Can ovarian insufficiency be cured? A consultant gynaecologist explains

Professor Nick Panay, founder and director of Hormone Health (hormonehealth.co.uk), in a joint venture with TFP Fertility, brings cutting-edge practice and insight to reproductive medicine, with a special interest in surgery, menopause and menstrual disorders. In 2021, he contributed to the review Premature ovarian insufficiency: A toolkit for the primary care physician, available on PubMed for deep-dive insight and is currently collaborating on updating global guidelines on POI.

With premature ovarian insufficiency (POI) affecting around one in 100 women in the UK and possibly more according to recent research – and a significant number of the community at TRB – we’ve banked up the most crucial questions on this topic, for Dr. Panay to quick-fire. From causes and symptoms to pregnancy chances and treatment, it’s all here. 

Over to Dr. Panay.

1. What is premature or primary ovarian insufficiency?

Premature ovarian insufficiency – often shortened on your documents and results to POI – is a fairly common cause of infertility, affecting around one in 100 women. By ‘premature ovarian insufficiency’, we mean that your ovaries have stopped functioning before age 40. Early menopause occurs before the age of 45 years in 10-15% of women.

Previously known as ‘premature ovarian failure’ (healthcare providers now often refer to ‘insufficiency’ rather than ‘failure’, because ovulation can still be a possibility for some women), POI occurs when your ovaries aren’t producing typical levels of oestrogen, or they’ve stopped releasing eggs regularly.

More rarely, it can affect women at a much younger age – I’ve worked with women at age 20 with primary ovarian insufficiency. 

Quite often, the first time a patient really hears about premature ovarian insufficiency is at the point of diagnosis, or when we talk through testing. But recognising the problem earlier on in the journey can be key to better success rates, so if you’re concerned about any of the symptoms we cover here today, please speak to your GP. 

2. What are the symptoms?

Primary or premature ovarian insufficiency symptoms are, a little confusingly, often similar to menopausal symptoms – or oestrogen deficiency. They can include: 

• irregular periods – you might have an irregular cycle for years, after pregnancy or coming off birth control 
• hot flushes
• decreased libido 
• vaginal dryness and/or pain during sex
• dry eyes
• night sweats
• brain fog and/or irritability
• infertility

In some cases, women with POI may still have regular periods (anovulation – where you have a period without ovulating) and no symptoms at all. And, symptoms can come and go. POI is different for every patient, and the key is getting support early on, if you think something may be wrong. 

3. What is the most common cause?

POI is one of those frustrating areas of fertility and reproductive medicine – in around 90 per cent of cases the cause is unknown but is believed by many to be genetically linked.

We do know, however, that follicular health is a potentially leading factor. Your eggs develop inside your follicles, so when there’s an issue, it has a dynamic impact, leading to ovarian dysfunction. 

Whether they cause your follicles to stop working earlier than usual – or more general dysfunction – any of these problems and factors can lead to primary ovarian insufficiency: 

• a low number of follicles
• certain infections, such as tuberculosis, malaria and mumps
• metabolic disorder
• lifestyle factors, such as smoking and exposure to certain chemicals
• autoimmune disease, such as thyroiditis 
• surgery, for example, to remove the ovaries
• certain medications and treatments, such as chemotherapy 
• genetic disorder, such as Fragile X syndrome, or Turner syndrome

It’s also important to look at family history, if you can. Primary ovarian insufficiency can run in families, so if any of your relatives went through something similar – in their 30s or even 20s – this may be a contributing factor. 

4. Can you get pregnant with premature ovarian insufficiency?

First, it’s important to make the distinction between premature ovarian insufficiency (POI) and early or ‘premature’ menopause. These are not necessarily the same thing, and with POI, you may have occasional periods for years, before being in menopause, where your periods have stopped altogether. 

Because there’s still this potential to release an egg – even if very rarely – it is possible to become pregnant, with premature ovarian insufficiency, although the chances are much lower. Around 5-10 per cent of women with unknown causes of POI do ovulate and conceive naturally, or after hormone replacement therapy. This case study provides a helpful example. 

IVF with egg donation is the most reliable option for achieving a pregnancy in POI.  

IVF success rates are typically low when using your own eggs in POI, unless you have previously frozen eggs e.g. before chemo/radiotherapy.

Occasionally a causing factor of POI – for example a genetic condition – may result in lower quality eggs, however. In this case, your team will likely recommend considering the donor egg option. 

Your POI treatment plan, with healthy pregnancy as its goal, can include: 

• IVF with or without egg donation
• hormone replacement therapy
• treatment for underlying causes and conditions – for example, treating a thyroid disorder

5. Can ovarian insufficiency be cured?

While it is still possible to get pregnant with POI – and what I’m aiming for with many women on a daily basis – the condition isn’t reversible. We can treat symptoms and associated conditions, and put a plan in place to help you conceive, but there currently isn’t a cure for POI. 

A proportion of women with POI may ovulate sporadically, even after diagnosis. And this may result in pregnancy – although, of course, timing natural conception around this would be difficult. But current treatment options will not reverse POI, or trigger your ovaries to function as normal, although research is looking into this e.g. stem cells

Keen to dive deeper? Touch base with myself and the team at Hormone Health and TFP Fertility UK for premature ovarian insufficiency support – whether you suspect it as a factor or have a diagnosis – and next steps, specific to your unique journey.