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Primary Ovarian Insufficiency (POI)

What is Primary Ovarian Insufficiency (POI)?

POI is a hormone deficiency. Treatments can help.

Although primary ovarian insufficiency (POI) is not fully understood by the medical community, we continue to bring to light what the research uncovers. We do know POI is a rare disorder caused by an issue within the ovaries’ follicles. In addition to being tiny pouches where eggs are held, the follicles are also responsible for producing estradiol, a critical chemical message in the blood of young women. In women with POI, these follicles don’t work normally, which causes estradiol hormonal deficiency, ultimately affecting the normal patterns of menstrual cycles and fertility. 

Primary ovarian insufficiency is not premature menopause, though it’s often confused with menopause considering the similarity in symptoms. In POI, ovaries may periodically function, and then stop; and then start and stop again, whereas menopause occurs when a woman’s body stops producing the hormones that cause a menstrual period entirely. It’s important to understand that there are effective treatments for POI and that it’s not a permanent obstacle to pregnancy or quality of life.

To determine if a woman has POI, her clinician will test her blood for follicle stimulating hormone (FSH). FSH will be higher than normal in women whose follicles are no longer working to produce normal levels of estradiol in the blood. This simple blood test will often be the only test needed to determine if a woman has POI.

POI Fast Facts:

  • POI is a hormonal deficiency.
  • POI is not menopause, rather it is a fluctuation of fertility and ovarian hormone cycles.
  • There are POI treatments available that have been proven to be safe and effective to relieve symptoms and restore health.
  • In about 10 percent of cases, the cause of POI can be determined by special testing; however, in most cases, the cause of POI remains a mystery.
  • There are steps women can take to optimize the chance of pregnancy when diagnosed with POI.
  • A small percentage of women with POI do get pregnant with their own eggs and have a healthy baby.

Understanding Ovarian Health and Hormones

Understanding POI begins with first understanding ovarian hormones. A woman’s reproductive system is a wonderfully complex system involving continuous communication between the brain and the ovary. The hypothalamus, pituitary, and ovary are the messengers that regulate the monthly cycle. Given the first sign of ovarian hormone complex is usually the loss of regular menstrual periods, it’s important to track your cycle’s regularity.

Women who have POI are deficient in estradiol, a critical hormone typically present in a young woman’s blood. Evidence has shown the onset of estradiol deficiency early in life is associated with a shorter life expectancy — among other health concerns — which makes education, early diagnosis, and treatment of POI critically important.  

You could have ovarian hormone complex if:

  • your menstrual cycles are erratic and unpredictable
  • your menstrual periods are less than 21 days or more than 35 days apart
  • you have bleeding or spotting between cycles
  • you skip periods (sometimes for months at a time)
  • you have had any of these symptoms in the past and were prescribed birth control pills with no testing to determine the cause of the abnormality

If any of these statements are true, it’s critical to ask your health care provider two questions:

1 –   What is my FSH?

2 – What is my prolactin?

Once you have these answers, you can move forward empowered to take control of your menstrual health.

Seeking the Right Treatment

If your doctor or healthcare professional has ever responded to your menstrual cycle symptoms with any of the following statements, it may be time for a second opinion. 

  •  “Your periods stopped due to stress.”
  •  “We don’t need to do any tests.”
  • “It is a blessing to not have any periods.”
  •  “All you can do is egg donation if you want to have a family.”
  • “Take birth control, and you’ll be fine.”
  • “Just let us know when you want to get pregnant.”
  • “There is nothing we can do for you now.”

Exploring the Scientific Evidence

  • Published evidence has demonstrated the most common problem preventing normal ovarian follicle function and ovulation in women with POI is inappropriate luteinization of growing follicles.
  • Published evidence has demonstrated the NIH P-HRT regimen suppresses serum LH levels to normal in women with POI. Published evidence has demonstrated you should be on the NIH P-HRT regimen to keep your bones healthy.
  • Theoretically, lowering the LH level in your blood should improve the chances of you ovulating by reducing the chances of the follicles becoming luteinized. This has not yet been proven by prospective study, however. As a group, women with POI should be advocating for more studies about how to improve their natural fertility.

We want women with POI to know there’s hope and there’s help.

Symptoms of POI

One of the early symptoms of the onset of POI is irregular or missed periods. As the disorder progresses and the hormonal deficiency worsens, other symptoms that resemble menopause may appear, including:

  • Hot flashes
  • Night sweats
  • Mood instability and irritability
  • Poor concentration and/or “brain fog”
  • Decreased libido
  • Painful intercourse
  • Vaginal dryness
  • Infertility

In addition, the hormonal deficiency caused by POI can upset other normal operations and processes within the body, which can often result in other conditions, such as: 

  • Osteoporosis. Although the hormone message estradiol is associated with reproductive organs, it also affects skeletal health and bone density. Without sufficient levels of estradiol, bones can become weak, brittle, and less dense, increasing risk for fracture.
  • Heart disease. The lower levels of estradiol in the body are associated with increased risk of hardened arteries, also called atherosclerosis.
  • Anxiety and depression. Rather than just short-term irritability or moodiness, POI can be associated with more longer-term mental health issues, even triggering the onset of depression and anxiety where there was no major problem before.

Dry eye syndrome. and other issues with the surface of the eye. Without treatment, severe dry eye can cause permanent vision damage.

Menstrual and Ovarian Health

Follow the Evidence

POI Fast Facts

POI is a hormonal deficiency. It is not menopause.

Read More

Know Your Numbers

Understanding estradiol deficiency begins with understanding ovarian hormones.

Read More

The Evidence

Research can help you make evidence-based decisions.

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Think Again

Educate and advocate. Your doctor may not be an expert.

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