“Premature ovarian insufficiency (POI)
is a condition defined by
loss of ovarian activity before the age of 40 years”.1

Umbrella

What may the Premature Ovarian Insufficiency Umbrella include?

Depending on the Source (DotS) this umbrella may include:

  • Impending Menopause
  • Premature Ovarian Failure (POF)
  • Premature Ovarian Insufficiency (POI)
  • Primary Ovarian Insufficiency (POI)

Premature Ovarian Insufficiency

What is premature ovarian insufficiency (POI) or primary ovarian insufficiency?

DotS the definition of POI may vary. On page 26 in the Guideline on Premature Ovarian Insufficiency: Guideline Group Statement, published online 08 December 2024, the ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI’s definition is:

Premature Ovarian Insufficiency“Premature ovarian insufficiency (POI) is a condition defined by loss of ovarian activity before the age of 40 years.

POI is characterised by amenorrhea or irregular menstrual cycles with elevated gonadotropins and low estradiol”.2

What is ESHRE, ASRM, CREWHIRL and IMS?

In the context above, these abbreviations stand for the:

Premature Menopause

Is premature menopause the same as POI?

In Primary Ovarian Insufficiency: Symptoms & Causes – Overview the (United States) Mayo Clinic note:

“Sometimes, primary ovarian insufficiency is confused with premature menopause. But they aren’t the same. People with primary ovarian insufficiency can have irregular or occasional periods for years. They might even get pregnant. But people with premature menopause stop having periods and can’t become pregnant”.3

POI Common or Not

How common is POI?

In Premature Ovarian Insufficiency: How Common Is Premature Ovarian Insufficiency? You and Your Hormones, the (United States) Society for Endocrinology elaborate on:

“It is relatively uncommon, occurring in one in 1,000 women under the age of 30 years and 1-4% of women under the age of 40 years. Early menopause (40-45 years) occurs in up to 4-12% of women”.4

POI and Periods

Can women with POI have periods?

In Menopause Before 40 and Spontaneous Premature Ovarian Insufficiency the Australasian Menopause Society (AMS) note:

“Women with spontaneous POI have irregular or no periods”.5

POI and Pregnancy

Can women with POI become pregnant?

In Premature and Early Menopause: What Causes Premature and Early Menopause? POI and Fertility the (Australian) Jean Hailes for Women’s Health explain:

“If you have been diagnosed with POI and do not want to become pregnant, you should use contraception. Many women are unable to conceive a baby naturally after POI; however, there is a one in 50 chance of a spontaneous pregnancy”.6

POI and Menopausal Symptoms

Can women with POI have menopausal symptoms?

In Menopause Before 40 and Spontaneous Premature Ovarian Insufficiency the AMS note:

“Women may or may not have menopausal symptoms such as hot flushes”.7

POI Symptoms

What may be POI symptoms?

In Premature Ovarian Insufficiency (POI): Summary – What Are the Symptoms of Primary Ovarian Insufficiency (POI)? according to the (United States) Medline Plus:

“The first sign of POI is usually irregular or missed periods. Later symptoms may be similar to those of natural menopause:

  • Hot flashes
  • Night sweats
  • Irritability
  • Poor concentration
  • Decreased sex drive
  • Pain during sex
  • Vaginal dryness

For many women with POI, trouble getting pregnant or infertility is the reason they go to their health care provider”.8

Hormone Therapy

Is there a role for HT for women with POI?

In the British Menopause Society’s BMS Consensus Statement Premature Ovarian Insufficiency: Summary of Recommendations, reviewed March 2024, one of the recommendations is:

“Women with POI are at increased risk of cardiovascular disease, osteoporosis and cognitive impairment. Sex steroid hormone replacement is likely to lower the long-term risk of cardiovascular disease in women with POI, prevent osteoporosis and have a beneficial effect on cognitive function”.9

On page four of Menopause and Menopause Hormone Therapy: 2. What Is MHT? the International Menopause Society’s (IMS) Leaflet for Women for World Menopause Day 2024, the IMS note:

Premature Ovarian Insufficiency“MHT is also recommended for:

  • Premature Ovarian Insufficiency: When menopause happens before the age of 40. Even if there are no symptoms, MHT helps protect against conditions like osteoporosis (weak bones), heart disease, and brain issues”.10

Chronic Disease

Is there an association between POI and chronic disease?

In Optimising Health After Early Menopause: Summary, published 05 March 2024, a paper included in The Lancet: Series From the Lancet Journal – Menopause 2024 also published on 05 March 2024, the authors note:

“Both early menopause and premature ovarian insufficiency can herald an increased risk of chronic disease, including osteoporosis and cardiovascular disease”.11

POI Guideline 2024

What is the POI Guideline published October 2024?

According to the International Menopause Society in Update of the 2015 Evidence Based Guideline on Premature Ovarian Insufficiency – Now Published:

“To improve the care of women with POI, an international expert group, including representation from ESHRE, ASRM, CRE-WHiRL and IMS collaborated to address 40 key questions through 145 recommendations”.12

In Guideline on Premature Ovarian Insufficiency the European Society of Human Reproduction and Embryology (ESHRE) explain:

Premature Ovarian Insufficiency“This updated guideline offers best practice recommendations for the care of women with with both primary and secondary premature ovarian insufficiency (POI). POI is a clinical condition defined by the loss of ovarian function indicated by irregular menstrual cycles together with biochemical confirmation of ovarian insufficiency before the age of 40”.13

In International Monash Partnership Announced for Premature Ovarian Insufficiency Guidelines, dated 10 December 2024, the authors elaborate on:

“The 2024 guidelines provide 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI. The recommendations were developed using the best available evidence and graded according to the strength of that evidence. Topics to cover in the guideline were informed by an international survey of women and healthcare professionals. New information is provided about the genetic causes of POI, the impact of POI on muscle health, use of anti-mullerian hormone, non-hormonal therapies, lifestyle interventions and complementary therapies”.14

Early Menopause: Women’s Experiences

What is the (Australian) Healthtalk Australia’s Early Menopause: Women’s Experiences?

In Early Menopause: Women’s Experiences – Overview Healthtalk Australia elaborate on:

“On this unique site you can read, watch and listen to stories of 30 women aged between 28 and 51 years, from diverse socio-cultural backgrounds living in Victoria, Australia, who have shared what it is like to experience early menopause (EM).

Women talked about being diagnosed with spontaneous early menopause, premature ovarian insufficiency (POI), medically-induced early menopause, or menopausal symptoms as a result of cancer and/or other medical treatments”.15

Health Care Provider

What if I think I have POI?

If you think you have POI it may be in your best interest to choose to talk to your health care provider about this.

In Primary Ovarian Insufficiency: Symptoms – When To See A Doctor the (United States) Mayo Clinic elaborate on:

“If you’ve missed your period for three months or more, see your health care team to figure out the cause. You can miss your period for many reasons, such as pregnancy, stress, or a change in diet or exercise habits. But it’s best to get a health care checkup whenever your menstrual cycle changes.

Even if you don’t mind not having periods, see a health care professional to find out what’s causing the change. Low estrogen levels can lead to a condition that causes weak and brittle bones, called osteoporosis. Low levels of estrogen also can lead to heart disease”.16

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Sources

  1. Panay, N., Anderson, R. A., Bennie, A., Cedars, M., Davies, M., … Vincent, A. J. (2024). Evidence-Based Guideline: Premature Ovarian Insufficiency. Published Online: 08 December 2024. Climacteric, 1–11 https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2423213 Accessed: 10 December 2024
  2. Panay, N., Anderson, R. A., Bennie, A., Cedars, M., Davies, M., … Vincent, A. J. (2024). Evidence-Based Guideline: Premature Ovarian Insufficiency. Published Online: 08 December 2024:26. Climacteric, 1–11 https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2423213 Accessed: 10 December 2024
  3. Primary Ovarian Insufficiency: Symptoms – When To See A Doctor. 20 October 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683 Accessed: 10 December 2024
  4. Premature Ovarian Insufficiency: How Common Is Premature Ovarian Insufficiency. Last Reviewed: June 2024. You and Your Hormones, An Education Resource From the Society for Endocrinology https://www.yourhormones.info/endocrine-conditions/premature-ovarian-insufficiency/ Accessed: 10 December 2024
  5. Menopause Before 40 and Spontaneous Premature Ovarian Insufficiency. Content Updated: October 2020. Australasian Menopause Society https://www.menopause.org.au/health-info/fact-sheets/menopause-before-40-and-spontaneous-poi Accessed: 10 December 2024
  6. Premature and Early Menopause: What Causes Premature and Early Menopause? POI and Fertility. Last Updated: 28 August 2024. Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/premature-early-menopause Accessed: 10 December 2024
  7. Menopause Before 40 and Spontaneous Premature Ovarian Insufficiency. Content Updated: 13 August 2024. Australasian Menopause Society https://www.menopause.org.au/health-info/fact-sheets/menopause-before-40-and-spontaneous-poi Accessed: 10 December 2024
  8. Primary Ovarian Insufficiency: Summary – What Are the Symptoms of Primary Ovarian Insufficiency (POI)? Last Updated: 05 May 2021. MedlinePlus https://medlineplus.gov/primaryovarianinsufficiency.html Accessed: 10 December 2024
  9. Premature Ovarian Insufficiency: Summary of Recommendations. Reviewed: March 2024. British Menopause Society https://thebms.org.uk/publications/consensus-statements/premature-ovarian-insufficiency/ Accessed: 10 December 2024
  10. Menopause and Menopause Hormone Therapy: 2. Who Is MHT? 2024:2. International Menopause Society https://www.imsociety.org/wp-content/uploads/2024/10/2024-WMD-Leaflet_English.pdf Accessed: 10 December 2024
  11. Mishra, G. D. et al. Optimising Health After Early Menopause: Summary. 05 March 2024 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02800-3/fulltext Accessed: 10 December 2024
  12. Update of the 2015 Evidence Based Guideline on Premature Ovarian Insufficiency – Now Published. 31 october 2024. International Menopause Society https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Premature-ovarian-insufficiency Accessed: 10 December 2024
  13. ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI. Guideline on Premature Ovarian Insufficiency. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Premature-ovarian-insufficiency Accessed: 10 December 2024
  14. International Monash Partnership Announced for Premature Ovarian Insufficiency Guidelines. 10 December 2024 https://www.monash.edu/news/articles/international-monash-partnership-announced-premature-ovarian-insufficiency-guidelines Accessed: 10 December 2024
  15. Early Menopause: Women’s Experiences – Overview. Healthtalk Australia https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-womens-experiences/ Accessed: 10 December 2024
  16. Primary Ovarian Insufficiency: Symptoms – When To See A Doctor. 20 October 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683 Accessed: 10 December 2024
Topic Last Updated: 24 January 2025 – Topic Last Reviewed: 10 December 2024