Premature Ovarian Insufficiency

Premature ovarian insufficiency (POI), previously referred to as premature ovarian failure, is a condition in which a woman’s ovaries lose their normal function at an earlier than expected age. This means that the ovaries will significantly decrease the amount of estrogen and progesterone they produce in addition to ceasing to produce eggs. Generally, this condition applies to women younger than 40 years of age and not having periods for more than 4 months with confirmatory lab testing. Approximately 1% of all women will experience POI. As a direct result of this condition, women may experience infertility and other symptoms of menopause. Women may have irregular periods, hot flashes, vaginal dryness or insomnia.

There are many causes of POI including autoimmune and genetic conditions. There are also circumstances in which a woman may have been exposed to earlier in her life that may precipitate POI such as chemotherapy, radiation, surgery on the ovaries, and certain infectious agents. However, in up to 90% of cases the actual cause of POI remains unknown.

TREATMENT

Women with POI have several options to address the specific goals of treatment. Ultimately, the goals of care are tailored to the individual’s symptoms and her desired treatment goals in an effort to address menopausal symptoms, bone health and fertility options. Genetic testing may be warranted to address the cause of early ovarian failure.

PREGNANCY

In most cases, POI leads to a depletion of the available eggs and thus a natural pregnancy may not be possible. In certain cases a woman may be eligible to attempt a cycle of controlled ovarian hyperstimulation to attempt an IVF pregnancy with her own eggs. Natural cycle IVF may be another option if spontaneous ovulation occurs. When a woman is no longer having regular menstrual cycles, treatment with estrogen can also be attempted to achieve spontaneous ovulation.

Women who want to become pregnant may consider using donor eggs as they are still able to carry a pregnancy even when menopausal. Pregnancy rates with donor egg are excellent as success is mostly dependent on the age of the egg, not the uterus.

HORMONAL BALANCE

Hormonal treatment for women experiencing menopausal symptoms can address quality of life issues while also maintaining bone health. Typically hormonal treatment will consist of estrogen and progesterone which may be safely continued up to about age 51, the average age for menopause. Calcium and vitamin D supplementation are also important for decreasing the risk of osteoporosis.