Understanding Primary Ovarian Insufficiency

Contemporary women face increasing health challenges, and primary ovarian insufficiency (POI) is a topic that merits attention. POI refers to impaired ovarian function before the age of 40, leading to menstrual disturbances and reduced fertility potential. Globally, about 1% of women aged 15–44 experience POI before 40, with higher prevalence from age 30 onwards. With rising life stress, delayed marriage and later childbearing, POI has been trending upwards in recent years. Women planning a family should be particularly vigilant. 

Causes of Primary Ovarian Insufficiency 

In around 90% of POI cases, the exact cause is unknown. Research links POI to follicular dysfunction. In some, otherwise normal follicles are depleted prematurely; in others, follicles are present but do not function properly. In most cases, the reason for follicular problems is unclear, but possible causes include: 

• Genetic conditions, such as Turner syndrome and fragile X premutation
• Low primordial follicle number
• Autoimmune disease
• Chemotherapy or radiotherapy
• Endocrine/metabolic disorders, such as Addison’s disease and thyroiditis
• Toxins, including cigarette smoke, industrial chemicals and pesticides 

Risk factors for Primary Ovarian Insufficiency 

The following factors can increase a woman’s risk of POI: 

• Family history: risk is higher if a mother or sister has POI
• Genetic factors: Turner syndrome and fragile X premutation
• Medical conditions: autoimmune disease and certain viral infections
• Treatments: prior chemotherapy or radiotherapy 
• Increasing age: POI can affect younger women, but is more commonly diagnosed between 35 and 40

Symptoms of Primary Ovarian Insufficiency 

Some women with POI have no obvious symptoms. Beyond menstrual disturbance, most symptoms resemble those of the menopause. Common features include: 

• Irregular or missed periods (most common)
• Hot flushes 
• Night sweats 
• Difficulty concentrating
• Vaginal dryness
• Low sex drive 

Two Key Ovarian function markers: AMH and FSH 

AMH levels 

Anti-Müllerian hormone (AMH) reflects ovarian reserve and helps assess whether the ovaries are ageing prematurely. Higher AMH generally indicates greater ovarian reserve. Typical values are about 1–3 ng/mL; levels below 1 ng/mL are considered low. 

AMH declines with age. Approximate reference values: 

FSH levels 

Follicle-stimulating hormone (FSH) reflects ovarian function and is usually measured on day 3 of the menstrual cycle. In general, elevated FSH suggests impaired ovarian function. Studies indicate that women with day-3 FSH below 15 mIU/mL have higher in vitro fertilisation (IVF) success rates than those with 3-day FSH between 15 and 24.9 mIU/mL. 

Reference FSH ranges by life stage:

Why ovarian health checks matter 

Because POI cannot be prevented and is not reversible, management focuses on alleviating symptoms and reducing the risk of associated conditions such as osteoporosis, cardiovascular disease, hypothyroidism, depression and anxiety. Women at higher risk and those planning pregnancy should consider early assessment and, where appropriate, fertility preservation (for example, oocyte cryopreservation) or other assisted reproductive technologies. 

OT&P Healthcare provides women’s health assessments. Please contact us for more information. 
  

Managing Primary Ovarian Insufficiency 

Although POI cannot be reversed, women with a confirmed diagnosis can improve symptoms and quality of life through: 

• Hormone replacement therapy (HRT): oestrogen with or without a progestogen to relieve symptoms and help prevent osteoporosis and other POI-related risks.
• Nutritional support: adequate calcium and vitamin D to support bone health and reduce osteoporosis risk.
• Regular exercise: helps maintain a healthy weight; resistance training supports bone strength.
  

For women at higher risk of POI or those focused on health optimisation and planning pregnancy, nicotinamide adenine dinucleotide (NAD+) supplementation is sometimes considered. NAD+ is a key coenzyme in cellular energy metabolism and DNA repair; levels decline with age and may affect oocyte quality and ovarian function. Some research suggests NAD+ supplementation may improve oocyte quality and potentially enhance the chance of conception. 

Prioritising ovarian health 

Ovarian health is integral to overall women’s wellbeing. While POI cannot be prevented, regular check-ups, understanding personal risk, lifestyle adjustments and early professional support can help women retain control over their health and fertility plans. Do not let POI hinder your future family goals—stay proactive about ovarian health to build a healthier, more confident future. Consult gynaecologists at OT&P to learn more about POI and take the first step toward protecting your reproductive health.

References

1. Cleveland Clinic, (2022) Primary Ovarian Insufficiency. Retrieved 22 Aug 2025 from https://my.clevelandclinic.org/health/diseases/17963-primary-ovarian-insufficiency
2. Tesarik, J. (2025). Endocrinology of Primary Ovarian Insufficiency: Diagnostic and Therapeutic Clues. Endocrines, 6(2), p.18.  
3. MedlinePlus, (2023) Primary Ovarian Insufficiency. Retrieved 22 Aug 2025 from https://medlineplus.gov/primaryovarianinsufficiency.html
4. Cleveland Clinic, (2022) Anti-Mullerian Hormone Test. Retrieved 22 Aug 2025 from https://my.clevelandclinic.org/health/diagnostics/22681-anti-mullerian-hormone-test 
5. Cleveland Clinic, (2023) Follicle-Stimulating Hormone (FSH). Retrieved 22 Aug 2025 from https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh
6.  Bertoldo, M.J., et al., (2020). NAD+ Repletion Rescues Female Fertility during Reproductive Aging. Cell Reports, 30(6), pp.1670-1681.e7.