What is premature ovarian insufficiency (POI)?
POI is a clinical condition characterised by gonadal failure and elevated gonadotropin production in women under the age of 40 years, also known as primary ovarian insufficiency or premature menopause. The ovaries fail to function properly or respond normally to gonadotropins, such as follicle-stimulating hormone (FSH). Women with POI tend to experience a range of symptoms including:
Irregular or cessation of menses
Lack of normal vaginal discharge
Lack of breast development/decrease in breast size
Mental health issues including depression and anxiety
In addition, POI can have long-term consequences that range in severity and can often impact on women’s quality of life:
The prevalence of POI is approximately 1% and varies with ethnicity. The risk of spontaneous POI typically increases with age from 1 in 1000 women under 30 to 1 in 100 women under 40 years of age.
So why does POI occur and what causes it?
What causes POI?
The short answer is that usually, we don’t know. There might be a whole host of reasons for developing POI or the reason might not be so obvious. Often, POI can be linked to chromosomal abnormalities resulting in the abnormal development of the ovaries, Fragile X syndrome due to a premutation in the FRM1 gene, or chemotherapy and radiation therapy. Despite these associations, predicting imminent POI is not easy.
How is POI treated?
The main treatment goal in POI is to replace the hormones that are lacking. This treatment is typically provided as oestrogen and progesterone in hormone replacement therapy (HRT). HRT is important not only to relieve symptoms but also to support bone, cardiovascular and sexual health.
How can POI impact day-to-day life?
Women with POI can live healthy lives while on HRT. While side effects may occur, HRT can be modified and optimised to suit each patient.
One major issue associated with POI is infertility. However, if a woman decides to have children, there are several options available to them:
In-vitro fertilisation (IVF) – donor eggs can be fertilised in-vitro and implanted into the patient’s uterus. The patient would then carry and deliver the baby. However, patients are encouraged to consult with their gynaecologist to ensure that any fertility treatment they receive is best suited to them
Oocyte cryopreservation/vitrification – prior to chemotherapy or radiation therapy, women might have the option to freeze their eggs
Adoption/foster parenting – women with POI might want to consider this option if they are physiologically unable to conceive
Interestingly, women with POI can experience spontaneous pregnancies. There is a 5-10% chance that ovarian function can resume; therefore, it is important for patients to have discussions on effective contraception with their healthcare providers, unless pregnancy is desired.
In some cases, a POI diagnosis is unexpected and can have emotional implications for the patient. As such, it is important for patients to be informed about the diagnosis, to understand how they feel and to talk with a counsellor or therapist if necessary.
It should be noted that optimised HRT can bring hormone levels in POI back to normal and there are options if the patient chooses to have children, so women with POI can live healthy normal lives. In addition, there is continuous research into the causes and long-term consequences of POI to help patients manage their condition.
The EMAS conference on 15th-17th May in Berlin will be packed with nuggets of new research and data on this interesting topic, and we look forward to hearing more in the insightful talks and poster sessions during the conference.
 Zegers-Hochschild F, Adamson GD, Dyer S, et al. The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril. 2017 Sep;108(3):393-406. doi: 10.1016/j.fertnstert.2017.06.005
 Center for Young Women’s Health, Boston Children's Hospital. Primary Ovarian Insufficiency. https://youngwomenshealth.org/2013/06/20/primary-ovarian-insufficiency/ [Accessed April 2019]
 ESHRE. Guideline on the management of premature ovarian insufficiency. https://www.eshre.eu/-/media/sitecore-files/Guidelines/POI/ESHRE-guideline_POI-2015_FINAL_11122015.pdf?la=en&hash=4956225FEC25B0A0752F79EDEAD1A3D4237D1568
 Fenton AJ. Premature ovarian insufficiency: Pathogenesis and management. J Midlife Health. 2015 Oct-Dec;6(4):147-53. doi: 10.4103/0976-7800.172292.
 ACOG. Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. Obstet Gynecol. 2014 Jul;124(1):193-7. doi: 10.1097/01.AOG.0000451757.51964.98