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Primary ovarian insufficiency (POI) means the ovaries stop working normally before age 40. Fertility naturally declines with age, usually from around 40 or later, and periods may become irregular on the way to menopause. With POI these changes come early — sometimes as early as the teenage years.
Not the same as premature menopause
| Premature menopause | POI | |
|---|---|---|
| Periods | stop before 40 | may still come now and then |
| Pregnancy | no longer possible | sometimes still possible |
| Cause | natural, or disease, surgery, chemotherapy or radiation | unknown in most cases |
What causes it
In about 90% of cases the exact cause is unknown. Research points to the follicles — the small sacs in the ovaries where eggs grow and mature. Either they run out earlier than normal, or they don't work properly. Sometimes a cause can be found:
- genetic disorders such as Fragile X syndrome and Turner syndrome;
- a low number of follicles;
- autoimmune diseases, including thyroiditis and Addison disease;
- chemotherapy or radiation therapy;
- metabolic disorders;
- toxic exposures — cigarette smoke, chemicals, pesticides.
Who is at higher risk
- Family history — a mother or sister with POI.
- Genes — certain gene changes and genetic conditions, such as Fragile X or Turner syndrome.
- Certain diseases — autoimmune diseases and some viral infections.
- Cancer treatment — chemotherapy and radiation.
- Age — POI can happen young, but is most common between 35 and 40.
Symptoms
The first sign is usually irregular or missed periods. Later come symptoms like those of natural menopause: hot flashes, night sweats, irritability, poor concentration, lower sex drive, pain during sex and vaginal dryness. Many people first see a provider because of trouble getting pregnant.
Health risks
POI lowers certain hormone levels, which raises the risk of:
| Condition | Why |
|---|---|
| Osteoporosis | estrogen keeps bones strong; without enough, bones become weak and brittle |
| Heart disease | low estrogen affects the artery walls and increases cholesterol buildup, raising the risk of atherosclerosis |
| Anxiety and depression | hormonal changes can contribute |
| Dry eye and eye-surface disease | uncomfortable, can blur vision, and untreated can cause permanent damage |
| Hypothyroidism (low thyroid function) | low thyroid hormone can cause very low energy and mental sluggishness |
| Infertility |
Diagnosis
- a medical history, including relatives with POI;
- a pregnancy test;
- a physical exam for signs of other disorders;
- blood tests for certain hormones, and possibly a chromosome analysis;
- a pelvic ultrasound to see whether the ovaries are enlarged or have multiple follicles.
Treatment
There is no proven way to restore normal ovarian function, but symptoms and risks can be treated:
- Hormone therapy for menopause (hormone replacement therapy, HRT) — the most common treatment. It replaces the estrogen and other hormones the ovaries aren't making, improves sexual health and lowers the risk of heart disease and osteoporosis.
- Calcium and vitamin D every day, because of the osteoporosis risk.
- In vitro fertilization (IVF) for those who want to become pregnant.
- Regular exercise and a healthy weight, to lower the risk of osteoporosis and heart disease.
- Treating related conditions, with medicines and hormones as needed.
Sources
Based on "Primary Ovarian Insufficiency," MedlinePlus, U.S. National Library of Medicine, drawing on the NIH National Institute of Child Health and Human Development; a work of the United States government in the public domain.
Licens: CC0 1.0 (offentligt eje) · Bearbejdet efter medlineplus.gov
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