Premature ovarian failure (or insufficiency)

Premature ovarian failure (POF), also known as premature or primary ovarian insufficiency (POI), is the loss of function (or insufficient function) of the ovaries before the age of 40, most often for no definable reason. ​1​

The loss of function results in reduced or no production of oestrogen and other hormones, and no ovulation, so infertility is the natural result. You may still get your period and even ovulate, however, your ovaries may be sporadic in their action, making periods irregular and ovulation uncertain. ​2​

Premature ovarian failure is not the same as early menopause, since menopause shuts up your reproductive shop as a normal part of ageing, however the symptoms can be very similar.

Premature ovarian failure causes the loss of eggs, which may be caused by genetic conditions (Turner’s syndrome, fragile X syndrome), toxic cancer treatments, an autoimmune disease, or for unknown reasons.

There are two classifications of ovarian insufficiency: primary and secondary. Ovarian insufficiency is classified as primary if the ovary doesn’t function normally in concert with other hormones, however, it is considered secondary if the hypothalamus and pituitary don’t produce the right hormones to set off this cascade. The issue is then more with the hypothalamus and pituitary than the ovary itself.

Primary ovarian insufficiency results in a form of early menopause, but they are not the same thing, since a woman with ovarian insufficiency can still get pregnant and ovulate (although the chances are reduced).

Secondary ovarian insufficiency is not premature ovarian failure but more a problem with ovulation, which may need the help of an IVF specialist and/or a naturopath.

Symptoms of premature ovarian failure

  • Irregular periods or periods stop (secondary amenorrhoea)
  • Infertility due to lack of ovulation
  • May occur after stopping hormonal birth control or a pregnancy
  • Hot flashes
  • Night sweats
  • Dry, irritated vagina
  • Problems concentrating
  • Irritability
  • Low libido

Causes of premature ovarian insufficiency or failure

A loss of function of the ovaries is divided into four states, with the woman likely entering and exiting the various states, rather than staying in one state. This movement can be unpredictable, and ovaries may function normally for some periods of time without warning.

Some causes of primary ovarian insufficiency​3​

  • Genetic abnormalities
  • Autoimmune disease
  • Anatomical abnormalities
  • Caused through other channels, like surgery or accident
  • Tumours

Often the cause can not be found.

Risk factors that increase your chances of developing premature ovarian failure

  • Aged between 35 and 40 (though it can happen to teenagers and younger women)
  • Family members with the condition
  • Repeated ovarian surgeries

Diagnosing premature ovarian failure

Diagnosis is a process of elimination, with several reasons for the symptoms of low oestrogen to occur. First, you’ll have a pregnancy test performed, to rule that out. ​4​

Then, a test will look for follicle stimulating hormone levels (FSH), which is the hormone that starts the process of getting an egg out of your ovary to ovulate.

Other hormone tests will include oestrogen and prolactin. Genetic testing may be warranted if nothing else can be found.

Treatment for premature ovarian failure

Your doctor may prescribe oestrogen therapy, either on its own or in combination with progesterone. If you have a uterus, progesterone therapy is more likely. This doesn’t start your ovaries up again, and may cause bleeding. ​5,6​

You may take oestrogen therapy until you are about 50, to coincide with your natural menopause timing. Calcium and vitamin D may be recommended to help prevent osteoporosis, which can occur without oestrogen.

You need oestrogen to keep calcium in bones, and you need vitamin D to absorb the calcium. You can see a naturopath for herbs and supplements to support your ovarian function, if you do have some eggs left.

There is nothing that can be done to reverse primary ovarian failure and if you don’t have any eggs left in the ovaries, there is nothing that can be done to reverse this and an egg donor will be needed. You will need nutritional and hormonal support no matter what, to optimise bone health. ​7​

Fertility outcomes

If your ovaries stop producing eggs, you can’t get pregnant naturally, as there is no egg to fertilise. If you still have some eggs left you can fall pregnat naturally but the chances are slim so in vitro fertilisation (IVF) is the recommendation.

Your uterus will still be functional so you may be able to have children with the assistance of IVF using ovulation induction (where your ovaries are stimulated by drugs to release an egg) or using an egg donor. ​8,9​

Emotional support

Losing ovarian function early and unexpectedly can cause some huge emotional upheavals and grief, so make sure you get support while you adjust to the idea and seek any additional treatments you may want to try.


  1. 1.
    Anasti JN. Premature ovarian failure: an update. Fertility and Sterility. Published online July 1998:1-15. doi:10.1016/s0015-0282(98)00099-5
  2. 2.
    Tucker EJ, Grover SR, Bachelot A, Touraine P, Sinclair AH. Premature Ovarian Insufficiency: New Perspectives on Genetic Cause and Phenotypic Spectrum. Endocrine Reviews. Published online October 3, 2016:609-635. doi:10.1210/er.2016-1047
  3. 3.
    Fenton A. Premature ovarian insufficiency: Pathogenesis and management. J Mid-life Health. Published online 2015:147. doi:10.4103/0976-7800.172292
  4. 4.
    Rahman R, Panay N. Diagnosis and management of premature ovarian insufficiency. Best Practice & Research Clinical Endocrinology & Metabolism. Published online December 2021:101600. doi:10.1016/j.beem.2021.101600
  5. 5.
    Machura P, Grymowicz M, Rudnicka E, et al. Premature ovarian insufficiency – hormone replacement therapy and management of long-term consequences. pm. Published online 2018:135-138. doi:10.5114/pm.2018.78559
  6. 6.
    Moustaki M, Kontogeorgi A, Tsangkalova G, et al. Biological therapies for premature ovarian insufficiency: what is the evidence? Front Reprod Health. Published online September 7, 2023. doi:10.3389/frph.2023.1194575
  7. 7.
    Gonçalves CR, Vasconcellos AS, Rodrigues TR, Comin FV, Reis FM. Hormone therapy in women with premature ovarian insufficiency: a systematic review and meta-analysis. Reproductive BioMedicine Online. Published online June 2022:1143-1157. doi:10.1016/j.rbmo.2022.02.006
  8. 8.
    Fraison E, Crawford G, Casper G, Harris V, Ledger W. Pregnancy following diagnosis of premature ovarian insufficiency: a systematic review. Reproductive BioMedicine Online. Published online September 2019:467-476. doi:10.1016/j.rbmo.2019.04.019
  9. 9.
    Bidet M, Bachelot A, Bissauge E, et al. Resumption of Ovarian Function and Pregnancies in 358 Patients with Premature Ovarian Failure. The Journal of Clinical Endocrinology & Metabolism. Published online December 2011:3864-3872. doi:10.1210/jc.2011-1038

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Josephine Cabrall BHSc(NAT) | ATMS
Josephine Cabrall is qualified naturopath specialising in PCOS and hormonal and fertility issues, based out of Melbourne, Australia. Josephine is a fully insured member of the Australian Traditional Medicine Society (ATMS).