Premature ovarian insufficiency (POI)

Hello everyone


This blog is the next part of the series on Premature Ovarian Insufficiency(POI). Last time we discussed the occurrence of the condition and how it is important to be aware of it.


Even though many people are unfamiliar with POI, it’s not exactly a rare condition.


"FACTS DO NOT CEASE TO EXIST BECAUSE THEY ARE IGNORED”

Having spoken with hundreds of women in the past few years dealing with infertility, I can definitely say that Primary Ovarian Insufficiency is one of the most distressing conditions.


And the obvious reason is that it affects relatively younger women who by nature are least likely to have an issue with conceiving. This journey to fertility is challenging and sometimes difficult to handle, but with knowledge, expertise, and support along the way, anything is possible!

Who is at risk of premature ovarian insufficiency?
  • Age: the risk increases between the age of 35 to 40. In rare situations, it could affect women under the age of 30 and even teenagers.

  • Ovarian surgery: previous surgeries involving the ovaries increase the risk of POI

  • Family history: having a close family member like a sister, mother of POI increases the risk of developing one.

What are the causes?

Although fertility treatments and artificial reproductive techniques have progressed immensely in the last decade, there are some things that are still difficult to diagnose and justify. One of these cases is Premature Ovarian Insufficiency. In about 90% of the cases, the cause is unknown. From the known cases though, 20%-30% is reported to be associated with autoimmune diseases.


Research indicates that follicle problems (e.g dysfunctional follicles making it impossible for the eggs to grow and mature inside) may cause ovarian insufficiency.

Therefore, the diagnosis might be difficult and stressful for women suffering from infertility due to this condition. Some of the known causes are the following:

  • Some genetic disorders such as Turner Syndrome, Fragile X Syndrome

  • Toxins such as chemicals, pesticides, and cigarettes

  • Autoimmune diseases such as thyroiditis and Addison disease

  • Radiation therapy or chemotherapy

  • Metabolic disorders

The main symptom of POI is absent or irregular menstrual periods.

Others are

  • Hot flashes

  • Night sweats

  • Irritability

  • Poor sleep

  • Poor concentration

  • A decrease in sex drive

  • Pain during sex

  • Vaginal dryness

  • Mood swings

Women with POI may present with symptoms typical of menopause, sometimes preceded by menstrual cycle changes. Hot flushes and night sweats are characteristic of estrogen deficiency. Vaginal symptoms, dyspareunia, and dryness may be very distressing for the patient. Other symptoms include sleep disturbance, mood changes, poor concentration, stiffness, dry eyes, altered urinary frequency, low libido, and lack of energy. (refer to the previous blog on menopause for more information).

Symptoms may be transient or intermittent and may be variable in severity, reflecting the fluctuations in ovarian activity that occur during the spontaneous onset of POI.


In contrast, women experiencing l menopause due to surgery and cancer treatment usually have severe and persistent symptoms. POI is not exactly the same as premature menopause because there are chances of egg formation occasionally which can result in pregnancy.

How is Premature Ovarian Failure diagnosed?

There is always a possibility of misdiagnosing and that’s the reason why it is necessary to exclude causes of menstrual cycle dysfunction such as thyroid disorder -evaluating TSH level - and hyperprolactinemia -evaluating prolactin level.

Although women might notice signs of POI, the condition may be suspected only if your periods stop being regular or if you are having trouble getting pregnant.

Before diagnosing POI, the doctor might recommend a pregnancy test, hormone levels tests, or even search for certain genetic/gene defects such as Fragile X Syndrome. The diagnosis of POI is usually confirmed in women < 40 years by a combination of a 4-6 month period of absent or irregular menses and two measurements of elevated follicle-stimulating hormone (FSH). Some women with POI express FSH levels lower than these proposed cut-off values.


Hot flashes or vaginal dryness might suggest POI if it is combined with lack of period or irregularity of cycles. But the absence of these symptoms does not necessarily mean that there is no POF. In order to be 100% sure that it is indeed POI you are dealing with, you may need to take some blood tests measuring AMH (anti-müllerian hormone) level, FSH, and Estradiol Level and it might be necessary to assess the AFC (antral follicle count) in the ovaries by a transvaginal sonogram.


All in all, irregular cycle or no cycle at all, an elevated FSH, low Estradiol levels, an insignificant level of AMH, in women younger than 40 years old, can be consistent with Premature Ovarian insufficiency.


Since it is an early age disorder -sometimes in women under 30 years of age- it is very important to offer support to these women in order for them to process better an infertility issue that was not expected.


The battle against infertility may seem uneven sometimes, but thanks to the extended research and expertise on the matter, the chances of winning are becoming more each day!


Thank you.

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Stay Safe Stay Healthy.