Primary Ovarian Insufficiency (POI) is a little understood but potentially devastating diagnosis. In numbers alone, POI currently affects some 250,000 women under age 40 in the United States. Understanding what POI is and what it means to a young woman helps to sort out the prevailing myth that POI is early menopause.

What Primary Ovarian Insufficiency is, and what it is not
Primary Ovarian Insufficiency or POI is a relatively new term. In the past, POI was more commonly referred to as Primary Ovarian Failure (POF), and ‘premature menopause’ that is quite inaccurate. In POF, the ovaries were described as failed in that they had shut down and could no longer perform their usual functions. However, the reality is that the ovaries are still functioning and this will be addressed shortly.

Premature menopause is also a misleading term, because it implies that based on the ovarian functions alone, a woman has entered menopause and experiences the associated aging process. The ovaries are not necessarily aging any more quickly in women with POI than in those who do not have this condition. But the lingering perceived connections between loss of reproduction abilities and menopausal women remain ingrained in the social consciousness.

Who develops POI?
Women under age 40, some as young as in their early teens, may be diagnosed as having POI. Again, this does not mean that they are in menopause. Compare the following scenarios:

*In normal menopause, the ovaries naturally lose their follicle stimulating hormones (or FSH) as these levels decrease. The ovaries actually lose their ability to function due to an actual absence of FSH hormones. For women who have their ovaries surgically removed, it is clear as to the connection to menopause.

*In POI, the FSH hormones are present in the ovaries. But for reasons largely still unknown, the ovaries do not work as they should. These ovaries are considered dysfunctional but not completely failed, which explains the shift from Primary Ovarian Failure to Primary Ovarian Insufficiency. The latter term is a more realistic description of what is happening to the ovaries.

Why is this important?
One of the biggest misconceptions about POI is that the ovaries had failed to the point that pregnancy was impossible. But in fact, up to 10% of women diagnosed with POI will become pregnant. There is no denying the emotional impact of a POI diagnosis, but unlike in the past, there is some hope for women who desire to have children and POI is not always an automatic closed door to having a family.

Symptoms of POI
The symptoms of POI are very similar to menopause, and explain why in the past POI and menopause were believed to be the same. While the lower FSH hormone levels may contribute to these symptoms, it is not an overall reflection on how the rest of a woman’s body is aging.

*Irregular menstrual periods, or complete absence of periods
*Hot flashes and night sweats
*Irritability and moodiness
*Trouble concentrating
*Decreased libido and painful intercourse
*Genital or vulvar dryness
*Infertility

After a diagnosis, what comes next?
At this time, there are no proven treatment options that are deemed to be safe and effective either to restore normal ovarian function or to improve fertility. The most common prescribed course is to put younger women on estrogen and/or progestin to adjust hormonal levels.

Generally, a slightly higher does is recommended, as lower dose estrogen does not help safeguard against osteoporosis, which tends to develop in women with POI. Vigilance and ongoing support from a woman’s healthcare professional is very important in the treatment process.

Since POI affects younger women, the issues and challenges are quite different from women undergoing menopause. Women with POI must deal with their own feelings as well as those of the population at large. Having a caring healthcare professional is one of the greatest allies a woman needs to cope with POI.

To find a support group in your area, or for Internet support, please visit www.POFsupport.org. The POF stems from the original term Primary Ovarian Failure, but this site offers a wealth of resources and help.

Another great site to learn more about POI is http://poi.nichd.nih.gov/index.html

Resource: Spontaneous Premature Ovarian Failure: Young Women, Special Needs; Lawrence M. Nelson, MD, MBA 2001. Dr. Nelson is dedicated to research about POI and supports the much needed name change of this condition.

Menopause, Your Doctor, and You