Premature Ovarian Insufficiency: Facing Early Decline in Ovarian Reserve

Premature ovarian insufficiency (POI) is a condition where the ovaries lose normal function well before the typical age of menopause, leading to an unexpectedly early decline in a woman’s egg supply or ovarian reserve. In a healthy woman, the natural fertility decline in women usually becomes noticeable in the late 30s, with menopause occurring around age 50. However, those with POI experience this decline much sooner – often in their 20s or 30s – resulting in irregular menstrual cycles, menopause-like symptoms, and challenges with fertility. This scenario is sometimes referred to as “early menopause” or premature menopause, though there are important distinctions between POI and actual menopause.

Women facing POI often struggle with the sudden change in their reproductive health. It can be distressing to have symptoms of menopause so early and to worry about fertility in what should be the peak reproductive years. Statistically, premature ovarian insufficiency is relatively uncommon, affecting roughly 1% of women under age 40. This means only about one in 100 women experience this condition. In this article, we will explore what POI is, how it differs from typical menopause, the symptoms of early ovarian failure, possible causes, how doctors diagnose it, and what can be done in terms of management and fertility options.

Understanding Premature Ovarian Insufficiency vs. Premature Menopause

The condition was historically termed “premature ovarian failure,” and some may casually call it premature menopause because many features overlap with menopause. However, POI is not exactly the same as menopause. In natural menopause, the ovaries have ceased functioning completely, and periods stop permanently. By contrast, women with POI might still have intermittent ovarian activity – they could have occasional periods or even rare spontaneous ovulations. In other words, someone with POI might still get a menstrual cycle now and then and, in uncommon cases, even become pregnant despite the diagnosis. With true premature menopause, once periods stop before 40, they do not return, and natural pregnancy is no longer possible.

Special Considerations in Adolescents and Young Women

Diagnosing premature ovarian insufficiency (POI) in adolescents and young women presents unique challenges that differ significantly from those seen in older adults. One of the primary difficulties is that menstrual irregularity is common in early puberty, making it hard to distinguish between normal variations and the early signs of POI. During adolescence, the menstrual cycle can be naturally unpredictable as the hypothalamic-pituitary-ovarian axis matures, and it is not unusual for young women to experience irregular or missed periods in the first few years after menarche. This physiological variability often leads to delays in recognizing POI, as both patients and healthcare providers may attribute symptoms to normal pubertal development rather than an underlying ovarian disorder. As a result, POI in this age group is frequently underdiagnosed or diagnosed only after a significant delay, which can have important implications for both physical and emotional health.

The emotional and psychosocial impact of a POI diagnosis during adolescence can be profound. Adolescence is a critical period of identity formation and self-esteem development, and learning about a condition that affects fertility and hormonal health can be distressing and isolating. Young women may experience feelings of grief, loss, anger, or even guilt, particularly when faced with the realization that their reproductive potential is compromised at such an early stage in life. Concerns about femininity, future family-building, and long-term health risks can contribute to anxiety, depression, and impaired self-esteem. The diagnosis can also affect relationships with peers and family members, as adolescents may struggle to communicate their feelings or may feel misunderstood. Supportive counseling and open, empathetic communication are essential to help young women process the diagnosis, cope with emotional challenges, and build resilience.

Given these complexities, the management of POI in adolescents and young women requires a multidisciplinary approach and regular, long-term follow-up. Annual evaluations are recommended to monitor overall health, address evolving medical and psychosocial needs, and adjust treatment as the patient matures. A care team may include gynecologists, endocrinologists, reproductive specialists, mental health professionals, and, when appropriate, genetic counselors. This collaborative approach ensures that hormonal therapy is tailored to support bone, cardiovascular, and sexual health, while also addressing emotional well-being and future fertility planning. Ongoing support and education empower young women and their families to better understand the condition, advocate for their needs, and maintain the best possible quality of life as they navigate adolescence and adulthood with POI.

What Causes Premature Ovarian Insufficiency?

Anyone diagnosed wants to know what causes premature ovarian insufficiency. Unfortunately, in the majority of cases, there is no clear answer, as about 90% of POI cases have no identifiable cause. Still, doctors have identified several factors that can contribute to or trigger POI in some women:

• Genetic factors: A woman’s genetic makeup plays a significant role in her ovarian health. Certain genetic disorders are strongly linked to an increased risk of developing POI at a young age. For instance, a premutation in the FMR1 gene, which causes Fragile X syndrome, is a common genetic cause of POI. Turner syndrome, a chromosomal disorder affecting females, is another well-known genetic condition that often leads to premature ovarian failure due to an accelerated loss of ovarian follicles. Other less common genetic mutations or chromosomal abnormalities can also impact ovarian development and function, predisposing individuals to early ovarian decline.
• Autoimmune disorders: In some instances, the body’s own immune system, which normally protects against foreign invaders, mistakenly identifies and attacks the ovarian tissue. This condition, known as autoimmune oophoritis, can lead to inflammation and damage of the ovarian follicles, ultimately resulting in early ovarian failure. Autoimmune POI is often associated with other autoimmune conditions, such as autoimmune thyroid disease, Addison’s disease, or systemic lupus erythematosus, suggesting a broader systemic autoimmune predisposition.
• Cancer treatments: Medical interventions for cancer, particularly chemotherapy drugs and pelvic radiation, can have a profound impact on ovarian function. Many women who undergo these treatments, especially with certain alkylating agents or platinum-based drugs, may experience ovarian insufficiency afterward. 
• Surgery or injury: Surgical procedures involving the ovaries can significantly reduce ovarian reserve and precipitate POI. An oophorectomy, the complete surgical removal of one or both ovaries, directly eliminates ovarian tissue. Even less invasive surgeries, such as the removal of ovarian cysts (cystectomy), can inadvertently reduce the number of healthy follicles or compromise the ovarian blood supply, thereby diminishing ovarian reserve and increasing the risk of POI. Trauma or injury to the pelvic region that affects the ovaries can also lead to similar outcomes.
• Environmental toxins and smoking: Exposure to certain environmental factors and lifestyle choices can negatively impact ovarian health. Cigarette smoking, for example, has been consistently linked to earlier ovarian failure and menopause due to the presence of harmful chemicals that are toxic to ovarian follicles. 

 It’s important to emphasize that nothing the woman did caused her POI in these unexplained cases.

Symptoms of Early Ovarian Failure

Many women with POI first notice changes in their menstrual cycle. The most common sign is irregular or missed periods (amenorrhea) that are not due to pregnancy or other obvious causes. Over time, periods may become very infrequent or stop altogether before age 40. Beyond menstrual changes, POI leads to symptoms caused by low estrogen levels:

• Hot flashes and night sweats: These sudden, intense waves of heat or profuse sweating episodes are a hallmark symptom, often mimicking the experience of natural menopause. They can be particularly disruptive at night, leading to significant discomfort and sleep disturbances.
• Vaginal dryness: The decline in estrogen levels directly impacts the vaginal tissues, causing them to become thinner, drier, and less elastic. This can result in considerable discomfort, itching, and pain during sexual intercourse, significantly impacting quality of life.
• Mood swings and irritability: Fluctuations in hormone levels can profoundly affect emotional well-being. Many women with POI report experiencing increased anxiety, heightened irritability, and periods of depression. Additionally, some describe a noticeable difficulty concentrating and a general feeling of mental fogginess, often referred to as “brain fog,” similar to what is experienced during menopause.
• Decreased sex drive: The reduction in key hormones, particularly estrogen and testosterone, can lead to a significant decrease in libido or sexual desire. This can be a distressing symptom, impacting intimate relationships and overall well-being.
• Fatigue and sleep disturbances: A pervasive feeling of low energy and chronic fatigue is common. This can be directly related to the hormonal imbalances and is often exacerbated by sleep disturbances, such as insomnia, which can be triggered by night sweats.
• Trouble getting pregnant: For many women, infertility is the initial and often most compelling symptom that prompts them to seek medical attention. Difficulty conceiving or recurrent pregnancy loss often leads to an undiagnosed POI being discovered during fertility evaluations.

Any woman under 40 experiencing several of these symptoms together, especially along with missed periods for three or more months, should see a healthcare provider for evaluation.

Diagnosis and Testing of Ovarian Reserve

When doctors suspect POI, they will perform evaluations to confirm the diagnosis and assess the woman’s ovarian reserve. Key steps for how to test ovarian reserve and diagnose POI include:

1. Hormone Blood Tests:
   • Follicle-Stimulating Hormone (FSH) and Estradiol (Estrogen): These are primary indicators. In women with POI, the ovaries are not responding effectively to the pituitary gland’s signals. Consequently, the pituitary gland increases its production of FSH in an attempt to stimulate the ovaries, leading to abnormally high FSH levels, often mirroring those seen in natural menopause. Simultaneously, the ovaries produce less estrogen, resulting in low estradiol levels.
   • Anti-Müllerian Hormone (AMH): AMH is a crucial marker for ovarian reserve, reflecting the number of remaining small follicles (and thus eggs) in the ovaries. A significantly low AMH level for a woman’s age is a strong indicator of diminished ovarian reserve, a hallmark of POI. This test provides a more direct assessment of the existing egg supply.
2. Pelvic Ultrasound:
   • A transvaginal or abdominal pelvic ultrasound allows for a direct visualization of the ovaries. The primary goal is to perform an antral follicle count (AFC), which involves counting the small fluid-filled sacs (antral follicles) that contain immature eggs. In POI, the ovaries often appear smaller than typical, and the AFC will be notably low, indicating a significantly reduced number of developing follicles and overall egg count. This imaging also helps rule out other structural abnormalities of the ovaries or uterus.
3. Genetic and Autoimmune Screening:
   • Chromosome Abnormalities and Genetic Mutations: Blood tests may be conducted to screen for underlying genetic factors. Conditions such as Turner Syndrome (a chromosomal disorder) or Fragile X syndrome (a genetic mutation) are known to be associated with an increased risk of POI. Identifying these genetic causes can provide valuable information for family planning and understanding the long-term implications of the condition.
   • Autoimmune Markers: POI can sometimes be an autoimmune condition where the body’s immune system mistakenly attacks its own ovarian tissue. Blood tests for specific autoimmune markers, such as adrenal antibodies or thyroid antibodies, may be performed to investigate a potential autoimmune etiology. Discovering an autoimmune link can influence treatment strategies and lead to further evaluation for other autoimmune conditions.

Other Important Evaluations:

Beyond the core diagnostic tests, a comprehensive evaluation is essential to confirm the diagnosis of POI and rule out other potential causes of irregular or absent periods.

• Thyroid Disorders: Hypothyroidism (underactive thyroid) can cause menstrual irregularities that mimic symptoms of POI. Blood tests for thyroid-stimulating hormone (TSH) and thyroid hormones (T3, T4) are crucial to assess thyroid function.
• Hyperprolactinemia: Elevated levels of prolactin, a hormone produced by the pituitary gland, can also disrupt menstrual cycles. A blood test for prolactin levels will be performed to rule out this condition.
• General Physical Exam and Medical History Review: A thorough physical examination, including a pelvic exam, helps assess overall health and identify any other contributing factors. A detailed medical history, including menstrual history, family history of autoimmune diseases or early menopause, past surgeries, and medication use, provides invaluable context for diagnosis and personalized management. This comprehensive approach ensures that symptoms are accurately attributed to POI rather than other conditions.

Typically, a diagnosis of POI is confirmed if a woman under 40 has had very infrequent or no periods for several months and shows menopausal-range hormone levels on at least two occasions, a few weeks apart.

Complications and Associated Conditions

One of the most significant complications is osteoporosis, or loss of bone density. Estrogen plays a vital role in maintaining bone strength, so women with POI are at a much higher risk for developing osteoporosis and experiencing bone fractures at a younger age than their peers. Regular bone density screening (such as a DEXA scan) is recommended, and preventive strategies include hormone replacement therapy (HRT), adequate calcium and vitamin D intake, weight-bearing exercise, and avoiding smoking or excessive alcohol. Another major concern is cardiovascular disease. Estrogen also helps protect the heart and blood vessels, so women with POI face an increased risk of developing high cholesterol, atherosclerosis (hardening of the arteries), and heart disease earlier in life. To lower these risks, it is important to maintain a healthy lifestyle, manage blood pressure and cholesterol, and continue HRT as advised by a healthcare provider.

Endocrine disorders are also more common in women with POI. Hypothyroidism (underactive thyroid) is seen in up to 20% of cases, particularly when the cause of POI is unknown or related to autoimmunity. Screening for thyroid function (TSH and thyroid antibody tests) is often recommended every 1–2 years. Adrenal insufficiency, another endocrine disorder, can occur, especially in those with autoimmune POI, so testing for adrenal antibodies and regular follow-up may be warranted. In some cases, other autoimmune conditions can be associated, so women and their providers need to remain vigilant for new symptoms. Mental health is another crucial aspect of POI. The diagnosis itself can be emotionally distressing, and the hormonal changes may contribute to mood disorders such as anxiety or depression. Feelings of grief, loss, or reduced self-esteem are common, particularly for those facing unexpected infertility. 

Fertility and Reproductive Health

Premature ovarian insufficiency (POI) has a profound impact on fertility and reproductive planning. Because the ovaries lose normal function earlier than expected, women with POI experience a significant reduction in both the number and quality of eggs available for fertilization. This often leads to difficulty conceiving naturally, and for many, infertility is the first sign that prompts medical evaluation.

Unlike true menopause, POI does not always mean that ovarian function has ceased entirely. Ovarian activity can be unpredictable and intermittent. Some women may still have occasional menstrual cycles and, in rare cases, spontaneous ovulation. As a result, natural conception is not impossible—clinical studies suggest that approximately 5% to 10% of women with POI may achieve a spontaneous pregnancy, even after diagnosis. However, these pregnancies are unpredictable and cannot be reliably planned for, which can be challenging for those trying to conceive.

For women who wish to build a family, several fertility treatment options are available. The most effective and widely used approach is in vitro fertilization (IVF) with donor eggs. In this process, eggs from a healthy donor are fertilized with sperm in a laboratory, and the resulting embryo is transferred to the uterus. This method bypasses the problem of diminished egg supply and offers high success rates for achieving pregnancy. Other options include the use of donor embryos (embryo adoption) or pursuing traditional adoption.

It is important for women with POI to consult with reproductive endocrinologists or fertility specialists. These experts can evaluate whether any remaining ovarian function can be maximized and guide patients through the available options. Support and counseling are also crucial, as coming to terms with alternative family-building methods can be emotionally challenging.

Contraception remains an important consideration for women with POI who do not wish to become pregnant. Even if periods are irregular or absent, unexpected ovulation and pregnancy can still occur. Healthcare providers typically recommend discussing contraceptive options, such as barrier methods or hormonal contraceptives, to prevent unintended pregnancies until menopause is fully reached.

Open communication with healthcare providers ensures that both the medical and emotional aspects of POI are addressed, empowering women to navigate this diagnosis with confidence and support.

POI’s Impact on Fertility

One of the most significant implications of POI is its effect on fertility. When the ovaries are not reliably producing eggs, conceiving becomes significantly more challenging. A common question is, does low AMH affect fertility? Low AMH itself doesn’t directly cause infertility, but it is a strong indicator of reduced egg supply, meaning there are fewer chances for a healthy egg to be released and fertilized. AMH is like a measure of the remaining fuel in the ovarian tank. When the tank is near empty (very low AMH), it becomes harder to achieve pregnancy, although not absolutely impossible. POI often leads to infertility or subfertility. Women with POI have a far lower chance of conceiving naturally than other women their age. A small percentage of women with POI might ovulate occasionally and get pregnant on their own. However, because these cases are uncommon and unpredictable, doctors advise against relying on this possibility if one hopes to have children. On the other hand, if a woman with POI is not trying to conceive, she should still use contraception unless she wishes to become pregnant, while unlikely, spontaneous ovulation and pregnancy can still occur until menopause is fully reached.

Fertility and Reproductive Health

Because the ovaries lose their normal function well before the expected age, women with POI experience a significant reduction in the number and quality of eggs available for fertilization. This leads to difficulty conceiving naturally, and for many, infertility is the first sign that prompts medical evaluation. However, POI is distinct from complete menopause in that ovarian activity can be intermittent and unpredictable. Some women may still have occasional menstrual cycles and, in rare cases, spontaneous ovulation. As a result, natural conception is not entirely impossible. Clinical studies and expert guidelines suggest that approximately 5% to 10% of women with POI may achieve a spontaneous pregnancy, even after diagnosis. These pregnancies tend to occur unpredictably and cannot be reliably anticipated or planned for, making it challenging for women and couples who wish to conceive naturally.

Importantly, the possibility of intermittent ovarian function means that contraception remains a relevant consideration for women with POI who do not wish to become pregnant. Even if periods are irregular or absent, unexpected ovulation and pregnancy can still occur. Healthcare providers typically recommend discussing contraceptive options, such as barrier methods or hormonal contraceptives, to ensure that pregnancy does not happen unintentionally. Open communication with healthcare providers ensures that both the medical and emotional aspects of POI are addressed, empowering women to navigate this challenging diagnosis with greater confidence and support.

Fertility Treatment Options

Facing a diagnosis of POI can be heartbreaking for someone who hoped to have biological children, but there are fertility treatments and family-building options to consider. The most successful and widely utilized treatment for achieving pregnancy is in vitro fertilization (IVF) using donated eggs. This innovative reproductive technology has emerged as the gold standard, offering a viable pathway to parenthood for many individuals facing the challenges of POI. The process of IVF with donor eggs is meticulously designed to circumvent the limitations imposed by the patient’s own ovarian function. It involves several key steps. First, healthy, carefully screened egg donors contribute their oocytes, which are retrieved through a minor surgical procedure. Donor selection is a rigorous process, often considering factors like age, medical history, and genetic screening to maximize the chances of a successful outcome and minimize risks. Secondly, the retrieved donor eggs are then fertilized in a specialized laboratory setting with sperm, which can be from the patient’s partner or a sperm donor. This fertilization process aims to create viable embryos, often involving advanced techniques like intracytoplasmic sperm injection (ICSI) if sperm quality is a concern. Thirdly, once the embryos have developed to an appropriate stage, typically a few days after fertilization, one or more healthy embryos are carefully transferred into the uterus of the woman with POI. This transfer is a delicate procedure performed under ultrasound guidance, aiming to place the embryo in the optimal location for implantation.

This method effectively bypasses the critical hurdle of the patient’s own ovaries being unable to produce viable eggs, which is the defining characteristic of POI. By utilizing healthy donor eggs, the focus shifts to ensuring a receptive uterine environment for implantation and supporting the subsequent pregnancy. The high success rates associated with IVF using donor eggs have made it an invaluable solution, empowering numerous women with POI to experience the profound joy of carrying a pregnancy to term and building their families. Aside from IVF, other paths to motherhood include using donor embryos (embryo adoption) or pursuing traditional adoption.

Women with POI should consult with reproductive endocrinologists (fertility specialists) at specialized fertility clinics. These experts can explain the options, help maximize any chance of using one’s own eggs if possible, or facilitate treatments with donor eggs. They also provide support and counseling, since coming to terms with alternative family-building options can be emotionally challenging. While it may not be the path originally envisioned, many women with POI do become mothers through these alternatives.

Managing Health and Hormone Therapy

Fertility aside, another critical aspect of POI is managing the health effects of early estrogen loss. Young women are not meant to be estrogen-deficient in their 20s or 30s; estrogen is important for various aspects of health, including bone density, heart health, sexual function, and cognitive well-being. Hormone therapy for women with POI is usually recommended to replace the hormones the ovaries would normally make. This typically involves hormone replacement therapy (HRT) with estrogen (often via a patch or pill) and progesterone (if the woman still has a uterus). By restoring estrogen levels, HRT can relieve symptoms like hot flashes and vaginal dryness and, importantly, help prevent long-term issues such as bone loss and heart disease.

Hormone therapy for POI is considered safe and effective under medical supervision, because these women are simply replacing hormones they would otherwise naturally have at their age. In fact, the benefits of HRT in young women with POI generally outweigh the risks. Along with HRT, doctors advise general health measures to protect bone and heart health: getting sufficient calcium and vitamin D (through diet or supplements), engaging in weight-bearing exercise to strengthen bones, not smoking (since smoking further increases bone loss and heart risks), and having periodic bone density screenings. With proper treatment and healthy lifestyle habits, a woman with POI can expect to lead a normal, active life.

For women diagnosed with premature ovarian insufficiency (POI), hormone therapy is typically the cornerstone of medical management. The primary goal is to replace the hormones—mainly estrogen and, if the uterus is present, progesterone—that the ovaries would normally produce until the natural age of menopause. Hormone replacement therapy (HRT) can be delivered in various forms, such as patches or pills, and is tailored to each individual’s needs. This therapy not only helps alleviate uncomfortable symptoms like hot flashes and vaginal dryness but also plays a critical role in preventing long-term complications associated with early estrogen loss, such as osteoporosis and cardiovascular disease.

Hormone therapy for POI is considered both safe and effective when supervised by a healthcare provider. Unlike HRT used after the natural age of menopause, hormone therapy for women with POI simply restores hormone levels to what is typical for their age group. As a result, the benefits of HRT—especially in protecting bone and heart health—generally outweigh the risks in this younger population.

In addition to hormone therapy, several lifestyle and health measures are recommended to further reduce the risk of complications. Ensuring adequate calcium and vitamin D intake, either through diet or supplements, is important for maintaining bone strength. Engaging in regular weight-bearing exercise, such as walking or strength training, also helps to support bone density. Avoiding smoking is crucial, as it can accelerate bone loss and increase cardiovascular risks. Periodic bone density screenings are advised to monitor bone health over time and allow for early intervention if needed.

Natural Ways to Boost Egg Quality

A common question is whether there are natural ways to boost egg quality or slow ovarian aging. No lifestyle change or supplement can reverse POI, but adopting healthy habits may support overall reproductive health and any remaining ovarian function:

1. Nutrition and supplements: Eat a balanced diet rich in vitamins and antioxidants. Some fertility specialists suggest supplements such as Coenzyme Q10 (CoQ10) or DHEA to women with low ovarian reserve, as these may support egg quality (consult a doctor before use).
2. Maintain a healthy weight: Engage in regular moderate exercise and aim for a healthy body weight. Being significantly overweight or underweight can negatively affect fertility. Avoid extremely intense exercise regimens if trying to conserve ovarian function.
3. Reduce stress: High stress levels might disrupt hormonal signals. Practices like yoga, meditation, or acupuncture can help manage stress and may have a positive influence on hormonal balance.
4. Avoid smoking and toxins: Quit smoking, as it is known to accelerate egg loss and ovarian aging. Also, minimize exposure to environmental toxins (pesticides, chemicals) as much as possible, since these can harm overall reproductive health.

These natural approaches cannot cure POI, but they create a more favorable environment for health. For instance, if any eggs are still being released, a healthy lifestyle could improve the likelihood of those eggs being of better quality. At the very least, these strategies improve one’s general well-being and preparedness for fertility treatments or pregnancy.

Coping and Emotional Support

The emotional impact of POI can be significant. It’s normal to feel grief, anger, or anxiety upon learning of an early loss of fertility potential. Coping with this diagnosis often means seeking support and information. Many women find it helpful to connect with others who have gone through similar struggles – support groups (in person or online) or counseling can provide a safe space to share feelings and learn coping strategies. Involving one’s partner or family in discussions can also ease the burden, as loved ones can offer emotional support and help with decision-making. Educating yourself about POI and your options tends to make the situation less overwhelming; knowledge can replace some fear with a sense of empowerment. While it may take time to come to terms with the news, remember that there are paths forward – both in terms of health management and building a family – and you don’t have to navigate them alone.

Prognosis and Outlook

The long-term outlook for individuals with premature ovarian insufficiency (POI) is complex and can vary from person to person, but several important themes consistently emerge. POI is generally considered a chronic, lifelong condition, meaning that most women will continue to experience reduced ovarian function and persistently lower estrogen levels compared to their peers. However, unlike natural menopause, ovarian function in POI can be unpredictable. While the ovaries typically lose their ability to function regularly, they do not always cease to work entirely. This unpredictable nature underscores the importance of ongoing communication with healthcare providers regarding both contraception and family planning, as natural conception, while uncommon, is not impossible. From a general health perspective, with appropriate medical management, women with POI can expect to live healthy, fulfilling lives. The most significant health risks associated with POI are primarily related to the deficiency of estrogen at a younger age than typical.  

Premature ovarian insufficiency is a life-altering diagnosis, but it is not the end of the road for a woman’s health or family plans. The symptoms and health risks of POI can be managed – for example, hormone therapy can address the estrogen deficiency to protect bones and the heart. And with modern reproductive technologies or alternative paths like egg donation or adoption, having children is still possible, even if the journey looks different from what was initially imagined. The experience of an early decline in ovarian reserve is undoubtedly challenging, but many women with POI go on to thrive in their lives. By working closely with healthcare providers, seeking support when needed, and prioritizing their physical and emotional well-being, women with POI can face this challenge and move forward with hope and resilience.

Sources

• Fertility Institute of Hawaii – “What Is Premature Ovarian Insufficiency?”ivfcenterhawaii.comivfcenterhawaii.com
• Mayo Clinic – “Primary Ovarian Insufficiency – Symptoms & Causes”mayoclinic.orgmayoclinic.org
• Mayo Clinic – “Primary Ovarian Insufficiency – Diagnosis & Treatment”mayoclinic.org
• MedlinePlus – “Primary Ovarian Insufficiency (Premature Ovarian Failure)”medlineplus.govmedlineplus.gov
• CREATE Fertility – “Low AMH and fertility”createfertility.co.uk