What is Primary Ovarian Insufficiency or POI?

What is Primary Ovarian Insufficiency or POI?

More than one in 100 women have menopause before they are 40 years old, one in 1000 before the age of 30, so it is not so rare. When your ovaries stop producing eggs and hormones at this earlier age, it is diagnosed as Premature Ovarian Insufficiency or POI. The process of menopause is different to a later ‘ordinary’ menopause in that it is an autoimmune condition in which the body may attack the eggs or the hormonal receptors to make them not function. You usually have 2 blood tests (a few weeks apart) to check your hormone levels to diagnose POI.

POI can be caused by

  • autoimmune conditions that mistakenly attack ovarian tissue
  • treatments for cancer like chemo or radiotherapy
  • some genetic conditions such as Fragile X or Turner Syndrome
  • surgery that removes or impairs your ovaries

Symptoms of POI are the same as menopause, as they all relate to the body reacting to a lack of oestrogen, progesterone and testosterone. Your fertility may be compromised as there will not be a monthly release of an egg. (There may be an occasional egg released though, so if you’re having penis-vagina sex, contraception is still advised if a pregnancy is not desired).

The health risks associated with menopause become particularly important if you’re diagnosed with POI, as you will be living longer without these important hormones. The main two diseases of concern are the bone weakening disease osteoporosis and cardiovascular disease that may lead to circulation problems, heart attack or stroke.

It is strongly recommended that HRT is taken to reduce these risks, at least until the average age of a typical menopause at 51 years. You will also be at risk of genitourinary syndrome of menopause (GSM) and may be advised to use vaginal oestrogen, which helps reduce any dryness, thinning and fragility of the genital tissue as well as minimising the risk of incontinence and infections.

Some women choose to use contraception to provide the hormones – which can feel more age appropriate if you’re in your 20s or 30s. However, treating POI symptoms with birth control does not help reduce the risks to future health diseases mentioned as much as traditional HRT.

You ought to have bone scans to check the strength of your bones at diagnosis and regular intervals. Living a clean lifestyle is also very beneficial to living with POI.

Many women find it helpful to gain support from other women with POI. There is a charity called the Daisy Network that has information and support groups for this.