What is Primary Ovarian Insufficiency?

The term primary ovarian insufficiency (POI) refers to when the ovaries stop working before the age of 40. It is also called premature ovarian failure (POF) by some doctors.

To put this in simple terms: POI is when your period stops long before you expect it to.

The average age for menopause is around 50, but there is a wide range of ages that is still considered normal.(study) Women can start going through normal menopause anywhere from age 42 - 54. If you stop getting your period before age 40 and have follicles (egg cells) still remaining, it is considered primary ovarian insufficiency.

What causes primary ovarian insufficiency?

When the number of follicles (egg cells) in the ovaries drop below 1,000, menstruation usually ceases. This is accompanied by ovarian hormonal changes, such as an increase in follicle stimulating hormone (FSH) and a decrease in estradiol.  (study)(study)

In most cases, POI is caused by one of three causes:

  • Genetics
  • Chemotherapy, radiation, or surgery
  • Autoimmune condition

POI (or POF) occurs in less than 1% of women.

Can you still get pregnant if you have primary ovarian insufficiency?

Yes! In POI, you have follicle cells still available. But these follicle cells have stopped progressing to the point of ovulation.

But the odds of spontaneous pregnancy are pretty low. Only about 5 - 10% of women with POI will end up getting pregnant without any intervention. (reference) (study)

The key is what researchers refer to as “activating dormant primordial follicles”.  Signaling between the cells needs to be activated to turn the dormant follicles into maturing follicles.

There are several different cell signaling pathways that you can target through diet and lifestyle changes!

What are your treatment options for POI?

Activating mTOR

mTOR (mechanistic target of rapamycin) is a key protein in cell signalling. It is a signal determined by nutrients in the body that promotes cell growth.  mTOR needs to balanced, at the right level in the body and at the right time.  As people get older, decreasing mTOR helps to promote healthy longevity. But when you are trying to get pregnant, you need more mTOR activity in the dormant follicle cells.  (study)

Activating mTOR in the dormant follicles has been shown in studies to cause the follicles to go ahead and mature, allowing for pregnancy. (study) (study)

There are a couple of natural ways to activate mTOR without medications or negative side effects.

Resistance exercise, such as moderate weight lifting, has been shown to activate mTOR. But aerobic exercise doe not activate mTOR. If you are regularly doing aerobic exercise, try switching to resistance training for a bit. (study)(study)

Getting enough protein in your diet will activate mTOR. Or to put it another way, restricting protein decreases mTOR - so make sure you are eating a balanced diet that contains all the essential amino acids. (study)

It is also important to make sure that you are getting enough protein when you exercise. Studies show that protein in the form of branch chain amino acids along with exercise is a way to activate mTOR. (study)

Optimize your methylation cycle

One way that your body regulates which proteins and cellular molecules get produced is through methylation. The DNA in your cell nucleus is transcribed and translated by RNA into the proteins needed in your cells.  This is a process that is going on all the time, in all of your cells.  One way for your body to turn off genes that don’t need to be transcribed is through methylation.

Methylation refers to adding a methyl group to something in your cells, whether it is added to a protein to change it into another protein or using that methyl group to turn off the transcription of a gene.

If a signaling molecule is turned off in your ovaries, this can limit the activation of the primordial follicle cells.(study)

There is a lot you can do, through diet or supplements, to optimize your methylation cycle. And case studies show that, for some women, this can help to restart ovulation in POI. (study)

There are two main dietary factors that influence your methylation cycle: folate and choline. Good sources of folate include liver, asparagus, broccoli, egg yolks, leafy greens, and lentils. (reference) Eggs and liver are also excellent sources of choline, along with caviar, salmon, and beef. (reference)

Supplements to help your methylation cycle include adding in methylfolate (not folic acid) and vitamins B12, B6, and B2.

Check your thyroid hormone levels!

The link between hypothyroidism and POI isn’t completely understood.  But there are several studies and case reports that show that hypothoidism can be a cause of POI.  To understand more about how the thyroid affects fertility, go here.

Women with the autoimmune condition Hashimoto’s thyroiditis are three times more likely to have POI. (study)

If you have been diagnosed with primary ovarian insufficiency, getting a thorough thyroid check done is a good idea.  Supporting your thyroid health with nourishing foods is essential for everyone.

Avoid cigarette smoke exposure

We all know that cigarette smoking isn’t good for us for many reasons -- including your ability to get preganant! Smoking is strongly linked to premature menopause and primary ovarian insufficiency. Studies estimate that it more than doubles your risk of infertility due to POI or premature menopause.(study)

Animal studies show that exposure to cigarette smoke, such as through second hand smoke, can also cause POI. (study)

If you are a smoker, now is the time to seek help and find a way to stop. If you are living with someone who smokes indoors, this is the time to find ways to eliminate the indoor smoking and restore your living spaces to a smoke-free area.

Acupuncture may be a solution for POI

Used for thousands of years in China, acupuncture is an ancient option that is backed by modern science.

A pilot study of 31 women with POI followed their results in response to three months of acupuncture treatment given three times per week.  The results showed increased estrogen and decreased luteinizing hormone (changes in the right direction!). About 20% of the women resumed having their periods. (study)

While not a miracle cure for everyone, acupuncture may be a very effective treatment for some women with POI--  without any negative side effects!

Melatonin is important for treating POI

Animal studies show that treatment with melatonin reduces oxidative stress in the follicles and changes the cell signaling. This allows the follicles to go ahead and mature. (study)

Blocking blue light at night through turning off your electronic devices or by wearing blue-blocking glasses will increase melatonin levels. Melatonin supplements are also readily available over the counter.

5 Steps You Can Take Today to Treat POI:

  1. Workout: Try a moderate weight lifting workout at the gym. If you aren’t a gym member, body weight exercises such as push ups and squats are easy (and free!) to do at home.
  2. Schedule some lab tests: The only way to know how well your thyroid is functioning is to get it tested. So call your doctor to schedule an appointment or order your own lab work today.
  3. Avoid smokers: Make an effort to remove yourself from situations where people are going to be smoking around you. This may mean taking a walk during lunch instead of hanging out with coworkers who are smoking.
  4. Eat a healthy diet that includes plenty of folate: Fix a salad for dinner tonight that includes organic dark leafy green veggies topped with grilled, grass-fed steak.
  5. Stimulate melatonin production: Turn off your electronic devices and turn down the overhead lights for a couple of hours before bed. Reading a book using a table lamp or relaxing in a bathtub surrounded by candles is a great way to wind down before bed while increasing melatonin naturally.