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Specialised Management

Premature ovarian insufficiency

What is premature ovarian insufficiency?

Premature ovarian insufficiency (POI), also known as premature menopause, is when menopause occurs in women younger than 40 years of age.

What causes premature 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 family history of early menopause. 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 premature ovarian insufficiency?

POI may cause 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 oestrogen deficiency (i.e. hot flushes, mood changes, sleep deprivation, vaginal dryness or poor lubrication during sexual arousal)
  • Difficulty falling pregnant

Diagnosing premature 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 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.

Premature 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 use donor eggs or donor embryos.

Treating premature ovarian insufficiency

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

  • Hormone replacement therapy: this acts to replace the hormones that the ovaries would otherwise be producing.
  • The combined oral contraceptive pill (OCP): this also acts as a hormone replacement up to the age of 50.
  • Oestrogen therapy: this is advised for younger women for further symptom relief and for bone protection.

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

Want to find out more?

If you have been diagnosed with or suspect you may have POI, and that it may be affecting your ability to fall pregnant, you can arrange a nurse chat or book an appointment with one of our fertility doctors.