Primary Ovarian Insufficiency (POI)

Key Takeaways

Primary Ovarian Insufficiency can be triggered by various factors, including genetic abnormalities, metabolic disturbances, and specific health conditions.
Despite menopause-like symptoms, ovaries may still function to a degree with POI, necessitating the need for contraceptive use.
Where fertility is a concern, treatment options like In Vitro Fertilization, embryo donation, and Ovarian Tissue Cryopreservation and Transplantation can be used.

What is it?

Primary Ovarian Insufficiency (POI) (also called Premature Ovarian Insufficiency and Premature Ovarian Failure) is when the ovaries fail to release eggs regularly. This condition disrupts the normal menstrual cycle and often results in infertility. The disruption may lead to menopause before the age of 40, which is called premature menopause. POI is typically diagnosed in young adulthood when women notice irregular menstrual cycles.

What causes it?

While some cases of POI are attributable to genetic factors, chromosomal abnormalities, metabolic disturbances, autoimmune disorders, health conditions like human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), as well as specific medical or surgical treatments, the underlying cause often remains unclear.

Despite experiencing symptoms akin to menopause, the ovaries in women with POI may still be functional to some extent, so they should use contraceptives as appropriate. POI affects a woman’s fertility and has implications for overall health and wellness, including increased risks of health conditions such as osteoporosis and cardiovascular disease.

Premature & Early Menopause

Premature and early menopause differ in the age at which menopause begins and some of the causes. Premature menopause occurs before 40 years. Early menopause occurs between 40 and 45 years. Both can be induced from surgical or medical procedures. Premature menopause may result from POI. Early menopause can occur naturally. Regardless of the cause, premature and early menopause increase health risks because of the more extended period with lower levels of hormones, such as estrogen, compared to the majority of women.

Where fertility is a concern, specialized treatments are available, such as In Vitro Fertilization (IVF) using donor eggs, which allows a woman to carry a child that is genetically related to their partner. Embryo donation is another option involving implanting a fertilized embryo (including frozen embryos not used by other couple’s IVF treatments) into the uterus. Experimental procedures like Ovarian Tissue Cryopreservation and Transplantation (OTCT) involve freezing ovarian tissue and later thawing and transplanting it back into the body. When a woman does not have a uterus as a result of a Total Hysterectomy, for example, she can complete IVF through surrogacy, or undergo a Uterus Transplantation (also known as Uterine Transplantation). In this procedure, surgeons implant a healthy donor’s uterus into the recipient.

While not a fertility treatment and a rare unintended consequence, Hormone Replacement Therapy (HRT) may induce ovulation. This inducement happens because the hormones from the therapy can stimulate the ovaries enough to release an egg. Last, couples may consider a gestational carrier, where carrying a pregnancy is not advisable, or fostering or adopting children.

Experiencing menopause before the typical age can be physically and emotionally taxing. Women also face increased health risks due to extended periods of reduced hormone levels. Many options exist to safeguard health from associated impacts, as well as navigate the path of fertility. Support from healthcare professionals, family, and support groups can be invaluable during this period. Additionally, if you experience symptoms such as menstrual changes, vasomotor symptoms such as hot flashes, or sleep disturbances, consult a healthcare professional to determine if the symptoms are menopause related or related to hormonal disorders or other health conditions.

Frequently Asked Questions

What is the youngest age to experience menopause?

Menopause can technically occur at any age after menstruation, however, before age 30 is rare, and between ages 45 and 55 is typical.

Premature menopause, before age 40, may occur because of Primary Ovarian Insufficiency (POI) as a result of genetic factors, autoimmune disorders, chromosomal abnormalities, or other medical conditions, or due to being induced by surgical or medical interventions, such as a bilateral oophorectomy, where both ovaries are surgically removed, leading to abrupt cessation of hormone production by the ovaries, or pelvic radiation therapy.

Is Premature Ovarian Failure the same as premature menopause?

Premature Ovarian Failure, also called Premature Ovarian Insufficiency and more commonly Primary Ovarian Insufficiency (POI) differs from premature menopause, although the terms are used interchangeably. POI, which involves early loss of ovarian function, typically before the age of 40, can lead to symptoms like irregular periods or the absence of periods (amenorrhea), and often leads to premature menopause.

However, unlike premature menopause, where ovarian function ceases completely and menstrual periods and ovulation stop, women with POI may still have some intermittent ovarian function and the potential for occasional ovulation, meaning they may still be able to conceive.

Can you get pregnant with Premature Ovarian Failure?

Pregnancy with Premature Ovarian Failure, also called Premature Ovarian Insufficiency and more commonly Primary Ovarian Insufficiency (POI) is possible, yet unlikely to occur naturally, as the ovaries intermittently fail to produce normal amounts of estrogen or release eggs regularly. So, while a woman with POI may occasionally ovulate, and can technically become pregnant, it is unlikely as POI typically leads to reduced fertility due to decreased egg production.

Assisted Reproductive Technologies (ARTs), such as In Vitro Fertilization (IVF), are often considered for women wishing to conceive. These technologies can utilize donor eggs, which significantly increases the chances of a successful pregnancy for women with POI.