Premature ovarian insufficiency (POI)

Periods that become irregular or stop before 40 deserve an assessment. Premature ovarian insufficiency, or POI, is one possible explanation: the ovaries lose activity earlier than expected. The term is also written as primary ovarian insufficiency in some US information.

POI can affect fertility, bones and heart health as well as symptoms. Hearing that you have POI can be difficult. There needs to be space to talk about how you feel, as well as questions about pregnancy if that matters to you.

Symptoms that can prompt a check

Alongside missed or irregular periods, symptoms can include hot flushes, night sweats, vaginal dryness, sleep difficulties, low mood and reduced interest in sex. Changes in memory or concentration can occur too. Your clinician will consider these changes together; symptoms alone cannot identify POI.

POI can follow chemotherapy, radiotherapy or surgery to remove the ovaries. Genetic or immune-related causes may be investigated when treatment is not the explanation. Sometimes no exact cause is found. Ask what the suggested investigations could tell you and whether genetic counselling is relevant.

Why blood-test plans may differ

Assessment includes your period history and blood tests, including follicle-stimulating hormone, called FSH. Pregnancy needs to be excluded when periods have stopped. Hormonal contraception can affect both bleeding and FSH results, so tell the clinician what you use. Do not stop prescribed contraception or other hormones without discussing the plan with your doctor.

In the UK, NICE specifies raised FSH on 2 blood samples taken 4 to 6 weeks apart, alongside relevant symptoms. The newer international guideline published by ASRM allows a single raised FSH assessment with the characteristic clinical picture, repeating it when there is uncertainty. These approaches differ; ask which guidance your specialist is following.

An anti-Müllerian hormone test, usually called AMH, is not the primary test for POI. A specialist may use it in selected uncertain cases. A clinician needs to interpret these tests. A home fertility result cannot replace this assessment.

Hormone replacement and longer-term health

NICE recommends offering a choice of HRT or combined hormonal contraception unless these treatments are unsuitable. Treatment generally continues until at least the age of natural menopause. The international guideline also recommends hormone therapy until the usual menopause age, even without symptoms of low oestrogen. Your specialist can advise which option fits your health and preferences.

Follow-up also includes care for your bones and heart health. The international guideline recommends a bone-density scan where available, assessment of cardiovascular risk and checks for cholesterol problems and diabetes. Weight-bearing activity, a healthy diet and avoiding smoking are also part of its advice. Ask what follow-up you need rather than arranging tests or supplements yourself.

Fertility choices and support

POI substantially reduces the chance of conceiving without fertility treatment. With non-surgical POI, ovarian activity can still occur and pregnancy is possible. HRT does not provide contraception. If you want to avoid pregnancy, ask about contraception alongside treatment for POI.

Donor eggs are an established fertility treatment option. No treatment has reliably been shown to restore ovarian activity and increase the chance of conceiving naturally. A fertility specialist can discuss the options without assuming what you want to do next. You can ask for time before making decisions.

If treatment that could affect the ovaries is planned, ask about fertility preservation beforehand. The international guideline recommends discussing this with people at risk of POI, while recognising that preservation is often not possible once you have POI. This is a discussion to have with the team planning treatment, alongside the reasons that treatment is needed.

Asking for care beyond the blood tests

Book a GP appointment in the UK, or see your doctor elsewhere, for symptoms or changes to periods before 40. If POI is confirmed, ask about specialist follow-up and psychological support. The international guideline recommends care tailored to you, including support for emotional wellbeing. Ask for time to discuss how you feel alongside your treatment options.