When a woman receives a diagnosis of Primary Ovarian Insufficiency (POI), one of the first and most urgent questions she asks is: “What kind of doctor should I see?”
The honest answer is complicated — because our current medical system is not built around the needs of women with Primary Ovarian Insufficiency.
The Reality: Many Women Feel Abandoned
Women often tell me that Reproductive Endocrinology and Infertility (REI) specialists—the very doctors most familiar with ovarian hormones—frequently decline to see them unless they are trying to get pregnant.
This is not because REIs don’t care; it’s because their training and clinical structures are narrowly focused on fertility treatment, not chronic care. Most REI clinics are built around assisted reproduction. They rarely have systems in place to provide ongoing hormonal, metabolic, and emotional support for a young woman living with a chronic life-long condition like Primary Ovarian Insufficiency. That gap leaves women stranded between specialties — too young for menopause clinics, too complex for routine gynecology, and often misunderstood by general endocrinologists.
Primary Ovarian Insufficiency Is a Chronic Condition – Not a Fertility Failure
POI affects far more than fertility. It is a multisystem endocrine disorder involving the ovarian ecosystem—the intricate network linking the ovary to the brain, pituitary, immune system, and other organs.
It can lead to reduced estradiol levels, bone loss, cardiovascular risks, and emotional distress. These are chronic, lifelong health concerns — not temporary side effects of infertility. Women need care that acknowledges this broader context, not care limited to whether or not they wish to conceive.
A Better Model: Integrated Ovarian Ecosystem Care
What women with POI truly need is integrated, lifelong care that connects disciplines – not one more silo.
A forward-thinking care team might include:
- A gynecologist or reproductive endocrinologist who understands physiologic hormone replacement, even when fertility is not the goal.
- An internist or endocrinologist who monitors long-term bone, heart, and thyroid health.
- A psychologist or counselor trained in reproductive grief and identity adjustment.
- A nurse or care coordinator who ensures continuity and access to evolving science.
This is not “menopause care.” It’s ecosystem care – rooted in understanding how the body’s systems interconnect, and how disruption in the ovary reverberates through them all.
Coalition, Not Competition
POI World Day can inspire a coalition between reproductive medicine, endocrinology, and women’s health – not confusion over who “owns” this condition.
Women with POI need physicians who are willing to learn across boundaries. We can and must train the next generation of clinicians to think differently — to see the woman, not just her fertility.ed labels and toward a model of care that restores balance – body, mind, and hope.
Service. Truth. Heritage.
Our heritage in medicine calls us to serve those who fall between the cracks. Our truth demands that we distinguish Primary Ovarian Insufficiency from menopause. Our service must be to the women themselves – body, mind, spirit, and will.
Primary Ovarian Insufficiency is not the end of womanhood. It is a condition that invites science, compassion, and courage. Women with POI deserve doctors who embody all three.
Take care and be well,
Dr. Lawrence M. Nelson, MD, MBA
Director, My 28 Days® Initiative
President, Mary Elizabeth Conover Foundation, Inc.
