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Premature ovarian insufficiency and your fertility

If your ovaries aren’t working as they should, you might worry your fertility journey is over. This isn’t true and for many people, it’s just the beginning. Learn about your fertility options here.


Most of us hope to avoid fertility worries and menopause symptoms until later in life, but for some, they come much sooner than expected.

Around 3 in 100 women have primary ovarian insufficiency (POI), a fertility condition that can happen as early as your 20s. It used to be called premature ovarian failure.

A diagnosis of POI can be difficult news, but it doesn’t mean giving up on becoming a parent.

This page covers specialist fertility advice on:

What is primary ovarian insufficiency?

In POI, the ovaries produce less oestrogen and can stop releasing eggs.

It’s a type of premature or early menopause that affects people before age 40.

How does POI affect fertility?

Without enough oestrogen, the ovaries struggle to produce and release eggs, which causes irregular or missed periods.

This makes it harder to get pregnant but not impossible.

Up to 1 in 10 women with POI become pregnant naturally, but it usually takes longer.

When to see a fertility specialist

Our fertility specialists are medical professionals who offer advice and treatment for preserving fertility or trying to get pregnant with POI.

This could be if:

  • You’ve got POI and are trying to get pregnant

  • You’ve been trying to get pregnant for more than a year

  • You’re worried about POI in the future, for example, if it runs in the family or you have a condition that increases the risk

A consultation and fertility assessment gives you an overall picture of your current fertility, including whether it’s affected by POI.

Once you know your fertility health, we can support you in exploring the next steps.

These include specialist treatments like fertility preservation and IVF.

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Getting started patient stories

Check your fertility

If you're worried about POI or have symptoms like missed periods, a fertility assessment is a great first step in getting personalised support.

Symptoms of primary ovarian insufficiency

The main sign of POI is irregular periods (not coming every month), or your periods stopping. It can also make it difficult to get pregnant.

Other symptoms

Low oestrogen levels in POI can cause other symptoms, which are similar to menopause.

Not everyone gets them, but they include:

  • Suddenly feeling hot (hot flushes)

  • A dry vagina or discomfort during sex

  • Night sweats

  • Trouble sleeping

  • Less interest in sex

  • Mood swings, anxiety or low mood

  • Brain fog or memory problems

  • Headaches

  • A racing heart

  • Stiff or achy joints

  • Urinary tract infections

If you’re having symptoms of POI, see your GP or a specialist.

Risk factors

Some people are more likely to have POI.

The risk increases with:

  • Age 

  • Smoking

  • A family history of premature menopause

  • Being underweight

Getting a diagnosis

Primary ovarian insufficiency is diagnosed based on your age, symptoms, and blood tests for FSH and oestrogen, which are hormones affected by POI.

What causes primary ovarian insufficiency?

POI can be caused by:

  • Cancer treatment including chemotherapy, radiotherapy or surgery to remove the ovaries

  • Certain autoimmune conditions (thyroiditis, adrenal insufficiency, polyglandular syndrome, lupus, myasthenia gravis, pernicious anaemia)

  • Genetic or chromosomal conditions

  • In rare cases, specific infections such as mumps, measles or tuberculosis

Often, the cause of POI is unknown, but this shouldn’t affect your treatment or fertility option.

Couple embracing

Treatment for POI

There are hormone treatments to help you cope with POI symptoms, and fertility treatments to help with pregnancy.

At TFP Fertility UK, we tailor any treatment to you. The best route depends on you, including your current fertility, your health, and your preferences.

Hormone therapy

Hormone therapy (HRT) replaces the natural oestrogen that’s missing in POI. It comes as creams, gels, patches, pills, or implants.

HRT is advised because low oestrogen earlier in life can cause health issues such as weak bones, heart disease, and neurological conditions.

It can also help with symptoms of POI, and in some cases can bring back your periods.

We partner with Hormone Health to offer specialist hormone services for people with POI.

Learn more about hormone therapy.

Fertility preservation

Preserving your fertility allows you to have choices later on if you're concerned about POI but not yet ready for parenthood.

If you've recently been diagnosed with POI but still have enough ovarian reserve (eggs), this could be an option for you.

It's also an option if you're worried about getting POI in the future.

This could be if you're going to have cancer treatment, it runs in the family, or you have a certain condition.

Learn more about fertility preservation.


In vitro fertilisation (IVF) is when egg release (ovulation) is stimulated with medicine before removing your eggs and fertilising them in the lab.

If you have POI, it may be possible to have IVF using your eggs.

However, if you have low ovarian reserve (a small number of eggs), the best chance of success is to have fertility treatment with a donor egg.

You can find out your ovarian reserve from a fertility assessment

Learn more about IVF.

Using donor eggs

Egg donation is when someone gives their eggs for your treatment, which can be a donor or somebody you know.

The eggs are fertilised with your partner's sperm or donor sperm.

The embryo is then placed in your womb, and you carry the pregnancy, meaning you have a biological connection to the baby.

Learn more about egg donor IVF.

Real stories from our patients

- Elizabeth, who always thought she would never have a baby, but an egg donor helped her conceive a beautiful baby girl -

"I would say to anyone considering IVF using donated eggs to do their research. I can’t believe we almost went through life not knowing that we could receive treatment."

- Henriett and Balazs, who started their family with the help of IVF with donated eggs -

"Our GP recommended TFP Oxford Fertility as being the best. It doesn’t feel like you are in a hospital, it has a calm feeling. Our nurse was so professional and kind."

- Amber, whose periods stopped at the age of 14, is now proud parent to son Leo -

"I feel like Sue was the first doctor to really understand. TFP Wessex Fertility literally fixed our fertility and all of the mistakes that had previously been made by other consultants."


Is POI the same as early menopause?

Early menopause is when your periods stop for 12 months before the age of 45, or 40 for premature menopause.

POI is a cause of early menopause, but not everyone with POI goes through a full premature menopause (when your periods stop completely).

If you have POI, you may still have occasional periods and be able to get pregnant.

Learn about early menopause.

What is oestrogen?

Oestrogen is a reproductive hormone that’s needed to regulate your monthly cycle and release eggs.

It also has an important role in your overall health.

People with early menopause or POI can take oestrogen to replace their natural levels.

It can help with long-term health risks, ease symptoms and bring back your periods.

Learn about the myths of oestrogen and HRT

How does early menopause or POI start?

These conditions affect everyone differently, but the first symptom many people notice is irregular periods.

Your periods might get shorter at first, and then become longer and heavier.

You might notice symptoms of menopause, but not always.

If you’ve missed more than three periods without an explanation, such as taking contraception, see your GP.

How early can POI start?

Technically, POI can start anytime after puberty.

It increases with age and can be diagnosed in your 20s and 30s.

If you go through menopause after 40 but before 45, this is considered early menopause.

What is autoimmune POI?

Autoimmune POI is when the immune system damages the ovaries because it mistakes them for a threat.

It’s unclear what triggers this, but it can be diagnosed by blood tests for ovarian antibodies.

Autoimmune POI can cause your fertility to go up and down, especially when the condition begins.

People with autoimmune POI often have higher AMH levels than other types of POI, which can show up on a fertility assessment.

Can contraceptives cause POI?

Contraceptives do not cause POI or early menopause.

Sometimes POI or early menopause is only diagnosed when someone stops taking contraceptives because it masks symptoms like missed periods.


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