Reproductive Questions and Answers for Cancer Survivors: Premature Ovarian Insufficiency (POI)

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What is POI?

If your doctor has told you that you have POI, your ovaries are no longer able to release hormones or eggs and you will not get your period. This condition is called premature ovarian insufficiency. Premature means, “before it is supposed to happen.” Ovarian insufficiency means that the ovaries are not working as they should be.

What are the symptoms of premature ovarian insufficiency (POI)?

POI symptoms may include:

  • Lack of development during puberty
  • Amenorrhea (no menstrual periods)
  • Decrease in breast size
  • Hot flashes
  • Vaginal dryness
  • Mood swings
  • Decreased interest in sex
  • Insomnia (not being able to sleep)

The two most common symptoms that adolescents with POI report are lack of breast development and/or a lack of menstrual periods.

If you think you have POI, talk to your health care provider since other medical conditions may cause the same or similar symptoms.

How is POI diagnosed?

Your doctor can find out if your ovaries are working by doing a simple blood test to check two hormone levels, FSH and estrogen. Sometimes it’s necessary to repeat the blood test to figure out the average number or level. High levels of FSH and low levels of estrogen in a blood test usually mean that you have ovarian insufficiency. Another blood test called AMH (Anti-Mullerian Hormone) is often done to try to assess the size of a woman’s egg supply. Many fertility specialists believe that women with higher levels of AMH tend to have a better response to IVF (In vitro fertilization.)

Why are the hormones FSH and Estrogen so important?

In menstruating women, the pituitary gland in the brain can sense if the ovaries are making the right amounts of estrogen. If a woman is not getting her period and there is no estrogen being made, the pituitary gland in the brain will release a hormone called the follicle-stimulating hormone (FSH). This hormone sends a signal to the ovaries telling them to start making estrogen.

Your ovaries should respond to this signal and begin to release estrogen. When the estrogen is released, the pituitary gland then stops sending out FSH and the level of FSH in your blood stream lowers. However, if you have POI, your ovaries can’t make estrogen so the amount of FSH in your blood stays very high.

Is POI permanent?

POI can be unpredictable. After treatment for cancer, you may or may not get back regular menstrual cycles and ovarian function. It is possible to have POI after cancer treatment but later have your ovaries return to making hormones and possibly eggs. Unfortunately, there is no available test at this time for health care providers to tell for sure if POI will be permanent.

How is POI treated?

The treatment for POI is to replace the hormones your body is no longer making. The name for this type of treatment is called hormone replacement therapy, or HRT. The hormones that need to be replaced are estrogen, progesterone or both. These hormones are necessary for breast development, menstrual periods, and healthy bones.

How do you take HRT?

There are different types of HRT. HRT is available as pills, skin patches, and shots. Pills are usually the easiest type of HRT for young women to take, although some women prefer using patches (that contain estrodial) that are applied to the skin once or twice a week because the level of hormones are more similar to the hormones made by the ovaries. A vaginal hormonal ring is another option. Birth control pills are often used as an HRT because they contain estrogen and progestin

Although HRT may help to replace the hormones that your ovaries don’t make anymore, there is no way to replace your eggs if they have been damaged by cancer treatment.

What are the effects of Hormone Replacement Therapy (HRT)?

Your breasts may increase in size if they have not finished growing. You may start having menstrual periods if your uterus is healthy. You may get PMS, menstrual cramps, irregular menstrual periods, or mood swings, just like you would if your body was making the progesterone and/or estrogen.

If you are having any side effects from the HRT, it is important to discuss them with your health care provider. There are many different types of HRT, and your provider can work with you to find the one that is best for you.