What is POI?

Primary Ovarian Insufficiency (POI), formerly called "premature ovarian failure," is when the ovaries stop working normally before age 40. The ovaries do not produce normal amounts of estrogen and do not regularly release eggs.

Who gets POI?

POI affects approximately 1 in 100 women under 40 and 1 in 1,000 women under 30. It can occur at any age after puberty.

Causes:

• Genetic Factors: Turner syndrome, Fragile X premutation, other chromosome abnormalities.
• Autoimmune Disorders: The immune system attacks ovarian tissue (often associated with thyroid disease, Addison's disease).
• Infections: Mumps, tuberculosis, CMV.
• Cancer Treatment: Chemotherapy and pelvic radiation can damage ovaries.
• Surgery: Multiple ovarian surgeries or oophorectomy.
• Idiopathic: In many cases (60-70%), the cause is unknown.

Symptoms:

• Irregular or missed periods (oligomenorrhea or amenorrhea)
• Hot flashes and night sweats
• Vaginal dryness
• Irritability or mood changes
• Decreased libido
• Difficulty concentrating
• Infertility

Diagnosis:

• Medical History: Missed or irregular periods before age 40.
• Hormone Tests:
  • Elevated FSH (>25-40 IU/L on two occasions, one month apart)
  • Low estradiol
  • Low AMH (Anti-Müllerian hormone)
• Karyotype: To check for chromosomal abnormalities.
• FMR1 Gene Testing: For Fragile X premutation.
• Autoimmune Screen: TSH, adrenal antibodies.

Treatment:

Hormone Replacement Therapy (HRT):

• Essential until natural menopause age (~50-51) to replace missing estrogen
• Protects bone health, heart health, and reduces menopausal symptoms
• Estrogen plus progestin (if uterus present)

Bone Health:

• Calcium (1200 mg/day) and Vitamin D supplementation
• Weight-bearing exercise
• Bone density monitoring (DEXA scans)

Fertility:

• Spontaneous pregnancy is rare but possible (5-10% chance)
• Egg donation is the most effective option for pregnancy
• Fertility counseling strongly recommended

Emotional Support:

POI diagnosis can be devastating, especially for women who desire children. Mental health support, support groups, and counseling are essential components of care.

Long-Term Health Monitoring:

• Cardiovascular disease risk
• Osteoporosis screening
• Thyroid and adrenal function
• Mental health