POI
Understanding Premature Ovarian Insufficiency, its impact on fertility, and what you can do about it.
What is Premature Ovarian Insufficiency (POI)?
Premature Ovarian Insufficiency (POI), sometimes referred to as Premature Ovarian Failure (POF), is a condition where the ovaries stop functioning properly before the age of 40. That means lower estrogen levels, irregular or absent periods, and—most impactfully—reduced or absent ovulation.
Unlike natural menopause, which usually occurs around age 50, POI can happen in your 20s or 30s, and occasionally even in your teens. While it may sound like the end of your fertility journey, it’s not always. Many women with POI can still ovulate sporadically—and yes, still get pregnant naturally.
POI affects about 1 in 100 women under 40. Despite how life-altering it can be, it's often misunderstood, misdiagnosed, or missed entirely.
Signs and Symptoms of POI
POI can show up in a variety of ways—and often mimics other hormonal conditions. If this sounds familiar, it’s worth investigating:
🚫 Irregular or Missed Periods: This is often the first (and most obvious) sign. Cycles may become unpredictable or stop altogether.
🌡️ Hot Flashes or Night Sweats: Symptoms that resemble menopause can occur due to low estrogen.
🧠 Mood Changes: Anxiety, depression, or irritability may be triggered by hormone shifts.
🧬 Infertility or Difficulty Conceiving: Ovulation becomes irregular or stops entirely.
💤 Fatigue or Low Energy: Estrogen deficiency and adrenal stress may play a role here.
💔 Vaginal Dryness or Discomfort: Especially during sex, as estrogen helps maintain vaginal tissue health.
🧂 Low Libido: Often tied to declining estrogen, testosterone, or overall hormonal imbalance.
Many women are told these symptoms are “just stress” or “normal aging”—but they’re not normal if you’re under 40.
Who Does POI Affect?
POI can happen to anyone, regardless of health history or lifestyle. That said, some factors may increase your risk:
🧬 Genetics: Family history of early menopause or POI increases your risk.
🧪 Autoimmune Conditions: Conditions like Hashimoto’s or Addison’s disease are commonly linked with POI.
☢️ Medical Treatments: Chemotherapy, radiation, or pelvic surgeries can damage ovarian tissue.
🧫 Infections: Certain viral infections have been linked to ovarian damage.
❓ Unknown Causes: In up to 90% of cases, the cause of POI is idiopathic—meaning we simply don’t know why it happens.
POI can also overlap with other fertility conditions like diminished ovarian reserve, hypothalamic amenorrhea, or PCOS—making accurate diagnosis critical.
How is POI Diagnosed?
POI is typically diagnosed through a combination of symptom review, hormone testing, and sometimes imaging.
🩸 Elevated FSH Levels: If your FSH is elevated (especially on day 3 of your cycle) and your estrogen is low, that’s a major clue.
📉 Low Estradiol: Estrogen levels drop as ovarian function declines.
🥚 Low AMH: Anti-Müllerian Hormone (AMH) is a marker of ovarian reserve and often low in women with POI.
🔍 Ultrasound: May show small or absent follicles in the ovaries.
🧬 Genetic Testing: May be used to check for chromosomal abnormalities or fragile X premutation.
The diagnosis is usually confirmed if a woman under 40 has had irregular or absent periods for at least 4 months, and lab tests show two elevated FSH levels (typically above 25 IU/L), taken at least a month apart.
How Does POI Affect Your Fertility?
POI is one of the more challenging diagnoses in fertility—but it’s not always the end of the road.
Yes, POI means reduced ovarian reserve. But women with POI can and do get pregnant. Some ovulate sporadically, even years after diagnosis.
Here’s what it can impact:
❌ Ovulation: Irregular or absent ovulation makes conception more difficult.
🥚 Egg Quantity & Quality: Both tend to be diminished in POI.
🧠 Hormonal Signaling: Without proper estrogen feedback, the reproductive system may struggle to stay in sync.
🪷 Uterine Lining: Low estrogen may prevent your endometrium from thickening enough to support implantation.
But here's the hopeful part: by supporting your hormones, reducing inflammation, and restoring nutrient status, many women are able to recover cycles—or take steps toward pregnancy through egg preservation, natural conception, or assisted reproductive options.
We Can Help!
A POI diagnosis may feel like a dead end. But it’s really a starting point—a clue that your body is asking for deeper support.
✨ A client with POI got her cycle back after just 2 months of targeted nutrition, hormone support, and mineral rebalancing—despite being told she was in menopause at 38 years old.
At The Greenhouse, we take a functional approach to POI. We help you understand why your ovarian function is declining—and what you can do to support it.
You deserve a plan that’s backed by science and designed for your unique body.
Learn More
📰 My client just delivered her daughter at 45 years old. Here’s what she did to get pregnant.
📰 The number of birthdays you have had does not automatically define whether you can get pregnant
📰 What does low AMH really mean?
📰 Why your AMH levels aren’t everything.
References
- Nelson, L. M. (2009). Clinical practice. Primary ovarian insufficiency. The New England Journal of Medicine, 360(6), 606–614. https://doi.org/10.1056/NEJMcp0808697
- Conway, G. S., Kaltsas, G., Patel, A., Davies, M. C., & Jacobs, H. S. (1996). Characterization of idiopathic premature ovarian failure. Fertility and Sterility, 65(2), 337–341. https://doi.org/10.1016/S0015-0282(16)58090-6
- Golezar, S., Ramezani Tehrani, F., Khazaei, S., Ebadi, A., & Tohidi, M. (2019). The global prevalence of primary ovarian insufficiency and early menopause: A meta-analysis. Climacteric, 22(4), 403–411. https://doi.org/10.1080/13697137.2019.1574738
**Not medical advice. Always consult your doctor before making changes to your health or fertility plan.
