Definition

Primary ovarian insufficiency (POI) is the loss of ovarian function before 40 years of age. The ovaries are two small, oval-shaped organs in the pelvis. They release eggs and certain hormones called estrogen and progesterone.

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Causes

In most women, the cause is not known. In others, it may be caused by problems that harm the ovaries, such as:

• Ovarian surgery or removal
• Medical treatment, such as radiation therapy or chemotherapy
• Environmental toxins
• Genetic problems, such as Turner syndrome and galactosemia
• A problem with the immune system
• Viral infections, such as mumps, tuberculosis, and malaria

Risk Factors

The risk of this problem increases with age. The risk is also higher in women who have been treated for cancer.

Symptoms

Missed or irregular periods are often the first symptom. Other problems may be:

• Hot flashes
• Night sweats
• Irritability
• Problems with focus
• Lack of interest in sex
• Pain during sex
• Vaginal dryness
• Problems getting pregnant

Diagnosis

The doctor will ask about your symptoms and health history. A physical and a pelvic exam will be done.

A blood test will be done to check hormone levels.

Treatment

Any underlying causes will need to be treated.

The goal of treatment is to manage any problems caused by the change in hormones. Options are:

• Hormone replacement therapy (HRT) or estrogen/progestogen contraceptive pills to replace hormones until the age of natural menopause
• Dietary changes or supplements that contain vitamin D and calcium to support bone health and lower the risk of osteoporosis
• Lifestyle changes, such as exercising regularly, maintaining a healthy weight, and not smoking
• Mental health therapy to cope with the emotions of having POI

Infertility is a common problem with POF. In vitro fertilization (IVF) may be an option for women who want to become pregnant.

Prevention

Women with cancer should discuss treatment options with their doctors.