Premature ovarian insufficiency: symptoms, diagnosis and treatment

The ovaries release eggs and make the hormones oestrogen and progesterone. In premature ovarian insufficiency they stop doing so reliably before the age of 40. The Daisy Network, a UK charity for women with POI, says POI was previously called premature menopause or premature ovarian failure, and that POI is now the preferred term because it more accurately reflects the condition. NICE's menopause guideline NG23 covers diagnosing and managing POI in people under 40.

NICE Clinical Knowledge Summaries defines POI as the transient or permanent loss of ovarian function before 40 years of age, and early menopause as cessation of ovarian function between 40 and 45 years. The NHS uses early menopause for before 45 and premature menopause for before 40. Natural menopause occurs at around 51 to 52 according to the Daisy Network, and usually affects women between 45 and 55 according to the NHS.

The Daisy Network says that unlike menopause, which is permanent, ovarian function in POI can fluctuate. A woman with POI may still occasionally ovulate or even have a period months or years after diagnosis. This unpredictability matters for contraception and fertility, and is the reason the term insufficiency rather than failure is used.

It can happen in the teens, 20s, 30s or early 40s. It occurs naturally in some women and can result from treatments such as chemotherapy, radiotherapy, certain hormone medicines or surgery to remove the ovaries, according to the NHS. The NHS also notes that it is more likely if it runs in the family, if periods started early, if you smoke or if you are underweight; in many cases no cause is found.

The main symptom listed by the NHS is periods that are not regular or that stop completely before 45. The Daisy Network adds that reduced oestrogen and progesterone affect menstrual cycle regulation, bone strength, heart and blood vessel health, mood, memory and cognitive function, and vaginal and urinary health.

• Hot flushes and night sweats.

• Vaginal dryness.

• Difficulty sleeping.

• Low mood or anxiety.

• Reduced sex drive.

• Problems with memory or concentration.

The NHS says that if you are under 45 and having menopause symptoms, a GP may sometimes do blood tests. NICE CKS says that follicle-stimulating hormone (FSH) should not be used to diagnose menopause in otherwise healthy people aged 45 or over with typical symptoms, but that FSH measurement may be considered in people with symptoms under 40 where POI is suspected, and between 40 and 45. NICE CKS adds that specialist referral is advised when there is uncertainty about the diagnosis or management of POI, or when psychological treatment is needed for people who have experienced early menopause.

The NHS says the main treatments are medicines such as the combined contraceptive pill or hormone replacement therapy (HRT) to replace the hormones that are low. It explains that it is important to replace missing hormones if menopause began before 45 because there is a higher chance of bone and heart problems. If you have had certain types of cancer, such as certain breast cancers, you may not be able to have hormone treatment.

Lifestyle measures such as regular exercise and calcium-rich food are also suggested. If treatment and lifestyle changes are not enough, the NHS says you can be referred to a specialist menopause centre, and points to the British Menopause Society to find an NHS or private specialist. NICE CKS notes that menopause-specific CBT and non-hormonal options exist when HRT is unsuitable. The British Menopause Society publishes a consensus statement on premature ovarian insufficiency for clinicians.

The Daisy Network says POI significantly reduces the chances of natural conception, but about 5% of women with POI may still conceive naturally. The NHS says early or premature menopause can make it harder to get pregnant, and that some people may have children through IVF with their own frozen eggs or donor eggs, with surrogacy and adoption as other options.

The NHS says the condition can affect both physical and mental health, and that NHS talking therapies can be accessed without seeing a GP first. A diagnosis at a young age, often unexpected, can be emotionally hard; the NHS points to the Daisy Network for support with premature menopause.