What is premature ovarian aging or insufficiency or failure (POI, POF, or POA)?

Premature ovarian insufficiency, failure, or aging (POF or POA) is a loss of ovarian function in younger women, usually below the age of 35. Women with POI/POF/POA have eggs that don't fertilize easily and may even be incapable of becoming fertilized. Women with premature ovarian aging may still have regular menstrual periods along with difficulties getting pregnant and this is seen in about 10% of younger women with fertility problems.

POI/POF/POA is associated with:

• Normal but shorter menstrual cycles (usually less than 26 days apart)
• Amenorrhea (no menstrual period)
• More frequent menstrual periods (bleeding)
• Low anti-Mullerian hormone (AMH)
• Low estrogen
• Elevated follicle-stimulating hormone (FSH) 
• Low antral follicle count on sonogram

How is premature ovarian aging diagnosed?

In general, the diagnosis requires at least three to four months of amenorrhea as well as two FSH tests, taken at least one month apart, that are greater than 40 mIU/ML.

Another test, the AMH or anti-Mullerian hormone can detect whether there are any more follicles left. An elevated or normal (as compared to an absent) AMH may indicate that some follicles are left.

A while back it was thought that POI/POF/POA, like menopause, meant a total lack of eggs. It was called "premature" to signify that it started at an earlier-than-normal age. However, menopause appears to be permanent with a loss of ovarian activity, while POI/POF is not always permanent.

When the ovaries of women with POF are looked at on pelvic ultrasound, approximately 40% of the women have structures that appear to be ovarian follicles. Today, we know that women with premature ovarian failure intermittently produce estrogen and ovulate. This is why the term premature ovarian failure is preferred to premature menopause. Menopause means complete cessation of periods.

In some cases, premature ovarian failure may be reversible. POF can be temporary or periodic and there can be residual ovarian function. Even with high FSH levels women may intermittently produce estrogen and ovulate.

Primary or premature ovarian aging or failure vs. premature menopause

Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. and is often confused with premature menopause, but they are different. In premature ovarian failure, the ovaries don't produce normal amounts of the hormone estrogen or release eggs regularly. This condition often leads to infertility.
Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant, but women with premature menopause stop having periods and can't become pregnant.