Overview

POI means the ovaries stop producing adequate oestrogen and ovulating regularly before age 40. It affects ~1% of women under 40. Unlike menopause, POI is not always permanent — spontaneous pregnancy occurs in 5–10% of cases.

Symptoms

• Irregular or absent periods
• Hot flashes and night sweats
• Vaginal dryness and reduced libido
• Sleep disturbance and mood changes
• Difficulty concentrating
• Infertility

Causes & Risk Factors

• Genetic — Turner syndrome, Fragile X (FMR1 premutation)
• Autoimmune — thyroid disease, Addison's, type 1 diabetes
• Chemotherapy or radiotherapy
• Extensive ovarian surgery
• Idiopathic — most cases have no identifiable cause

Diagnosis

Requires: age under 40, irregular/absent periods ≥4 months, and two FSH measurements above 25 IU/L taken 4+ weeks apart. Additional tests: AMH, karyotype, FMR1, autoimmune screen.

Treatment

• Hormone Replacement Therapy (HRT) — protects bones, heart and wellbeing until average menopause age
• Calcium and Vitamin D supplementation
• Psychological support — counselling and peer groups
• IVF with own eggs — possible when residual ovarian function remains
• Fertility preservation before cancer treatment
• Regular monitoring — bone density, thyroid, cardiovascular risk

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