Primary ovarian insufficiency (POI), also called premature ovarian failure, occurs when the ovaries have a decrease in estrogen production and ovulation before a woman turns 40.
The most common sign of POI are irregular or missed menstrual periods. Periods may occur off and on, or may start again many years after POI is diagnosed. Due to the drop in estrogen levels, women with POI may also have menopause-like symptoms, including:
In most cases the cause of POI is unknown. Women with certain genetic disorders, such as Turner syndrome and fragile X premutation carriers, are more likely to develop POI. Also, exposure to chemotherapy and radiation therapy can lead to POI. Last, autoimmune disease—when your immune system attacks your ovarian tissue—may be responsible for POI.
The risk of developing POI increases if you have a family history of the disorder.
Because women with POI have low levels of estrogen at a young age, several health problems are more common than in women without POI:
If you have POI, you may also be more likely to develop other hormone-related disorders. Women with POI should be checked periodically for deficiencies in thyroid and adrenal gland hormones.
If you are younger than 40 and have stopped having periods or are having irregular ones, talk with your doctor to find the cause of the problem. Your doctor will ask about your menstrual history and any menopause-like symptoms you may be having. Blood tests will be done to check hormone levels and determine if your ovaries are working properly. Additional tests should also be done to check for possible genetic or autoimmune conditions that may be related to the ovarian insufficiency.
Treatment depends on whether you have symptoms or are at risk for serious health problems. Hormone therapy (HT) is the most common treatment. HT combines estrogen and progesterone, another sex hormone. HT relieves menopausal symptoms and also helps prevent osteoporosis. HT can be taken as a pill or applied to your skin as a patch. Vaginal rings can also supply estrogen to the body.
In older, postmenopausal women, HT may increase risk of breast cancer, heart disease, and stroke. In younger women with POI, these risks are thought to be much lower, since it’s normal for women in this age group to have higher estrogen levels. Usually, HT is stopped when a woman with POI reaches the age of natural menopause (around age 50).
If you cannot or do not want to take HT, you might benefit from non-hormonal treatments. In addition to medical treatment, you can lower your risk of osteoporosis and heart disease by eating a healthy diet and exercising regularly.
The Hormone Health Network is the public education affiliate of the Endocrine Society dedicated to helping both patients and doctors find information on the prevention, treatment and cure of hormone-related conditions.
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