Primary Ovarian Insufficiency (POI): Causes, Symptoms and Treatment

Introduction

Primary Ovarian Insufficiency (POI) is a condition in which the ovaries lose their usual function before the age of 40. In normal situations, the ovaries release eggs at intervals, regulate menstrual cycles, and produce hormones such as estrogen and progesterone. In POI, there is a loss of this very balance of function, resulting in amenorrhoea or irregular menstruation, sterility, and evidence of deficiency in hormones.

In contrast to natural menopause, which can occur at the age of 45–50, POI may strike at a younger age, even in females as young as teenagers or those in their twenties. POI differs from menopause because in POI, ovarian function can be less definite; females continue to ovulate, and in exceedingly rare instances, become pregnant spontaneously.

Today, professionals offer proper diagnosis, hormonal regulation, and advanced fertility treatment to assist women in coping with POI symptoms, promote long-term well-being, and realise their wish to become mothers.

What is Primary Ovarian Insufficiency?

POI is an ailment where the ovaries lose their normal function prematurely, which results in reduced egg production and secretion of reproductive hormones. It not only impairs fertility but also health since estrogen keeps some organs healthy, i.e., bones, heart, and brain.

Main Characteristics of POI:

• Ovaries stop producing eggs on a regular schedule before age 40
• Low secretion of estrogen results in menopausal symptoms
• Irregular or absent menstrual cycles
• Increased risk of infertility and long-term illnesses such as osteoporosis

POI goes undetected in many women for a few years, and they blame the symptoms on stress or irregular lifestyles.

Causes and Risk Factors for POI

The pathogenesis of POI is not homogeneous and is often multifactorial. In some women, the aetiology (causes) is clear, but in others, it is unknown.

Genetic Factors

• Chromosomal abnormalities such as Turner syndrome can affect ovarian development.
• Females with the Fragile X premutation are at risk.
• A family history of POI predisposes one to developing the condition.

Autoimmune Disorders

• The immune system sometimes mistakenly attacks ovarian tissue, leading to premature loss of function.
• POI may occur in conjunction with other diseases, such as thyroid disease or adrenal disease.

Medical Treatment

• Cancer, chemotherapy and radiotherapy have the potential to damage ovarian tissue.
• Ovarian surgery (for endometriosis or for cysts) will reduce ovarian reserve.

Unknown Causes

In about half of the instances, there is no known cause for it, hence the need for early detection and monitoring. Similar to endometriosis, other reproductive conditions like primary ovarian insufficiency failure and premature ovarian failure can also cause menstrual irregularities, ovarian insufficiency symptoms, and even early menopause.

POI vs PCOS vs Menopause – Finding Out the Difference

Women confuse POI with Polycystic Ovary Syndrome (PCOS), or early menopause, but the two are different.

Important Note: Women with POI do actually still ovulate, in contrast to menopause and PCOS, not because they have too many immature follicles, but because they have a low ovarian reserve.

Diagnosis of Primary Ovarian Insufficiency

Diagnosis of POI is mostly ignored as the majority of women will, in the first instance, blame irregular periods on stress, PCOS, or lifestyle changes.

Diagnostic Process:

• Medical history and physical examination to ascertain symptoms and risk factors
• Blood tests for serum to measure hormone levels:
• FSH (Follicle Stimulating Hormone): Elevated levels confirm reduced ovarian function
• Estrogen: Low in the majority of cases of POI
• LH and AMH (Anti-Müllerian Hormone): To check for ovarian reserve
• Thyroid function tests to rule out thyroid disease
• Pelvic sonogram to assess the number of follicles and the size of the ovaries
• Genetic testing if POI is suspected due to genetic causes

Diagnosis is usually made with FSH persistently elevated and estrogen decreased, combined with symptoms and absent or irregular menstruation.

Treatment of Primary Ovarian Insufficiency

POI cannot be cured, but some medications can regulate symptoms, preserve long-term health, and provide fertility.

Hormone Replacement Therapy (HRT)

• Replaces estrogen and progesterone balance
• Reduces hot flashes, night sweats, and vaginal dryness
• Slows osteoporosis and heart disease

Fertility Choices

• IVF using donor eggs: Ideal option for women with POI
• Preserving ovarian tissue: Useful in some cases before chemotherapy or radiation
• Surrogacy: An Option if pregnancy cannot be sustained

Lifestyle and Supportive Care

• A healthy diet rich in calcium and vitamin D keeps bones strong
• Regular exercise improves overall health and reduces stress
• Psychological counselling and support groups allow women to deal with POI's emotional toll

POI and Fertility

Most women suffer due to the effects of POI on fertility. Since the ovaries cease functioning periodically and stop producing eggs, natural conception becomes possible but not likely.

Women with irregular cycles who want to become pregnant will need to come in early for management of fertility preservation when ovarian reserve reaches zero. However, with advanced fertility care, fertility options for POI, such as IVF, hormonal support, or experimental treatments, can provide hope.