Premature ovarian insufficiency and getting pregnant

Premature ovarian insufficiency (POI) is when the ovaries stop working properly before the age of 45.

What is premature ovarian insufficiency?

Premature ovarian insufficiency (POI) is when the ovaries stop working properly before the age of 45.

If you have POI the ovaries stop producing normal levels of a hormone called oestrogen and may not release eggs.

It is also known as premature ovarian failure or premature menopause. But it doesn’t  always mean the ovaries completely fail. Women with POI may still occasionally release an egg and have a period.

This happens to all women when they go through the menopause and the ovaries stop working. In POI this happens at an earlier than average age, which is 51 in the UK. When the ovaries stop releasing eggs then this also causes the periods to stop.

What are the symptoms?

As well as infrequent or stopped periods, women with POI may also experience:

  • hot flushes
  • night sweats
  • difficulty sleeping
  • reduced sex drive
  • problems with memory and concentration
  • vaginal dryness
  • headaches
  • anxiety or low mood
  • heart palpitations
  • joint stiffness
  • frequent urinary tract infections.

What causes premature ovarian insufficiency?

POI can be caused by:

  • auto-immune diseases, such as diabetes or thyroid disease
  • genetic causes (if you have a family history of the condition)
  • an operation that removed the ovaries
  • cancer treatments such as chemotherapy or radiotherapy

However, most cases of premature ovarian insufficiency are idiopathic. This means the cause is unknown.

How is premature ovarian insufficiency diagnosed?

If your doctor believes you have POI they will consider your:

  • age
  • symptoms, such as changes in your periods or symptoms of oestrogen deficiency
  • family history of early menopause
  • medical history such as other autoimmune conditions.

You should be offered a blood test to measure your levels of the hormones FSH, AMH and oestrogen. You may also be offered a blood test to check for diabetes and thyroid problems.

It is very rare, but POI can be caused by a problem with the chromosomes (the cells in the body that hold genetic information). If you are under 35 you may be offered a blood test to check your chromosomes.

What are the treatments for POI?

It is recommended that women take oestrogen replacement at least until they reach the average age that most women would go through the menopause.  This helps protect against the risk of developing osteoporosis (a condition that weakens the bones), which increases risk of fracture.  The two main ways of replacing oestrogen for POI are hormone replacement therapy (HRT) and the combined contraceptive pill. These both contain the hormones oestrogen and progestogen. They can help relieve many of the symptoms of premature ovarian insufficiency.

There are different types of HRT available. Your doctor will discuss your options with you.  

Hormonal treatment is not always suitable for women with a history of breast cancer or another type of cancer stimulated by oestrogen.

There are also specialist NHS menopause clinics with an interest in POI across the UK.

You may also be referred to other healthcare professionals who have the right training and experience to help you to manage different aspects of your condition.

What are my chances of conceiving?

Women with POI do not ovulate (release an egg) every month. This makes it difficult to get pregnant.

But studies have shown that a small percentage of women (5-10%)  with idiopathic premature ovarian failure (where the cause is unknown) do sometimes ovulate and become pregnant.

If you have POI and are having difficulty getting pregnant you may be able to receive eggs from a donor. Treatment with donor eggs is carried out using In vitro fertilisation (IVF).

If you are diagnosed with POI you can ask your GP to refer you to a fertility specialist.

More information and support

The Daisy Network provides support to women, along with their families and partners, who have been diagnosed with premature ovarian insufficiency.

The Fertility Network UK provides free and impartial support, advice, information and understanding for anyone affected by fertility issues.

 

Sources

1. NHS Guy’s and St Thomas’ (accessed 01/05/2018) Premature ovarian failure Page last reviewed: July 2016
Next review due: July 2019.
https://www.guysandstthomas.nhs.uk/resources/patient-information/gynaecology/premature-ovarian-insufficiency.pdf 

2. NHS Choices (accessed 01/05/2018)  Menopause, Page last reviewed: 12/11/2015
Next review due: 01/11/2018. https://www.nhs.uk/conditions/Menopause/ 

3. NICE (2015) Menopause: diagnosis and management. National Institute of Health and Clinical Excellence, London, England

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Last reviewed on June 11th, 2018. Next review date June 11th, 2021.

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