Blog
Oct 8, 2026
POI, premature ovarian insufficiency, means the ovaries stop working normally before the age of 40, commonly called early or premature menopause. It affects about 1 in 100 women, causes menopause-like symptoms and reduced fertility, but does not always mean pregnancy is impossible.
Most women are aware that fertility gradually declines with age. But did you know that some women can experience a significant decline in fertility long before the age of 40? One condition that can cause this is POI (premature ovarian insufficiency), commonly referred to as early menopause, premature menopause or premature ovarian failure.
POI affects approximately 1 in 100 women under the age of 40 and can have a significant impact on fertility, hormone balance, and overall health. For many women, the condition is first discovered when pregnancy does not occur as expected or when menstrual cycles begin to change.
In this article, we explain what POI is, the symptoms it may cause, how it affects fertility, and the treatment options available today.
What this article covers
Premature Ovarian Insufficiency (POI) occurs when the ovaries stop functioning normally earlier than expected. This results in reduced production of reproductive hormones and less frequent ovulation, or ovulation may stop altogether.
For most women, fertility begins to decline gradually around the age of 35 and more noticeably after 40. With POI, this process occurs much earlier, sometimes before the age of 30.
Many women receive a diagnosis after hormone testing or a fertility assessment reveals a very low ovarian reserve and low levels of AMH (Anti-Müllerian Hormone), a key marker of ovarian reserve, together with a change in the bleeding pattern. Extended testing is needed to confirm the diagnosis.
POI is sometimes described as the body entering menopause earlier than normal, but there are important differences.
Menopause means that the ovarian reserve is essentially depleted and ovulation no longer occurs. A woman is no longer fertile.
Perimenopause, often referred to as the menopausal transition, is the period leading up to menopause when hormone production gradually changes.
Women with POI often experience a condition that resembles perimenopause, but this does not necessarily mean that all fertility has been lost. Some ovarian function may still remain, and spontaneous ovulation can occur in certain cases.
For this reason, it is important to understand that POI does not always mean complete infertility, although the likelihood of becoming pregnant is significantly lower than average.
For pregnancy to occur, the ovaries must produce mature eggs that can be fertilized.
With POI, this process is impaired because:
Many women with POI only discover the condition when they experience difficulty conceiving.
However, it is important to remember that spontaneous pregnancy can still occur. It is estimated that approximately 5-10% of women with POI conceive naturally.
Although research has increased our understanding of POI, the exact cause remains unknown in many women.
Several factors have been linked to an increased risk of developing the condition.
If your mother or sister has been diagnosed with POI, your risk may be higher.
Certain genetic conditions have been associated with POI, including Turner syndrome.
Research has identified links between POI and several autoimmune conditions, such as:
Chemotherapy and radiation therapy can affect ovarian function and reduce ovarian reserve.
Operations involving the removal of ovarian tissue, for example for certain cancers or endometriosis, may impact fertility and increase the risk of POI.
Smoking has been shown to accelerate ovarian ageing and is associated with earlier menopause.
The first sign of POI is often a change in the menstrual cycle, irregular, infrequent or absent periods in a woman under 40.
Common symptoms include:
As estrogen levels decline, other symptoms may develop, including:
Because these symptoms often develop gradually, many women do not immediately associate them with reduced ovarian function.
POI affects more than fertility. Low estrogen levels can also have long-term effects on overall health.
Possible consequences include:
Estrogen plays a crucial role in maintaining bone strength. Long-term estrogen deficiency can increase the risk of osteoporosis.
Low estrogen levels may affect blood vessels and increase the risk of cardiovascular disease.
Hypothyroidism is more common in women with autoimmune-related POI. Read more about thyroid disorders and fertility.
Many women report an increased risk of:
Estrogen deficiency can affect the mucous membranes of both the eyes and the genital tract.
Because several conditions can cause irregular or absent periods, a thorough evaluation is required.
When POI is suspected, the assessment typically includes:
An evaluation of the uterus and ovaries to assess their structure and function.
The physician will review menstrual patterns, previous medical conditions, and family history.
Blood tests commonly include:
In some cases, genetic investigations may be recommended to identify underlying causes.
According to the European (ESHRE) guideline, POI is defined as infrequent or absent menstruation for at least four months together with two elevated FSH levels (above 25 IU/l) measured some time apart, in women under the age of 40.
Currently, there is no treatment that can restore normal ovarian function or create new ovarian follicles.
However, several treatment options can help improve quality of life and reduce the effects of estrogen deficiency.
The most common treatment is estrogen replacement therapy.
The goals are to:
Treatment is often recommended until the average age of natural menopause, around 51-52 years.
If POI is likely to result from chemotherapy or radiotherapy, egg freezing before treatment can preserve the possibility of having a child with your own eggs later on.
Many women diagnosed with POI are concerned about their future fertility.
Although spontaneous pregnancy remains possible, the likelihood is lower than in women with normal ovarian function.
If functioning ovarian follicles are still present, IVF (in vitro fertilisation) may be an option.
Hormonal stimulation is used to encourage follicles to mature before egg retrieval.
Success rates depend on factors including:
If ovarian reserve is extremely low or IVF using your own eggs is not possible, egg donation may be recommended.
Today, donor egg IVF provides very good pregnancy success rates for women with POI. Read more about when your own eggs are not enough and see the price list for treatment with donated eggs.
You should consider seeking medical advice or a fertility assessment if you experience:
The earlier an assessment is carried out, the greater the opportunity to identify the cause and discuss appropriate treatment options.
At Ovumia, we help women understand their fertility through comprehensive fertility assessments, hormone testing, and personalised fertility counselling. If you are concerned about your ovarian reserve, have irregular periods, or are experiencing difficulties conceiving, our fertility specialists can help provide answers and guidance. Contact us and we will find the right starting point for you.
Understanding your fertility gives you the opportunity to make informed decisions about your reproductive health, both today and in the future.
Yes. Menopause-like symptoms before 40, irregular or absent periods, hot flushes, sleep problems, can be caused by POI, premature ovarian insufficiency. It affects about 1 in 100 women and should always be investigated.
In everyday language the terms are used interchangeably. Medically, POI is the correct term: ovarian function is reduced before 40 but not necessarily gone, unlike menopause, some ovulation can still occur.
Yes, but the chance is lower. About 5–10% of women with POI conceive spontaneously. IVF with your own eggs may work if functioning follicles remain; otherwise IVF with donor eggs offers very good chances.
A very low AMH level points to a low ovarian reserve, but POI is not diagnosed on AMH alone. The diagnosis rests on infrequent or absent periods for at least four months together with elevated FSH in a woman under 40.
Absent periods (amenorrhoea) have many possible causes, pregnancy, stress, low body weight, PCOS/PMOS or a thyroid disorder. If periods have stopped for several months and you are under 40, POI should be ruled out with hormone tests.
Ovarian function cannot be restored. Treatment is hormone replacement with estrogen until the normal age of menopause, to relieve symptoms and protect bones and heart, plus fertility treatment, IVF with your own or donor eggs, for those who want to conceive.
Medically reviewed by Balsam Haseeb, specialist in obstetrics and gynaecology, Ovumia Sweden · Last updated 2026-09-25.
