Premature ovarian insufficiency
Also known as:
POI, premature menopause, primary ovarian insufficiency
Loss of normal ovarian function before 40. Hormone replacement protects bone, heart and brain until the usual age of menopause.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
What it is
In POI, the ovaries stop working normally before age 40. Function can fluctuate, so periods and even pregnancy occasionally return. Causes include genetic conditions (Turner syndrome, FMR1 premutation), autoimmune disease, chemotherapy, radiation and surgery, though often no cause is found.
Symptoms
• Irregular or absent periods
• Hot flashes and night sweats
• Vaginal dryness
• Difficulty conceiving
How it's diagnosed
Guidelines diagnose POI when periods are absent or irregular for at least four months and FSH is elevated above 25 IU/L. Workup usually includes a karyotype, FMR1 premutation testing and screening for associated autoimmune conditions such as thyroid and adrenal disease.
Treatment
Hormone replacement is recommended at least until the average age of natural menopause, to protect bone, heart and brain health. Options include estradiol with a progestogen, or combined hormonal contraception when contraception is also wanted. Fertility counseling matters: spontaneous pregnancy is possible but uncommon, and donor egg IVF offers the highest success.
Clinical pearls
• Doses needed in POI are often higher than typical postmenopausal doses.
• Check bone density at diagnosis.
• Emotional support is part of care: the diagnosis can be a significant loss.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Category
Menopause & bone
Also known as
POI, premature menopause, primary ovarian insufficiency
Reviewed by
Farhan Tahir, MD
Questions about your own care?
Dr. Tahir’s team offers consults through Youthful Medicine.
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