Primary Ovarian Insufficiency (POI)

Primary ovarian insufficiency (POI) refers to significantly diminished or absent ovarian function before age 40 and affects 1-2% of girls and women. If your ovaries fail, they don’t produce normal amounts of hormones or release eggs regularly. Infertility is a common result.
POI is sometimes referred to as premature menopause, but POI does not always mimic the natural menopausal transition. Women with POI may have irregular or occasional periods for years, waxing and waning of symptoms, and occasionally pregnancy. Signs and symptoms of POI are often related to diminishing estrogen production and altered hormone profiles.

American endocrinologist Fuller Albright first used the term “primary ovarian insufficiency” in 1942. POI is also known as primary ovarian failure.

Signs And Symptoms Of Primary Ovarian Insufficiency

  • Shortening menstrual cycles and/or pre-cycle spotting
  • Ovulating unusually early in the menstrual cycle or not ovulating at all
  • Irregular or skipped periods, which may be present for years or not be recognized until after a pregnancy or stopping birth control pills
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Irritability
  • Difficulty concentrating
  • Mood lability

Primary ovarian insufficiency likely results from one of three processes: failure to establish an initial egg pool, more rapid egg depletion, or follicular (egg and surrounding cells) dysfunction.

Causes Of Follicle Depletion Include:

Chromosomal Defects
Certain genetic disorders are associated with primary ovarian insufficiency. These include Turner’s syndrome, a condition in which a woman has only one X chromosome instead of the usual two, and many other conditions in which part or a piece of the X chromosome is missing or there is a mosaicism of cell lines. There are several other genetic mutations on a variety of chromosomes that have been associated with POI.
Chemotherapy and radiation therapy (for cancer or autoimmune conditions) are the most common causes of toxin- induced ovarian failure or oocyte depletion. These therapies may damage the genetic material in cells. Other environmental toxins such as cigarette smoke, chemicals, pesticides and viruses may hasten ovarian failure.
When surgery on the ovary involves removal of ovarian tissue (cyst removal, endometriosis surgery, ovarian drilling, ovarian torsion) or alters ovarian blood supply at the time of pelvic or tubal surgery thousands of eggs are lost and cannot be replenished.
An Immune System Response to Ovarian Tissue
Your immune system may produce antibodies against your own ovarian tissue, harming the egg-containing follicles and damaging the egg. What triggers the immune response is unclear, but exposure to a virus is one possibility.
Receptor or Signal Abnormalities
The proteins produced by the brain to communicate with and/or stimulate the ovaries may be altered or abnormal. Conversely, the ovarian receptors these proteins bind to may be abnormal or dysfunctional.

While this list includes established causes of POI, over 90% of women diagnosed will have no identifiable cause using current diagnostic tests. We are dedicated to the research surrounding POI, diminished ovarian reserve, and other causes of abnormal ovarian aging.
For patients diagnosed with POI, the most common fertility treatment includes donor eggs. 
For young patients who are beginning to experience the symptoms of POI, fertility preservation may be an option.