Health Library
Primary Ovarian Insufficiency

Last Updated 12/2021

What is Primary Ovarian Insufficiency (POI)?

Primary ovarian insufficiency (POI), also known as primary ovarian failure or premature menopause, is a rare condition that affects teenagers and young women under the age of 40 years.

Patients with this condition will have menstrual periods less often, or will not have menstrual periods at all for four months or more. POI affects many parts of a girl’s life, including her physical health, emotional health and well-being.

Patients with POI have low levels of the hormone estrogen. Low estrogen may cause osteoporosis (weak bones and a higher chance of fractures) and heart disease at a younger age.

Causes of POI

Most of the time, the cause of POI is unknown. Sometimes, POI happens as part of another condition, such as Turner syndrome, fragile X syndrome, Fanconi anemia or galactosemia.

Some girls with POI have autoimmune conditions such as thyroid disease or celiac disease.

Patients with a family history of POI have a higher chance of developing POI.

Patients who receive chemotherapy or radiation may be at risk for POI.

Certain environmental exposures (cigarette smoke, pesticides and viruses) have been linked to POI, but we do not yet know if these things actually cause POI.

Research is being done to understand the causes POI in girls and young women.


Many girls and young women find out they have POI because their bodies are not developing as quickly as their peers. For example, they may have breast growth at a later age, and they may start their periods later. They may be shorter than their classmates, and they may not have a growth spurt until later on.

Other things that may be signs or symptoms of POI:

  • Not having menstrual periods, or having menstrual periods less often instead of monthly
  • Hot flashes
  • Night sweats
  • Trouble sleeping
  • Mood changes
  • Vaginal dryness
  • Weaker bones
  • In adult patients: difficulty getting pregnant

Some patients will have only one of these symptoms, and other patients will have many.


The treatment of POI is a team approach. Primary care doctors, gynecologists, endocrinologists and social workers help to care for these patients.

  • Estrogen replacement therapy is recommended. In patients with POI, the ovaries do not make enough estrogen. Estrogen replacement helps patients to go through puberty, start having periods, grow taller, and build stronger bones. Estrogen is also important for keeping the heart and brain healthy. Patients usually get estrogen replacement through a skin patch that they change one to two times each week.
  • Family planning is important. Patients with POI are less likely to get pregnant on their own, but there is a still a small chance of pregnancy. Good birth control is important for patients who are in intimate relationships. We recommend that you talk to your doctor about this.

Who treats this.

Contact our POI Center if you or your child are having any of the symptoms listed on this page, if you are concerned about your child’s growth or to schedule an appointment.