Premature Ovarian Insufficiency (POI)
Premature ovarian insufficiency, also known as premature ovarian failure, happens when women ovaries stop working before the age of 40. It is normal to experienced reduced fertility and irregular periods around the age of 40. If a woman starts experiencing those symptoms before the age of 40, this is called premature menopause. Sometimes it can even happen in the teenage years.
POI is different from premature menopause. With premature menopause, your periods stop before age 40. At this point, you can no longer get pregnant. The cause can be natural, or it can be a disease, surgery, chemotherapy, or radiation. With POI instead, some women can still have occasional periods. They may even get pregnant. In most cases of POI, the underlying cause is unknown.
Many research shows that POI is usually related to problems with the follicles. Follicles are defined as small “sacs” in your ovaries. Your eggs grow and mature inside them. One type of follicle-related problem is that you run out (they basically finish) of working follicles earlier than normal. Another problem is that the follicles are not working as they should. In most cases though, the cause underlying the follicle problem remains unknown.
But sometimes the cause may be between the ones below:
- Genetic disorders such as Fragile X syndrome and Turner syndrome
- A very low number of follicles
- Autoimmune diseases, including thyroiditis
- Chemotherapy or radiation therapy
- Some metabolic disorders
- Toxins exposure, such as cigarette smoke, chemicals, and pesticides
The first sign of POI is usually irregular or missed periods. Later symptoms are referred to be similar to those of natural menopause including
Some woman wait years to visit a specialist, but usually, for most women with POI, trouble getting pregnant or infertility is the main reason they go to their health care provider.
Risks related to Premature Ovarian Insufficiency
Since POI causes a decrease in certain hormones level, you become at greater risk for other health conditions, those including
- Dry eye syndrome and surface disease. Some women with POI present one of these eye conditions. Both can cause discomfort and may lead to something called blurred eye vision. If not treated on time, these conditions are likely to cause permanent eye damage.
- Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
- Heart disease. Lower levels of oestrogen can affect the muscles lining the arteries and increase the build-up of cholesterol. These factors together increase your risk of atherosclerosis (which is known as the hardening of the arteries).
- Low thyroid function. This problem is also known as hypothyroidism. The thyroid is a gland and it makes hormones that control your body’s metabolism and the energy level. Low levels of thyroid hormones can affect your metabolism and cause very low energy, mental confusion, and other symptoms.
- Osteoporosis. The hormone oestrogen helps keep bones strong. With low oestrogen levels, women with POI are more likely to develop osteoporosis. It is a bone disease that causes weak, brittle bones making them more likely to break.
How are you diagnosed?
After visiting your health care provider or gynaecologist, they may diagnose your POI by looking at:
- A medical history, including asking whether you have relatives already with POI
- A pregnancy test, to make sure that you are not pregnant in that specific moment.
- A physical exam, to look for signs of other disorders which could be causing your symptoms
- Blood tests, to check for certain hormone levels. You may also have a blood test to perform chromosome analysis.
- A pelvic ultrasound, to see whether the ovaries are enlarged or have multiple follicles, which can help POI diagnosis.
Which are the available treatments for POI?
Currently, there is no proven treatment that is able to restore normal function to a woman’s ovaries. But it is possible to treat some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions as well that POI can cause:
- Hormone Replacement Therapy (HRT). HRT seems to be the most common treatment. It gives your body the oestrogen and other hormones that your ovaries are not making any longer. HRT improves sexual health and decreases the risks of heart disease and osteoporosis. You usually carry on taking it until about age 50; that’s about the age when natural menopause usually begins.
- Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should increase the daily amount of calcium and vitamin D.
- In vitro fertilisation (IVF). If you have POI and you wish to become pregnant, you IVF could be something you can consider.
- Regular physical activity and a healthy body weight. Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease. I will also get you an overall better health.