Published: 18 Jun 2025

ICD9: 256.39      ICD10: E28.39      ICD11: GA30.6

Premature ovarian failure (POF), also known as primary ovarian insufficiency (POI), is a condition in which a woman's ovaries stop working normally before the age of 40.
This means they stop producing eggs regularly and produce lower levels of estrogen.

Here's a breakdown of what that means and key aspects of POI:

Key Characteristics:

Age of Onset: Before the age of 40 (typically diagnosed between 35 and 40, but can occur earlier).
Menstrual Irregularities or Absence: Periods become irregular, lighter, or stop altogether (amenorrhea). This is often the first noticeable symptom.
Elevated FSH Levels: Follicle-stimulating hormone (FSH) levels, measured on two separate occasions at least one month apart, are high. This indicates the brain is trying to stimulate the ovaries to produce eggs, but the ovaries are not responding.
Low Estrogen Levels: Estrogen, a key hormone produced by the ovaries, is low.

Impact and Symptoms:

Because the ovaries are producing less estrogen and not releasing eggs regularly, women with POI can experience a range of symptoms similar to those of menopause, including:

Infertility: The most significant concern for many women.
Hot Flashes: Sudden feelings of warmth and sweating.
Night Sweats: Similar to hot flashes but occurring at night.
Vaginal Dryness: Can lead to painful intercourse.
Sleep Disturbances: Difficulty falling asleep or staying asleep.
Mood Changes: Irritability, anxiety, depression.
Decreased Libido (Sex Drive): Reduced interest in sexual activity.
Difficulty Concentrating: Cognitive difficulties, sometimes referred to as "brain fog."
Bone Loss (Osteoporosis): Long-term estrogen deficiency increases the risk of weak and brittle bones.
Cardiovascular Issues: Estrogen helps protect against heart disease, so lower levels can increase risk over time.
Dry Eyes: Another symptom linked to estrogen deficiency.

Causes:

In many cases, the exact cause of POI is unknown (idiopathic). However, potential causes include:

Genetic Factors:
Turner Syndrome: A chromosomal disorder affecting females.
Fragile X Syndrome Premutation: Carrying a premutation for Fragile X can increase the risk.
Other genetic mutations.
Autoimmune Disorders:
The immune system mistakenly attacks the ovaries. Examples include Hashimoto's thyroiditis, Addison's disease, and type 1 diabetes.
Medical Treatments:
Chemotherapy: Can damage the ovaries.
Radiation Therapy: Especially if directed at the pelvic area.
Oophorectomy: Surgical removal of the ovaries.
Infections:
Rarely, certain infections like mumps can affect the ovaries.
Toxins:
Exposure to certain environmental toxins.

Diagnosis:

Diagnosis involves:

Medical History and Physical Exam: The doctor will ask about your menstrual cycles, symptoms, and family history.
Blood Tests:
FSH and Estradiol Levels: To check for high FSH and low estrogen. Repeated FSH tests are crucial.
Other Hormone Levels: To rule out other causes of menstrual irregularities.
Karyotype: Chromosome analysis to check for genetic disorders (like Turner syndrome).
Fragile X Premutation Testing: To check for the Fragile X premutation.
Autoimmune Antibody Testing: To look for autoimmune disorders.
Pelvic Ultrasound: To assess the ovaries.

Treatment:

POI is not generally reversible, but treatments can help manage symptoms and reduce long-term health risks:

Hormone Therapy (HT): The most common treatment. Estrogen replacement helps alleviate symptoms like hot flashes, vaginal dryness, and mood changes. It also protects against bone loss and cardiovascular disease. Progesterone is often added if the woman still has a uterus to protect against uterine cancer. The type and duration of HT should be discussed with your doctor.
Calcium and Vitamin D Supplements: To support bone health.
Lifestyle Modifications:
Healthy Diet: Important for overall health and bone strength.
Regular Exercise: Weight-bearing exercises can help improve bone density.
Smoking Cessation: Smoking can worsen symptoms and increase health risks.
Stress Management: Techniques like yoga, meditation, or counseling can help manage mood changes.
Fertility Treatment:
Egg Donation: The most common option for women with POI who want to have children. Eggs from a donor are fertilized with the partner's sperm (or donor sperm) and implanted into the woman's uterus.
Experimental Therapies: Some research is being done on therapies that might stimulate ovarian function, but these are still experimental.

Important Considerations:

Early Diagnosis is Key: Early diagnosis and treatment can help manage symptoms and reduce the long-term health risks associated with estrogen deficiency.
It's Not Early Menopause: While the symptoms are similar to menopause, POI is a distinct condition with potentially different underlying causes and management strategies.
Mental Health Support: The diagnosis of POI can be emotionally challenging, particularly due to the impact on fertility. Counseling or therapy can be beneficial.
Ongoing Monitoring: Regular check-ups with your doctor are important to monitor hormone levels, bone density, and overall health.
Spontaneous Ovulation: While rare, spontaneous ovulation and pregnancy can occur in women with POI. Contraception should be discussed if pregnancy is not desired.

If you are experiencing irregular periods or menopause-like symptoms before the age of 40, it is important to see your doctor for evaluation. A proper diagnosis can help you understand your options and manage your health.