What Is Primary Ovarian Insufficiency (POI)?

It’s totally normal to worry about any changes to your once-reliable menstrual cycle. Or, if you have been trying to get pregnant and have ruled out other conditions, such as PCOS. One explanation that doesn’t get nearly enough attention is primary ovarian insufficiency, or POI.

Sometimes called premature ovarian failure, POI happens when the ovaries stop functioning normally before the age of 40. They may release eggs less often, produce less estrogen and progesterone, or communicate less effectively with the rest of your hormonal system. 

POI can mimic the symptoms of menopause, but it is not the same thing. Ovarian function in POI can vary–sometimes active, sometimes quiet–which means periods may come and go, and you may still ovulate spontaneously. This means there’s a chance you can get pregnant with POI.

POI affects between 1-2% of women under the age of 40, so it’s not as well-understood as other hormonal conditions. But that doesn’t mean we don’t need accurate, insightful information about this condition. At Allara, we care deeply about conditions like POI because they sit at the heart of what we do: uncovering the deeper hormonal story behind your symptoms, validating your experiences, and guiding you toward personalized, evidence-backed care.

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How POI Differs From Early Menopause and PCOS

While they share several similarities, POI, PCOS and early menopause are three different conditions:

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Early Signs and Symptoms of Primary Ovarian Insufficiency

POI can be sneaky at first since symptoms often build slowly. Common signs include:

• Missed or irregular periods for several months
• Lighter, shorter, or more spaced-out periods
• Hot flashes or feeling flushed out of nowhere
• Night sweats that disrupt sleep
• Vaginal dryness or discomfort during sex
• Low libido or feeling “disconnected” from your body
• Mood changes, anxiety, or feeling more emotionally fragile
• Brain fog or trouble concentrating
• New or worsening sleep issues
  
  

But, when you look at these symptoms through a broader hormonal lens, they start to make more sense. Allara’s guide to hormone imbalances is a good starting point to start walking through exactly how these patterns show up in real life and why they’re worth investigating.

A good rule of thumb: if you’re under 40 and you’ve missed your period for more than three months with no other underlying conditions, it’s worth having a conversation with a knowledgeable provider.

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What Causes POI?

The exact cause of POI can be hard to pin down. In fact, in about 90% of POI cases, we don’t know the exact underlying cause. That doesn’t make your symptoms any less real, and it definitely doesn’t mean you did anything to cause them.

Through research, we’ve identified a few possible causes, though there’s no guarantee that any one thing causes POI.

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Genetic Factors

Genetics play a much larger role in hormonal health than we previously understood (we’re still discovering the potential genetic links of PCOS!), and POI isn’t any different. Certain genetic conditions are associated with POI, such as:

• Turner Syndrome: This chromosomal abnormality may affect ovarian development; ovarian dysfunction is a common feature.
• FMR1 gene premutation (connected to Fragile X): FMR1 is a genetic variation that can result in POI, infertility and early menopause.
  

In these cases, your provider might recommend genetic testing and, if needed, genetic counseling.

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Autoimmune Causes

For others, POI has an autoimmune component—meaning your immune system may be mistakenly attacking healthy ovarian tissue. POI may be a result of autoimmune thyroid disease, Addison’s disease or type 1 diabetes. 

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Iatrogenic (Treatment-Related) POI

Cancer treatments such as chemotherapy or pelvic radiation can also affect ovarian health, in addition to any surgeries around the pelvis– sometimes immediately and other times, years later.

If you’ve had cancer treatment and now have POI, it’s imperative to look at bone health, heart health, and hormone support early.

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Environmental and lifestyle factors

Chronic stress, nicotine, and exposure to environmental toxins (like pesticides or plastics containing BPA) may play a role in ovarian decline. 

Maintaining a healthy lifestyle with diet, exercise, and stress management techniques can help reduce these risks.

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Idiopathic POI

“Idiopathic” is doctor-speak for “we don’t know the exact reason.” This is the most common category. Though this can be discouraging, it does not mean you did anything wrong or that lifestyle alone caused your ovaries to stop working. It could be multifactorial, or we may simply not have identified the other possible causes of POI.

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How Primary Ovarian Insufficiency Is Diagnosed

If you and your provider have ruled out other conditions, such as PCOS or endometriosis, and you suspect POI, there are a few assessments your provider may turn to for a definitive answer. 

Below is an example of the steps for a diagnosis:

1. Medical history & vitals: Reviewing your most recent menstrual history, symptoms, and vitals such as weight and blood pressure is usually the first step.
2. Pelvic ultrasound: A physical examination of your pelvis can provide a sense of ovarian size and visible follicles, and also helps rule out other causes for cycle changes.
3. Basic blood work: The next step is usually a blood panel that tests for several hormonal imbalances:
   
   • FSH (follicle-stimulating hormone)
   • Estradiol (a form of estrogen)
   • Thyroid function tests
   • Prolactin and sometimes other hormones
4. Additional testing (if needed): Based on your symptoms, age, and history, your provider might consider:
   
   • Karyotype or genetic testing
   • Autoimmune panels
   • Screening for other endocrine conditions

Two elevated FSH levels, taken at least a month apart, combined with low estradiol and irregular cycles, usually point strongly toward POI.

Once you receive confirmation, the goal is not only to label what’s happening but to build a long-term plan to support bone health, heart health, fertility, and symptom management.

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How POI Affects Fertility

If you’re on a fertility journey, a POI diagnosis can be disheartening. It’s even okay if your first reaction is shock or grief. However, POI doesn’t mean you cannot get pregnant. You still ovulate, though less frequently than others, and often sporadically. That’s why spontaneous pregnancy is possible, though not common, with most data putting the number at around 5%-10%.

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Ways to Support Your Fertility Journey

So, what can you do? Some choose to track their cycles and try to conceive naturally, while also building a medical plan around their hormone needs. 

Certain lifestyle changes may help, such as limiting smoking and drinking, and prioritizing antioxidant-rich foods. Oxidative stress can affect ovarian cells, egg quality, and even how your hormones communicate. Foods like berries, citrus fruits, leafy greens, and green tea offer daily protection and can support cellular health over time.

Others explore assisted reproductive options such as IVF or egg and embryo freezing, if there’s still enough viable ovarian activity.

Donor egg IVF remains the most effective option for many people with limited ovarian reserve.

Regardless of what you choose, every path is valid. There is no “less real” way to become a parent. Your journey is your own, and you deserve support that honors that.

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Treatment and Long-Term Health

Beyond fertility, POI can have other long-term health implications. Estrogen has protective effects on the brain, bones, heart, and urogenital tissues. When those levels drop early, your care plan should focus on more than symptom relief. Low estrogen is generally the cause of many POI symptoms, like brain fog, cycle irregularity, and vaginal dryness. 

Currently, there aren’t any FDA-approved cures for POI, and treatment focuses on symptom management and ensuring a quality of life. 

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Hormone replacement therapy (HRT)

For many, hormone replacement therapy (HRT) is the gold standard for treatment. The goal isn’t to mimic menopause; it’s to replace missing hormones until the natural age of menopause.

HRT can:

• Reduce hot flashes and night sweats
• Help with vaginal dryness
• Support bone density
• Protect long-term cardiovascular health

HRT comes in several different forms: pills, patches, and topical gels/creams, depending on your symptoms and needs.

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Bone and Cardiovascular Health

Because low estrogen affects bone density, your provider may talk to you about calcium, vitamin D, and weight-bearing exercise—things that support bone health over time. They may also recommend periodic bone density scans and cardiovascular monitoring to keep an eye on things.

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Sexual Health 

Sexual wellness is another essential part of POI care. Much like perimenopause, declining estrogen affects the vaginal tissues. This leads to vaginal discomfort, dryness, and changes in libido. For many people, local vaginal estrogen and pelvic floor physical therapy make a tremendous physical and emotional difference.

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Living With POI: Practical Everyday Support

POI is a medical diagnosis, but it’s also an emotional experience. It can affect how you see your body, your relationships, and your future plans. Beyond support from a knowledgeable care team and therapeutic intervention, you can support these efforts with lifestyle changes.

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Diet & Nutrition

Lean into meals that feel grounding and nourishing. Choose colorful vegetables, high-quality proteins, whole grains, and plenty of healthy fats. Many people find that a fertility-friendly, anti-inflammatory style of eating helps stabilize energy, mood, and overall hormone balance.

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Stabilize Blood Sugar

Balanced meals with protein, fiber, and healthy fats help minimize insulin spikes, and that matters more than you might think—insulin is a hormone, too. Emerging research suggests there’s a close relationship between reproductive and metabolic health. Keeping blood sugar stable lessens cravings and stabilizes mood and energy.

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Exercise

Walking, yoga, Pilates, and swimming all improve circulation, support bone health, and act as a natural mood stabilizer. And remember: you don’t need intense workouts to see benefits. Consistency is more important than intensity.

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Consider adding a supplement designed to support hormonal balance. 

Many people with POI want added nutritional support, especially around mood, stress, and steady hormone signaling. Allara’s Hormone Equilibrium blend was created with this in mind; it includes ingredients that help promote metabolic balance, regulate stress responses, and support overall hormonal harmony. It’s not a treatment for POI, but it can complement your broader care plan.

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FAQs About Primary Ovarian Insufficiency

Is POI the same as premature menopause?

No. Menopause is permanent. POI can be intermittent, and some ovarian function may continue.

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Can a woman with premature ovarian failure get pregnant​?

It’s possible but less likely, and between 5-10% of women with POI get pregnant spontaneously. Some people do conceive naturally, and others build families through assisted reproductive technologies, such as IVF.

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How is POI diagnosed?

Typically, through missed or irregular periods, high FSH on two tests, low estrogen, and ruling out other causes.

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Do I need hormone replacement therapy?

Many people benefit from HRT to protect bone and heart health and to manage symptoms, but everybody’s journey is different, and your care plan may look different.

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Will POI affect my long-term health?

Without proper care, POI can affect bone density, cardiovascular health, and sexual wellness. With the right support, you can protect your health and feel more like yourself.

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Key Takeaways and Next Steps

If you’re under 40, your periods are off, and you’re seeing low estrogen symptoms pop up, it’s not “too dramatic” to get checked out. Getting a diagnosis is the first step in accessing care that returns your quality of life.

At Allara, conditions like POI are our bread and butter. We don’t just look at one symptom or one lab; we look at the whole you and create a plan that supports your hormones, fertility goals, and long-term health. Reach out today for hormone-informed care that’s centered on you.

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