What is Premature Ovarian Insufficiency (POI)?

Premature or Primary Ovarian Insufficiency, also called premature ovarian failure (POF) occurs when the ovaries normally stop working in women who are younger than 40 years. This condition is characterised by the following:

  • Infrequent ovulation or complete stop of follicle growth and ovulation
  • Decrease or stop of production of reproductive hormones

Development of POI often is a slow process, in case it is not caused by treatment with chemotherapy or radiation or extensive ovarian surgery. Some women with POI do not stop menstruating totally, but could experience very irregular or infrequent periods. Hence, the condition does not always mean that pregnancy is impossible. However, it may be very difficult.

POI may affect women at any age, even while they are teenagers.

Premature ovarian insufficiency and premature ovarian failure, are sometimes used synonymously, but failure more exactly refers to permanent infertility and complete reduction of follicles.

What are the causes of POI?

In most cases, the cause of POI is unknown. However, there are several known causes, among them is the genetic cause (example: Turner syndrome and Fragile X syndrome, parental consanguinity). Moreover, the condition may be also associated with autoimmune disease, including those affecting the thyroid and adrenal glands.

Therefore, it is assumed that there might be some hereditary influence, as POI can be found in females of the same family. It may also develop after a pelvic surgery, which causes ovarian tissue damage or exposure to radiation or chemotherapy treatment for cancer.

What are the symptoms of POI?

The typical symptoms are irregular bleeding or amenorrhea (absence of menstruation period) and usual symptoms or signs of estrogen deficiency, like found in perimenopausal women. e.g. hot flushes, sweating at night, mood fluctuations, osteoporosis, vaginal atrophy, and decreased libido.

How is POI diagnosed?

Premature ovarian insufficiency can be diagnosed based on the clinical findings, serum FSH levels and the level of the Anti-Muellerian-Hormone (AMH). These tests might have to be repeated to confirm the diagnosis. Other tests like karyotype may help to find the cause of ovarian insufficiency or failure in women below 35.

If a patient believes that she may be at risk of having or developing POI, she should consult a gynaecologist specialised in reproductive endocrinology. Further information will be discussed by our consultants in the outpatient department during your consultation.

How is POI treated?

Unfortunately for non-reversible causes of POI, no treatments exist to reverse the ovarian failure. Since this condition is related primarily to the depletion of afollicle in the ovaries; there is no medical or surgical treatment to make more eggs once they are gone.

Since POI is related primarily to depletion of follicles in ovaries, once all of them have gone, there is no medical or surgical method that can restore normal function or make more eggs. In cases where the cause of POI is non-reversible, unfortunately, at the momentno treatments exist to reverse the condition.

For medically- induced causes of POI such as radiation and chemotherapy, in some cases part of the ovarian function may return naturally over time. Hormonal therapy can be used to treat the symptoms related to the hormonal deficiency.

For women who desire to conceive, in some selected cases an in vitro fertilization (IVF) might be an option. Book an appointment with us, to discuss further information about the possible treatment options.

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