency (POI)?
Premature ovarian insufficiency (POI) is when the ovaries stop working normally before age 40, so periods become irregular or stop and estrogen levels are low. It affects about 1 in 100 people under 40. Unlike menopause, ovarian function can come and go, and around 5 to 10% of people with POI still conceive naturally.
Signs
- Irregular or missed periods, or periods stopping (secondary amenorrhea)
- Hot flashes and night sweats
- Vaginal dryness and lower libido
- Sleep problems, low mood, anxiety and poor concentration
- Difficulty getting pregnant
Causes
Often no cause is found. Known causes include genetic conditions (such as Turner syndrome or a fragile X premutation), autoimmune disease, chemotherapy or radiotherapy, and surgery on the ovaries.
Diagnosis and treatment
Doctors diagnose POI from irregular or absent periods for at least 4 months plus a raised FSH level on two tests a few weeks apart. Because low estrogen at a young age affects bones, heart and mood, hormone replacement is usually recommended until at least the average age of menopause. Egg donation and IVF are options for those who want a pregnancy.
The emotional side
A POI diagnosis can bring grief, shock and worries about fertility and identity. Low estrogen itself can also affect mood. Support groups and counseling help many people, alongside the medical treatment.
See a doctor if your periods stop for 3 months or more before age 40 and you are not pregnant, or you have menopause symptoms in your 20s or 30s.
Frequently asked questions
Is POI the same as early menopause?
Not quite. In POI the ovaries can still work on and off, so periods and even pregnancy are possible. Menopause is permanent.
Can you get pregnant with POI?
About 5 to 10% of people with POI conceive naturally. Egg donation offers higher chances.
Sources
- NICHD: Primary Ovarian Insufficiency (POI)
- NHS: Early menopause
- MedlinePlus: Follicle-Stimulating Hormone (FSH) Levels Test
This page is for information only and isn鈥檛 medical advice. If something worries you, please talk to a doctor.
Keep reading
Menopause: definition and meaningMenopause is the point 12 months after your last period, usually around age 51. What it means, how it differs from perimenopause, and common symptoms.
What is secondary amenorrhea?Secondary amenorrhea means your periods stop for 3 months or more after you've had them before. Common causes, tests, and when to see a doctor.
Ovarian reserve: definition and meaningOvarian reserve is the number of eggs left in your ovaries. How AMH and follicle counts estimate it, what it can and can't predict, and how age affects it.Menopause, gently explainedMenopause explained kindly: what it is, the average age, how it's confirmed, what changes in your body and mood, treatment options and when to see a doctor.Infertility: definition and meaningInfertility means not getting pregnant after 12 months of regular unprotected sex, or 6 months if you're 35 or older. Causes, tests and next steps.