Premature ovarian insufficiency: diagnosis, hormones and long-term health

In premature ovarian insufficiency the ovaries stop releasing eggs regularly and produce less oestrogen. Causes include genetic conditions, autoimmune disease, chemotherapy or radiotherapy, ovarian surgery and, often, no cause is found. Symptoms resemble menopause, including irregular or absent periods, hot flushes, night sweats, vaginal dryness, low mood and difficulty concentrating, but occur much earlier in life.

NICE guidance recommends diagnosing premature ovarian insufficiency in women under forty with menopausal symptoms and a change in periods, based on raised FSH levels on repeated tests several weeks apart. Because combined contraceptive pills can mask the picture, clinicians may advise a pause or alternative approach. Other tests may look for underlying causes, such as thyroid antibodies, chromosome analysis and checking for autoimmune conditions.

Long-term oestrogen deficiency raises the risk of osteoporosis, cardiovascular disease and possibly cognitive and mood effects. Guidance advises that, unless there is a contraindication, women with POI take hormone replacement or a combined hormonal contraceptive until at least the age of natural menopause. This is replacing hormones the body should still be making, not treating a normal ageing change, so risk-benefit considerations differ from those for women who go through menopause at the usual age.

• HRT, often at doses that aim to replicate physiological levels, or combined hormonal contraception.

• Calcium, vitamin D and weight-bearing exercise for bone health.

• Bone density assessment when diagnosed, with follow-up as advised.

• Vaginal oestrogen for local symptoms if needed.

• Psychological support, because diagnosis can be a profound shock.

• Testosterone may be considered in some cases for low sexual desire.

A diagnosis often raises questions about having children. Spontaneous pregnancy is possible but unlikely. Options include egg donation, adoption and fostering, and referral to a fertility specialist is appropriate. If you are not seeking pregnancy and are sexually active, contraception may still be advised if there is any possibility of ovulation. Fertility preservation before cancer treatment is a separate area, discussed with oncology and fertility teams.

Many women describe grief, isolation and anger. Talking to a counsellor, joining a support group or speaking with others who share the diagnosis can help. Charities provide information and peer support. Talk to your clinician if you feel persistently low or anxious, and contact NHS 111 or Samaritans on 116 123 if you feel unsafe.

Regular review should cover symptoms, HRT dose, bone health, blood pressure, cardiovascular risk factors and emotional wellbeing. When the age of natural menopause approaches, you and your clinician can discuss whether to continue or reduce treatment.