Primary Ovarian Insufficiency (POI) and Early Menopause

When menopause happens earlier than expected, what are your options and how can you access support?

Primary Ovarian Insufficiency (POI) and Early Menopause

When menopause happens earlier than expected, what are your options and how can you access support?

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Primary Ovarian Insufficiency (POI) and Early Menopause

Although the average age of menopause in the US is 52, for a lot of women and people born with ovaries it can happen earlier than this. Some women may even be in their teenage years or their 20s when their ovarian function changes and menopause begins.

The most obvious sign that your ovaries are no longer functioning in the same way, is that your periods become irregular or they may stop altogether. With that, menopause symptoms may also begin, but often many women don’t initially realize what’s causing their symptoms.

If you are under the age of 40 and your periods stop, you may be diagnosed with a condition called primary (also known as premature) ovarian insufficiency (POI).

Around 1 in 100 women are thought to have POI.

 

POI may also be called an ‘early’ menopause, though the actual medical definition of an early menopause is when menopause happens between 40-45 years. Remember, menopause is when you go 12 months in a row without having a period.

The signs, symptoms and implications of POI and early menopause are basically the same. POI is more serious than just not having periods. It’s a health condition with long term implications for your fertility and also for the strength of your bones, your heart and your blood vessel health. It requires specialist treatment such as hormone therapy (HT) and fertility support if you plan on having a baby.

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Symptoms of Perimenopause and Menopause

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Symptoms of POI

Are the same as those experienced in perimenopause and menopause as the trigger for them is the same – low levels of estrogen, progesterone and testosterone.

Causes of POI

The exact cause of POI is usually unknown. Most women don’t know what’s caused their ovarian function to change, but for some, there are more clear indicators such as:

  • a result of treatment for cancer such as chemotherapy or radiotherapy
  • surgery in which your ovaries have been removed or their function has been impaired (an oophorectomy or hysterectomy)
  • genetic conditions such as Fragile X or Turner Syndrome
  • various autoimmune diseases that mistakenly attack ovarian tissue

Whatever the reason, including those listed, they all require specialist support from healthcare providers to reduce the related health risks that can impact fertility.

Hormonally

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Diagnosing POI

If you think you might have POI, see your healthcare provider. Unless you’ve had your ovaries removed, you’ll probably have a blood test to confirm POI. This will look at your level of follicle-stimulating hormone (FSH) and whether these levels are raised over two tests, (4-6 weeks apart). If so, you may be diagnosed with POI.

If you are under 35 years of age when this happens, your clinician may also want to investigate your chromosomes, to see if there might be a genetic cause of your POI.

Symptoms of POI

Symptoms of POI are the same as those experienced in perimenopause and menopause as the trigger for them is the same – low levels of estrogen, progesterone and testosterone.

The possible symptoms of POI are varied, but typically involve some of the following:

  • changes to your periods (they may become lighter, less frequent, or stop altogether)
  • fatigue and problems sleeping
  • brain fog (lack of concentration, poor memory and focus, problems finding the right words)
  • hot flashes and night sweats (this is usually experienced as a sudden
  • feeling of warmth in the face neck and chest)
  • lack of interest in sex or changes to your desire
  • joint pains and aching muscles
  • hair and skin being dry, itchy, and dull
  • headaches and migraine attacks
  • vaginal dryness and soreness
  • needing to pee more often, experiencing ‘leaks’, or bladder infections.

You can always have a go at filling in our menopause symptom checker to see what you’re ticking off from this list.

Risks associated with POI

The hormones that the ovaries produce – estrogen, progesterone and testosterone – are needed by many systems in your body, in order for it to function at its best. When there’s not a good supply of these hormones over time, it can take a toll, especially on the health of your bones, heart and blood vessels, and your genitourinary health.

These are the health risks that increase if you have POI:

Osteoporosis

Having dense and tightly compacted bone tissue inside your bones is what makes them strong. If you have lower levels, or a lack of estrogen, especially from a young age, you lose bone tissue at a faster rate than your bones can produce new tissue. This means they become less dense, weaker and more likely to break.

In severe cases, this bone-weakening process causes a disease called osteoporosis which leads to people getting multiple bone fractures, sometimes from relatively minor bumps and knocks.

Anyone has an increased risk of osteoporosis when their hormone levels are lower. The risk is also greater if you have family members diagnosed with the condition, or you smoke or drink heavily.

Having POI increases your chance of developing the bone-weakening disease, osteoporosis.

Taking HT to top up your hormones, especially estrogen, is usually recommended. HT should be taken at least until the age of 52, (the average age of a natural menopause) to help keep your bones strong and healthy, however HT can be taken for longer if you find it helpful.



Cardiovascular disease

This refers to any disease affecting the heart and blood vessels, including heart attacks, stroke and vascular dementia.

Estrogen plays many roles in helping to keep your blood pumping throughout your body, so when it’s in short supply, your chances of developing some type of cardiovascular disease will increase. You will also raise your chance of cardiovascular disease if you smoke, have a higher than average body weight, have high blood pressure, or a family history of related conditions.

POI increases your risk of having heart issues because estrogen is in shorter supply and unable to protect your heart in the same way. This is why taking HT is recommended for people with POI, as it can help to reduce your risk of cardiovascular disease in the future.

Genitourinary health

This term describes everything to do with your genitals, bladder and bathroom habits. Living with low or no estrogen in your body can, over time, affect how comfortable you feel down below.

Genitourinary Syndrome of Menopause (GSM) describes the group of symptoms affecting your vulva, vagina and urinary system. Symptoms usually start around the time of menopause, and during your post-menopausal years.

Some (but not all) symptoms of GSM include:

  • Dryness around your vulva and vagina
  • Irritation, burning, or itching around your vulva or vagina
  • Needing to pee more frequently and urgently
  • Recurrent urinary tract infections (UTIs)
  • Thinning of your vulval tissue and reduced elasticity in the vagina
  • Less natural lubrication when you’re sexually aroused
  • Discomfort or pain during sexual activity
  • Decreased desire, arousal or difficulty reaching orgasm
  • Bleeding after penetrative sex

GSM is a condition that tends to get worse over time if no treatment is explored.

If you have POI, you will be at greater risk of developing GSM at some point. The recommended type of treatment for GSM is to use hormone medications directly on your vulva and inside your vagina on a regular basis for the long term.

Vaginal estrogen (or sometimes termed local estrogen) comes in the form of pessaries, creams, gels, or a soft silicon ring that is inserted into the vagina. These products all release estrogen, and sometimes testosterone too, directly to the affected area.

Treatments are very good at relieving pain and discomfort. They help to restore the appearance, feelings and functions to your vulva and vagina.



Getting help with POI or early menopause

Most OBGYNs will recommend if you have POI, you take HT until the age your menopause would naturally occur. For most women, this is 52. Using HT will reduce your chance of developing future health conditions and support you to feel well.

Some women prefer to use birth control medications to treat their POI. This may help ease some symptoms and feel more age appropriate for you, but it doesn’t give all the benefits to your future health as HT does.

If you have been diagnosed with POI or early menopause, here are our top tips:

  • Try to adopt a healthy lifestyle that includes:
    • staying active and exercising regularly
    • eating nutritiously
    • reducing your stress
    • ensuring good quality sleep
    • limiting the amount of alcohol you consume
    • reducing your caffeine intake
    • stopping smoking if you currently smoke.
  • If you are able, try to get a DEXA scan every few years, This measures your bone density.
  • See a doctor that specializes in treating POI if you can, and discuss using HT with them.
  • You may find linking up with other women affected by POI helpful, perhaps on social media or if there are any groups locally.

Fertility support

POI can affect your ability to become pregnant because regular ovulation (an egg being released every month) doesn’t always occur. Some people are still able to get pregnant following a diagnosis of POI, as ovulation does still occasionally occur. This is however not common and most women need additional support to get pregnant.

If you are finding the idea of not being able to conceive without help upsetting, make an appointment with your health care provider to discuss your options. They may be able to recommend a fertility specialist to talk too. You may also want to explore talking to a therapist who can help to support you with your POI diagnosis.

Support in Numbers

Whilst having POI can feel overwhelming there is support available. Many women find connecting with others who have this condition particularly helpful.

You can read more about other women’s experiences of navigating different hormone conditions on our Hormone Allies page. While we can’t always stop hormonal conditions from impacting our lives, we can support one another to feel more empowered as we find our way through.

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