Primary ovarian insufficiency (POI) is when chronologically young ovaries are behaving older than they are, by about a decade. Ovarian failure before the age of 40 is consistent with a diagnosis of POI. Infrequent to absent periods are the most common presenting feature of POI. Someone with POI typically has low estrogen levels and high levels of follicle-stimulating hormone.
POI affects about one percent of the female population. The prevalence is different at different ages and increases as people get older.
“I just want to clarify,” says Dr. Pal, “that women with POI have about a 10 percent chance of spontaneous ovulation. Unlike age-appropriate menopause, which on average takes place at about 51 years, women with POI still have a few eggs in their ovaries. Their ovaries are just not responding to their own hormones. So there is always a small probability they will ovulate and can even get pregnant. Pregnancy, however, is rare.”
About half of the time, there’s no known cause for early menopause, says Dr. Pal: “The etiology may never be known. Genetic abnormalities may cause the condition. I may look fine, but my ovarian genetics may not be completely normal.”
However, there are some health factors that can be linked to a higher chance of early menopause. People with the following conditions are more likely to have POI at a younger age:
- Certain chromosomal abnormalities, such as mosaic Turner’s syndrome — when a piece of X-chromosome is missing in some but not all cells.
- Conditions such as galactosemia, which is a metabolic genetic disorder related to carbohydrate handling.
- Autoimmune conditions can also present a higher risk. For example, someone with Hashimoto’s thyroiditis may want to have a conversation with their health care provider about timely fertility planning.
Read how Flo helped a couple with Hashimoto’s disease get pregnant.
Some people with POI have no signs until they stop having their periods.
“What I often see as a specialist,” says Dr. Pal, “is that young women who are on birth control pills don’t know their biology is abnormal until they start planning their pregnancy. And when they stop taking the pill to try to get pregnant, they don’t get their period. The earliest sign that happens for them is not getting their periods.”
“Some people with POI have no signs. For others, the earliest sign is not getting their periods.”
Another common scenario for POI is when someone has no trouble getting pregnant for the first time, but then their periods don’t return after they stop breastfeeding.
Another possibility is when periods started regular, became irregular, and then just stopped.
“But there is no single pattern,” says Dr. Pal.
“It’s important to recognize that POI can run in the family.”
It’s important to recognize that POI can run in the family. If the women in your family have experienced early menopause, you’re more likely to experience it too. It’s important to have awareness around this condition, but there’s no single symptom that defines it.
So, do people who experience early menopause need treatment?
“That’s a great question!” says Dr. Pal. “People with POI and in good health need to be on estrogen-based hormonal therapy because this population is at high risk for bone fractures, osteoporosis, cardiovascular disease, Parkinson’s disease, and even dementia. There is a whole list of health concerns relating to POI that merit attention.”
As far as fertility is concerned, donor egg in vitro fertilization and adoption are the only two options available to people with POI right now. There are some research studies examining other options that look promising, but they haven’t made it to the clinical world yet.
“I just wanted to add one thing,” says Dr. Pal. “Egg donation can be a very expensive undertaking unless someone within the family offers to donate their eggs. However, siblings of people with POI may not be the best egg donors, as their ovarian response is likely to be less than someone else who is unrelated.”
