Typically women start their periods in their early teens and stop when they reach around 50 years old. During this time, the ovaries produce hormones such as oestrogen and testosterone that are critical in maintaining their health.
However, the ovaries of two to four per cent of women cease functioning much earlier, before they reach 40 and as early as their teens – just years after their periods first begin. This condition is known as premature ovarian insufficiency, or POI.
POI is usually diagnosed in women under 40 who haven’t had their period for at least four months. It can also be detected by a high level of a hormone secreted from the brain that helps the ovaries release an egg during the menstrual cycle.
Unless they are expecting a pregnancy, this abrupt ceasing of ovulation can, of course, come as a complete shock to women in their teens, twenties or thirties.
It's also a condition often accompanied by other symptoms caused by hormonal changes when the ovaries stop working. These include irregular periods, hot flushes and night sweats, poor sleep, fatigue, changes in mood and the occurrence of anxiety and depression.
Yet, despite the condition’s relative prevalence, exactly why it happens, in most cases, is unknown. But there are some clues.
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One known cause of POI is a form of autoimmune disease in which the body attacks itself. This can lead to several other conditions such as thyroid disease and type 1 diabetes. Even so, it’s not yet fully understood exactly why this happens.
We do know that some women may be genetically predisposed to POI. Often this is first detected as the condition is known to run in families. These women may have genetic changes in their sex chromosomes, or perhaps Turner’s syndrome – a chromosomal abnormality where a female assigned at birth has one X chromosome rather than the default two.
Hidden impacts
The loss of functioning ovaries and the accompanied ceasing in hormone production significantly impacts the body in both the short and long term. This leads to women with POI being at double the risk of cardiovascular disease, heart attacks, strokes and even heart failure.
Without treatment, women with POI may have a shorter life expectancy. This is mainly because low estrogen levels can increase the risk of heart problems by causing fatty build-up in the arteries. However, studies have shown that replacing the ‘missing’ oestrogen with medication can reverse this effect.
Low oestrogen levels can also lead to a reduction in bone density, ultimately increasing the risk of bone fractures, even in women under 50. In addition, women with POI are at an increased risk of cognitive decline and are more likely to suffer from degenerative cognitive diseases such as Alzheimer’s and Parkinson’s as well as mental health conditions such as depression.
The condition also affects fertility. And any pregnancy will inevitably carry a higher risk of miscarriage. However, as ovarian activity can be intermittent, there is still a small chance of women with POI conceiving so the use of contraception is advised to prevent unwanted pregnancies.
The bottom line is that women with POI must be managed by specialists across multiple medical disciplines so that they can be treated effectively to prevent the wide-ranging consequences the loss of ovarian function can lead to. In this way, many of the effects of the condition can be reversed and the life expectancy of the women suffering from it lengthened.
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