Premature ovarian insufficiency (POI)

If your periods become irregular or stop before 40, get them checked. One possible reason is premature ovarian insufficiency (POI), which means the ovaries stop working normally earlier than expected. Some US information calls it primary ovarian insufficiency.

POI can affect your fertility, bones and heart as well as causing symptoms. Being told you have POI can be hard. You need space to talk about how you feel, and to ask about pregnancy if that matters to you.

Symptoms that can prompt a check

As well as missed or irregular periods, symptoms can include hot flushes, night sweats, vaginal dryness, trouble sleeping, low mood and less interest in sex. You may notice changes in memory or concentration too. Your clinician will look at these changes together, because symptoms alone can’t show that you have POI.

POI can follow chemotherapy, radiotherapy or surgery to remove the ovaries. If treatment isn’t the reason, genetic or immune causes may be looked into. Sometimes no exact cause is found. Ask what the tests could tell you and whether genetic counselling is relevant to you.

Why blood-test plans may differ

Checks include your period history and blood tests, including follicle-stimulating hormone (FSH). If your periods have stopped, pregnancy needs to be ruled out. Hormonal contraception can affect both bleeding and FSH results, so tell the clinician what you use. Don’t stop prescribed contraception or other hormones without agreeing a plan with your doctor.

In the UK, NICE asks for a raised FSH level on 2 blood samples taken 4 to 6 weeks apart, along with relevant symptoms. The newer international guideline published by ASRM allows one raised FSH result together with the typical symptoms and history. It repeats the test if there is doubt. These approaches differ, so ask which guidance your specialist follows.

An anti-Müllerian hormone (AMH) test is not the main test for POI. A specialist may use it in some unclear cases. These tests need a clinician to explain them. A home fertility test can’t replace this check.

Hormone replacement and longer-term health

NICE recommends offering a choice of HRT (hormone replacement therapy) or combined hormonal contraception, unless these aren’t suitable. Treatment usually continues until at least the age of natural menopause. The international guideline also recommends hormone treatment until the usual age of menopause, even without symptoms of low oestrogen. Your specialist can advise which option suits your health and what you prefer.

Follow-up also looks after your bones and heart. The international guideline recommends a bone density scan where available. It also recommends checking your risk of heart disease and testing for cholesterol problems and diabetes. Its advice includes weight-bearing exercise, a healthy diet and not smoking. Ask what follow-up you need rather than arranging tests or supplements yourself.

Fertility choices and support

POI greatly lowers the chance of getting pregnant without fertility treatment. If POI wasn’t caused by surgery, the ovaries may still work at times, and pregnancy is possible. HRT is not contraception. If you want to avoid pregnancy, ask about contraception alongside your POI treatment.

Donor eggs are a well-established fertility treatment. No treatment has been reliably shown to restart the ovaries and raise the chance of getting pregnant naturally. A fertility specialist can talk through the options without assuming what you want to do next. You can ask for time before you decide.

If you’re due to have treatment that could affect your ovaries, ask about preserving your fertility first. The international guideline recommends talking about this with people at risk of POI. It also accepts that preserving fertility often isn’t possible once you have POI. Have this talk with the team planning your treatment, alongside the reasons you need the treatment.

Asking for care beyond the blood tests

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