Endocrine Disorders

Primary ovarian insufficiency

What is primary ovarian insufficiency (POI)?

Primary ovarian insufficiency happens when a woman's ovaries stop working normally before she is 40. It is sometimes confused with premature menopause, but these conditions aren't the same. Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant. But women with premature menopause stop having periods and can't become pregnant.

What causes primary ovarian insufficiency?

There are many factors that have been linked with POI, such as smoking, hysterectomy, HIV infection, illicit drug use, adverse life events, genetic factors, or a family history of early menopause. Immune system-mediated damage to the ovaries is also well-known in people with other auto-immune conditions such as rheumatoid arthritis and lupus. It can happen spontaneously in about 1 in 100 women, and up to 8 per 100 women have POI due to other causes such as chemotherapy or surgery.

What are the symptoms of primary ovarian insufficiency?

POI may cause a range of symptoms and they can vary among individuals. Not all symptoms are experienced by one individual, but some of the following may be present:

• Irregular menstrual periods
• No menstrual periods
• Symptoms of estrogen deficiency (i.e. hot flushes, mood changes, sleep deprivation, vaginal dryness, or poor lubrication during sexual arousal)
• Difficulty falling pregnant

Diagnosing primary ovarian insufficiency

There isn’t a specific test available that can reliably diagnose POI at present. Current diagnostic criteria include the following:

• 4-6 months of no menstrual bleeding whilst not taking hormone therapy (i.e. the oral contraceptive pill)
• High Follicle Stimulating Hormone (FSH) levels; a hormone that is important for controlling the function of ovaries
• Low Anti-Mullerian Hormone (AMH) levels; a hormone that is used to predict the number of eggs in a woman’s ovaries (see low ovarian reserve for more information). Currently, AMH levels have been found to be the best predictor of POI.

Your fertility doctor will exclude other similar diseases before diagnosing POI.

Primary ovarian insufficiency and fertility

For women who have been diagnosed with POI, there is still a low chance (1-5% over a lifetime) of becoming pregnant spontaneously; however, egg freezing or IVF treatment may still be an important consideration depending on your individual situation. Many women with POI achieve a pregnancy using donor eggs or donor embryos.

Treating primary ovarian insufficiency

Depending on how old you are or where you are at in your life plan, some of the following options available to you are:

• Investigating and treating underlying causes.
  
• Egg-freezing if appropriate.
  
• Hormone replacement therapy: this acts to replace the hormones that the ovaries would otherwise be producing.

At Flinders Fertility, your clinical and emotional needs are very important to us, and we have a multidisciplinary team including a reproductive endocrinologist available to help you achieve the best outcome for your situation.