Premature Ovarian Insufficiency (POI)


Premature ovarian insufficiency (POI), also known as premature ovarian failure, is a chronic condition affecting approximately 1 out of every 1,000 females between the ages of 15 and 29.

Premature ovarian insufficiency occurs when a girl’s ovaries stop functioning normally, failing to produce normal amounts of hormones or release eggs regularly.

The most common first symptom of POI is a lack of menstrual periods, a condition known as amenorrhea. 

Patients can be seen by Texas Children's experts in Adolescent Medicine and Pediatric and Adolescent Gynecology.

Causes & Risk Factors

The cause is not yet known.

A small percentage of girls with POI (10-20%) have a relative such as a mother, sister, aunt or grandmother who has the condition. Premature ovarian insufficiency is sometimes associated with autoimmune conditions, including hypothyroidism and diabetes. Other factors that may contribute to the development of POI include chemotherapy and exposure to radiation, cigarette smoke, chemicals and pesticides.

Girls with POI often have difficulty becoming pregnant. They are also at increased risk of developing other serious health conditions, including:

  • Osteoporosis – loss of bone density
  • Hypothyroidism – thyroid does not produce enough hormones
  • Addison's disease – adrenal gland does not produce enough hormones
  • Diabetes
  • Heart disease

Symptoms & Types

The most common symptoms of POI in adolescents are:

  • Lack of breast development during puberty
  • Lack of menstrual periods

Other symptoms may include:

  • Decrease in breast size
  • Hot flashes
  • Vaginal dryness
  • Mood swings
  • Insomnia

The majority of girls who have the condition visit their healthcare provider because their periods have stopped. 

Diagnosis & Tests

Diagnosis starts with a detailed medical history and a physical exam, including a pelvic exam.

Diagnostic testing may include a blood test to evaluate hormone levels, including FSH (follicle stimulating hormone) to determine if the ovaries are working. These tests may need to be repeated.

Treatment & Care

Treatment depends on the individual patient but may include:

  • Hormone replacement therapy (HRT) – Combination oral contraceptive pills (those including both estrogen and progestin) may help replace the hormones that are not being naturally developed by the body. These hormones may help regulate the menstrual cycle, help breast development and bone density.
  • Vitamins and minerals – Calcium and Vitamin D may help reverse bone tissue loss and improve bone density.
  • Counseling for the adolescent and her family – Girls diagnosed with premature ovarian insufficiency may feel sad, angry or depressed. Talking with a counselor and other adolescents with POI may be helpful.

Living & Managing

Less than 10% of women with ovarian hypofunction will be able to get pregnant.  The chance of successfully getting pregnant increases to 50% when using a fertilized donor egg (an egg from another woman).