Understanding Premature Ovarian Insufficiency (POI)
Premature Ovarian Insufficiency or POI occurs when the ovaries slow down or stop producing hormones before the age of 40. It affects around 1 in 100 women and can happen naturally or as a result of medical treatments including chemotherapy, radiotherapy or surgery involving the ovaries.
Women with POI may notice changes such as missed or irregular periods, hot flushes, night sweats, mood changes or vaginal dryness. For some women, the first sign is difficulty falling pregnant. Because symptoms can vary, POI is often under-recognised or misdiagnosed, yet early identification is fundamental to protect long-term health.
Why POI happens
POI has many possible causes, but in most cases no specific reason is found (this is called idiopathic POI). Known causes can include:
Genetic conditions such as Turner syndrome or Fragile X premutation
Autoimmune conditions disorders, like thyroid or adrenal disease
Medical treatments such as chemotherapy or pelvic radiation
Surgical removal or damage to the ovaries
Lifestyle factors like smoking, very low body weight or severe stress can also contribute to earlier ovarian decline.
Diagnosing POI
Diagnosis usually begins when a woman under 40 has missed periods for four months or more. A blood test is used to measure the hormone FSH (follicle-stimulating hormone). If FSH levels are consistently high in the menopausal range on two separate occasions about six weeks apart and other causes such as pregnancy, thyroid problems or high stress are ruled out, POI can be confirmed.
Additional tests may check for genetic or autoimmune conditions or evaluate bone density and heart health as oestrogen deficiency can affect these systems.
Health and emotional effects
Losing ovarian function early affects more than fertility. Low oestrogen levels can impact bone strength, heart health, mood and cognitive function. Women with POI have a higher risk of osteoporosis, cardiovascular disease and sometimes anxiety or low mood.
The emotional impact of diagnosis can also be significant. Many women describe feelings of grief, loss of identity or worry about fertility and long-term health. Compassionate support and reliable information are essential parts of care.
Fertility and pregnancy
While natural conception is sometimes possible, fertility treatments and complementary medicines may offer a pathway to pregnancy. Women who don’t wish to conceive will also need contraception, as spontaneous ovulation and pregnancy can still occasionally occur. Equally important is nurturing emotional wellbeing through counselling, mindfulness or connecting with others who understand your journey.
Treatment and support
The cornerstone of medical treatment is menopausal hormone therapy (MHT), previously referred to as hormone replacement therapy (HRT). Oestradiol in the form of patches or gel (not oral application) and micronised progesterone (not progestins) are bioidentical hormones that mimic the hormones naturally produced by the body and are often used in combination for women under the age of 60 or those within 10 years of the last period. MHT replaces oestrogen that the ovaries no longer make, protecting the heart, bones and brain while relieving symptoms like hot flushes, low mood or vaginal dryness.
For those who can’t or prefer not to use hormones, there are non-hormonal and complementary medicine approaches that may help reduce symptoms such as nutrition, movement, stress support and specific supplements or herbs chosen for your individual needs. Every woman’s experience will be different and treatment should always reflect that.
Living well with POI
While the diagnosis can feel overwhelming, many women go on to lead healthy, fulfilling lives. With the right treatment, regular follow-up and emotional support, it’s possible to protect long-term health and restore confidence in your body.
If you’ve noticed irregular periods or changes that concern you, seek healthcare professional guidance early for information, support and personalised care can make all the difference.
References available upon request