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Previous terms include ‘premature ovarian failure syndrome’, ‘premature ovarian failure’ (POF).
Premature Ovarian Insufficiency (POI) is a condition in which the ovaries stop producing eggs unusually early (i.e. before the age of 40 years). The natural menopause generally occurs around the age of 51 years (usually between 45-55 years). Menopause before the age of 45 years can be described as ‘early menopause’.
It is not always possible to identify the reason as to why POI has occurred.
However, some known causes include:
The cessation of menstrual periods is the commonest symptom, and can be associated with other symptoms that can occur during menopause such as hot flushes, sweats, sleep disturbance and mood changes.
It is relatively uncommon, occurring in one in 1,000 women under the age of 30 years and 1-4% of women under the age of 40 years. Early menopause (less than 45 years) occurs in up to 12% of women.
Approximately 10% of patients with POI have a hereditary cause, such that most women with POI do not have an inherited cause. Genes can also influence the exact timing of menopause that does not occur prematurely.
Diagnosis is made by clinical assessment, with periods having stopped for at least 4 months, and by blood tests measuring hormone levels that suggest decreased function of the ovaries. In particular, a blood test for follicle stimulating hormone (FSH) levels, would be expected to show persistently elevated levels on at least two occasions more than 4-6 weeks apart. A medical practitioner may also request tests to look for causes of POI, such as antibody or genetic tests.
Treatment is centred around replacing the hormones that the ovaries are no longer able to produce (in particular oestrogen, and additionally progesterone if the uterus is still present). Hormone replacement therapy (HRT, which is referred to as Menopause Hormone Therapy or MHT when treating women with menopause) can help with relief of menopausal symptoms, prevent bone loss, and reduce the risk of cardiovascular disease in younger women.
Premature ovarian insufficiency (POI) is usually permanent, however depending on the cause, it can wax and wane in some women soon after diagnosis, more so than after the natural menopause. With regards to fertility, in vitro fertilisation (IVF) has a low chance of success using a woman’s own eggs as POI indicates that the ovaries are not functioning well and are unlikely to respond to hormonal stimulation, but receiving donated eggs can help facilitate pregnancy.
HRT can cause tender breasts, water retention, weight gain, nausea, headaches and erratic vaginal bleeding. These symptoms depend on the type of HRT that is prescribed, and women should seek advice from their doctor if they have concerns about side effects of their treatment. Changing the type of preparation or adjusting the dose of hormone treatment can reduce unwanted side effects.
Longer-term use has been linked with a small increase in the risk of breast cancer discussed in more detail in the article on menopause. An increased risk of blood clots in the veins (known as venous thrombosis) and of stroke is associated with the tablet form of oestrogens in HRT, but not with other modes of administration such as patches or gels. The balance of risks vs benefits can vary for each individual woman according to her medical history and thus HRT is best discussed with a medical practitioner.
In general terms, some risks of HRT are reduced if started at a younger age (as is the case in women with POI), and sooner after the menopause has occurred. Therefore, it is usually beneficial for women with POI to take HRT until the age that the natural menopause would have occurred (usually at least 51 years).
Premature ovarian insufficiency means that the ovaries are not functioning well, and therefore the chance of conceiving is much reduced. However, the function of the ovaries can wax and wane during the early years after diagnosis of POI, more so than after the natural menopause, such that spontaneous pregnancy can still occur even after the diagnosis of POI. Pregnancy is also possible through assisted conception treatments such as in vitro fertilisation (IVF) treatment, however, the success of IVF treatment is much reduced if the ovaries are not able to respond to hormonal stimulation very well, as is often the case in POI.
In the longer term, the loss of ovarian hormones, particularly oestrogens, if not replaced, can result in osteoporosis and an increased risk of heart disease. Regular exercise is a good, general health measure that can help maintain bone health, as well as helping to protect against heart disease and stroke. Women with POI are also encouraged to stop smoking, reduce stress, and try to maintain a healthy weight to reduce the risk of heart disease.
Learn more about premature/early menopause at Ask Early Menopause
Last reviewed: Apr 2022
