When ovarian function begins to decline before menopause, it is known as “premature ovarian insufficiency” (POI). This can make pregnancy planning more difficult and may also affect quality of life and mental well-being. This article introduces the common signs and possible causes of POI, and outlines 5 doctor-recommended care tips to help you understand how to look after your ovarian health and lay a solid foundation for your future fertility options and overall well-being.
What Is Premature Ovarian Insufficiency (POI)? 7 Symptoms You Shouldn’t Ignore
Premature ovarian insufficiency (POI) refers to a significant decline in ovarian function before the age of 40. It may directly affect fertility and can also disrupt hormonal balance, causing menopause-like changes and discomfort to appear earlier than expected. Below are 7 common symptoms of POI, to help you notice physical changes sooner and assess your ovarian health in time:
▍Irregular Periods
As ovarian function declines, estrogen secretion decreases, which can easily lead to an irregular menstrual cycle. Common signs include lighter menstrual flow, longer cycles, and even sudden loss of periods without warning. This is one of the most common warning signs.
▍Hot Flashes and Night Sweats
Hormonal imbalance can affect the body’s temperature regulation. Some women experience sudden hot flashes and heavy sweating, sometimes accompanied by heart palpitations, which can severely disrupt sleep and daily routines.
▍Decreased Libido
POI can cause a noticeable drop in sex drive. This may reduce satisfaction in sexual life and could also put strain on the relationship with a partner.
▍Sleep Disturbances
Besides difficulty falling asleep, women may also wake frequently at night or experience fragmented sleep. If this persists, it can lead to daytime drowsiness and reduced concentration and cognitive function, and may increase the risk of mood swings or irritability.
▍Vaginal Dryness
Reduced estrogen causes the vaginal lining to become thinner and produce less secretion, resulting in vaginal dryness and painful intercourse, which can negatively affect sexual quality of life and intimate relationships.
▍Anxiety and Depression
When physical discomfort and hormonal fluctuations occur together, emotions can also be affected, leading women to feel anxious, depressed, or powerless as ovarian function gradually declines.
▍Osteoporosis
Estrogen helps maintain bone metabolism and protect bone mass. When its levels drop, bone loss begins. Over time, this may lower bone density, make bones more fragile, and raise the risk of fractures.
Why Does Ovarian Function Decline Early? 6 Causes of Premature Ovarian Insufficiency (POI)
In most cases of premature ovarian insufficiency (POI), no single clear cause can be identified. However, the U.S. National Institutes of Health notes that many different factors are known to contribute to POI. Below are 6 possible causes, to help you better understand your own health and take preventive and evaluative steps early:
▍Environment and Lifestyle
Long-term high stress, staying up late, an unbalanced diet, or smoking may all interfere with hormone secretion and affect ovarian function. In addition, endocrine-disrupting chemicals such as air pollution, plasticizers, and pesticide residues may also affect hormonal balance, and are one of the risks modern women often overlook.
▍Ovarian Surgery
Women who have undergone partial removal of the ovary due to ovarian cysts, tumors, or other conditions may have reduced ovarian tissue, which can lower the number of follicles, affect ovarian reserve, and increase the likelihood of POI.
▍Chemotherapy
Chemotherapy drugs attack rapidly dividing cells. They target not only cancer cells but may also damage developing follicles in the ovaries, leading to declining ovarian function or premature depletion. Young cancer patients in particular, if their ovaries are not protected beforehand, may face the risk of early menopause and reduced fertility after treatment.
▍Radiation Therapy
When radiation therapy covers the pelvic or abdominal area, it may damage ovarian tissue and lead to reduced ovarian function, or even irreversible decline, causing women to face diminished fertility earlier than expected.
▍Family History
If an immediate family member (such as a mother or sister) has a history of POI, it may indicate a hereditary predisposition. Women in this situation are advised to have their ovarian function checked early and to discuss ongoing care or fertility planning with a specialist.
▍Genetic Factors
Certain genetic abnormalities can directly affect ovarian development and function. For example, Fragile X syndrome and Turner syndrome may cause signs of POI to appear at a young age.
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Who Is at High Risk for Premature Ovarian Insufficiency (POI)?
POI may sound like something far off, but some groups are at higher risk. If any of the following apply to you, it is advisable to pay closer attention to changes in your ovarian function:
▍Genetic or Chromosomal Abnormalities
Women with conditions such as Fragile X syndrome or Turner syndrome may have naturally weaker ovarian function and a higher likelihood of early decline.
▍Previous Ovarian Surgery
Although surgery can treat certain ovarian conditions, it may also damage some ovarian tissue and affect ovarian function and follicle count.
▍Chemotherapy or Radiation Therapy
For cancer patients, these treatments are necessary and life-saving, but the ovaries are also vulnerable to damage, and the risk of POI increases.
▍Autoimmune Diseases
In women with autoimmune conditions such as thyroid disease, type 1 diabetes, rheumatoid arthritis, or lupus, the immune system may mistakenly attack the ovaries as foreign tissue, leading to impaired ovarian function.
▍Long-Term Exposure to Toxic Environments
Smoking and long-term exposure to chemicals or various pollutants may cause the ovaries to age earlier.
▍Family History
If a woman in your family has been diagnosed with POI, you may also have a higher genetic risk.
▍Age
Although POI is most common in women aged 35 to 40, many cases occur at even younger ages.
How to Test for Premature Ovarian Insufficiency (POI)? Normal AMH Levels and AFC Ultrasound Assessment
If you are concerned about your ovarian function, you can use the following 2 methods for a preliminary assessment:
▍Blood Test (AMH)
AMH (anti-Müllerian hormone) is a common indicator of the ovarian “egg reserve.” A higher level suggests a larger number of eggs in reserve, while a lower level may indicate declining ovarian function. The reference ranges for AMH are as follows:
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2 to 5 ng/mL is the normal AMH range
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Below 2 ng/mL indicates a low ovarian reserve
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Above 5 ng/mL may be associated with polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome, PCOS)
▍Ultrasound Assessment (AFC)
A transvaginal ultrasound is used to observe the AFC (antral follicle count) in the ovaries. AFC should be interpreted in light of age, as some physiological variation is expected. For example, for women under 35, an AFC of 15 or more is generally considered normal, but a count of fewer than 7, regardless of age, suggests a low ovarian reserve and declining ovarian function.
Quick tip: If you are under 40 and experience shorter menstrual cycles, lighter periods, or early menopause-like signs such as hot flashes and insomnia, it is advisable to arrange an evaluation as soon as possible. The earlier the problem is identified, the sooner a treatment strategy can be developed.
How to Care for Your Uterus and Ovaries? 5 Tips to Prevent Premature Ovarian Insufficiency (POI)
So how can you take care of your uterus and ovaries? The ovaries are not only tied to fertility, but also closely linked to health indicators such as hormone secretion, metabolism, and emotional stability. If you want to prevent POI and slow the decline of ovarian function, daily care is essential. Here are 5 ways to help prevent POI:
▍Balanced Nutrition
Getting moderate amounts of nutrients such as vitamin D3, omega-3 fatty acids, and coenzyme Q10 may help maintain the vitality of ovarian cells, provide antioxidant support, and stabilize hormones. Deep-sea fish, nuts, egg yolks, and dark leafy greens are all healthy foods worth keeping on hand.
▍Keep a Regular Exercise Habit
Exercise not only promotes blood circulation but may also help regulate hormones and stabilize mood. Brisk walking, yoga, and swimming are all good choices. Aiming for 3 sessions a week of at least 30 minutes each may help support overall ovarian health.
▍Maintain Healthy Daily Habits
Sleep quality affects endocrine function. Frequently staying up late and keeping an irregular schedule not only leaves you tired but can also affect ovarian function. It is recommended to get 7 to 8 hours of deep sleep each night and to keep a consistent routine so that your body’s rhythm stays steady.
▍Keep a Positive Mood
High stress can disrupt the endocrine system and may also contribute to an earlier decline in ovarian function. To help relax and stabilize hormones, you can try meditation, deep breathing, exercise, listening to music, or chatting with friends, which may help your ovaries keep functioning well.
▍Avoid Excessive Intake of Processed Meats
Processed meats contain more additives and saturated fat, which can easily disrupt hormonal balance. It is recommended to cut back on sausages, ham, and bacon, and to focus on natural, fresh, minimally processed foods, which put less strain on the body.
How Can Poor Ovarian Function Be Improved? Can You Still Get Pregnant?
When ovarian function begins to decline, the biggest worry for many women is: “Do I still have a chance of getting pregnant?” This anxiety can be even stronger when facing conditions such as premature ovarian insufficiency (POI). In fact, modern reproductive medicine offers a wide range of options. Whether or not you are currently planning a pregnancy, with early evaluation and good timing, you may still be able to preserve your fertility options!
With years of clinical experience, TFC Taipei Fertility Center helps women find a suitable plan for different stages and needs. For example, some women choose egg freezing to preserve better-quality eggs in advance. Those who already have a partner but have had difficulty conceiving may consider embryo freezing or in vitro fertilization (IVF) as options. You can also consult our traditional Chinese medicine clinic for constitution-based care as part of your daily health maintenance.
If you are wondering how to improve poor ovarian function, or have questions about how to care for your uterus and ovaries, you are welcome to book a consultation. Start by understanding your own condition, and work with our professional team to develop the health plan that suits you best, so you can prepare ahead for your future fertility options.
