Primary ovarian insufficiency occurs when the ovaries stop working as they should before age 40. When this happens, the ovaries don't make the typical amounts of the hormone estrogen or release eggs regularly. The condition often leads to infertility. Another name for primary ovarian insufficiency is premature ovarian insufficiency. It also used to be called premature ovarian failure, but this term isn't used anymore.

Sometimes, primary ovarian insufficiency is confused with premature menopause. But they aren't the same. People with primary ovarian insufficiency can have irregular or occasional periods for years. They might even get pregnant. But people with premature menopause stop having periods and can't become pregnant.

Treatment can restore estrogen levels in people with primary ovarian insufficiency. This helps prevent some conditions that can happen due to low estrogen, such as heart disease and weak, brittle bones.


Symptoms of primary ovarian insufficiency are like those of menopause or low estrogen. They include:

  • Irregular or missed periods. This symptom might be present for years. It also could develop after a pregnancy or after stopping birth control pills.
  • Trouble getting pregnant.
  • Hot flashes and night sweats.
  • Vaginal dryness.
  • Anger, depression or anxiety.
  • Trouble with focus or memory.
  • Less sexual desire.

When to see a doctor

If you've missed your period for three months or more, see your health care team to figure out the cause. You can miss your period for many reasons, such as pregnancy, stress, or a change in diet or exercise habits. But it's best to get a health care checkup whenever your menstrual cycle changes.

Even if you don't mind not having periods, see a health care professional to find out what's causing the change. Low estrogen levels can lead to a condition that causes weak and brittle bones, called osteoporosis. Low levels of estrogen also can lead to heart disease.


Primary ovarian insufficiency may be caused by:

  • Chromosome changes. Chromosomes are thread-like structures that contain genes. Most often, people assigned female at birth have two X chromosomes in their cells. But some people with primary ovarian insufficiency have one typical X chromosome and one altered X chromosome. This can be a sign of genetic conditions such as mosaic Turner syndrome. Other people with primary ovarian insufficiency have X chromosomes that are fragile and break. This is called fragile X syndrome.
  • Toxins. Chemotherapy and radiation therapy are common causes of toxin-induced ovarian insufficiency. These treatments can damage genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses might speed up ovarian insufficiency.
  • An immune system response to ovarian tissue. This also is called autoimmune disease. In this rare form, the immune system makes protective proteins that attack ovary tissue by mistake. This harms sacs in the ovaries that each contain an egg, called follicles. It also damages the egg. What triggers the immune response is unclear. But being exposed to a virus may play a role.
  • Unknown factors. Most often, the cause of primary ovarian insufficiency isn't clear. You might hear this called an idiopathic cause. Your health care professional may recommend more testing to try to find the cause.

Video: Ovulation

Ovulation is the release of an egg from one of the ovaries. It often happens about midway through the menstrual cycle, although the exact timing may vary.

In preparation for ovulation, the lining of the uterus, or endometrium, thickens. The pituitary gland in the brain stimulates one of the ovaries to release an egg. The wall of the ovarian follicle ruptures at the surface of the ovary. The egg is released.

Finger-like structures called fimbriae sweep the egg into the neighboring fallopian tube. The egg travels through the fallopian tube, propelled in part by contractions in the fallopian tube walls. Here in the fallopian tube, the egg may be fertilized by a sperm.

If the egg is fertilized, the egg and sperm unite to form a one-celled entity called a zygote. As the zygote travels down the fallopian tube toward the uterus, it begins dividing rapidly to form a cluster of cells called a blastocyst, which resembles a tiny raspberry. When the blastocyst reaches the uterus, it implants in the lining of the uterus and pregnancy begins.

If the egg isn't fertilized, it's simply reabsorbed by the body — perhaps before it even reaches the uterus. About two weeks later, the lining of the uterus sheds through the vagina. This is known as menstruation.

Risk factors

Factors that raise the risk of primary ovarian insufficiency include:

  • Age. The risk goes up between ages 35 and 40. Primary ovarian insufficiency is rare before age 30. But younger people and even teens can get it.
  • Family history. Having a family history of primary ovarian insufficiency raises the risk of getting this condition.
  • Ovarian surgery. Surgeries that involve the ovaries raise the risk of primary ovarian insufficiency.


Primary ovarian insufficiency can lead to other health conditions, including the following:

  • Infertility. Not being able to get pregnant can be a complication of primary ovarian insufficiency. Rarely, pregnancy is possible until the body's supply of eggs runs out.
  • Osteoporosis. This condition causes bones to become weak, brittle and more likely to break. Women with low levels of the hormone estrogen have a higher risk of getting osteoporosis. That's because estrogen helps keep bones strong.
  • Depression or anxiety. Some people with primary ovarian insufficiency become depressed or anxious. This can be due to the risk of infertility and other conditions that arise from low estrogen levels.
  • Heart or blood vessel disease. Early loss of estrogen might raise the risk of heart conditions or stroke.
  • Dementia. This is the term for a group of symptoms that affect memory, thinking and social skills. The dementia risk may be linked with getting both ovaries removed and not receiving estrogen therapy afterward in people under age 43.
  • Parkinson's disease. This long-term condition affects the nervous system, which includes the brain and spinal cord. It also affects parts of the body controlled by nerves. The higher risk of Parkinson's disease also may be linked with surgery to remove the ovaries.

Treatment for primary ovarian insufficiency helps prevent these other health conditions.

Oct. 20, 2023
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