Early menopause and POI need a specialist — and get one here.
Loss of ovarian function before 40 is not simply early menopause. It is a distinct diagnosis with its own workup, its own risks, and an unambiguous standard of care.
Two diagnoses, one theme: more years without estrogen
Premature ovarian insufficiency (POI) is the loss of ovarian function before age 40; it affects roughly 1 to 3% of women. Early menopause refers to menopause between 40 and 45. Both matter because the body is exposed to estrogen deficiency for many additional years compared to the average woman — and that deficiency drives measurable increases in cardiovascular disease, osteoporosis, cognitive decline, depression, and overall mortality.
How POI is diagnosed
The diagnosis is made with an FSH greater than 25 IU/L in the right clinical context — or two such measurements at least four weeks apart when the picture is less clear. Once confirmed, additional workup is appropriate: genetic testing where indicated, autoimmune screens, thyroid function, and bone densitometry. Any woman under 40 with menstrual irregularity, unexplained subfertility, or hot flashes should be evaluated. This is not a “wait and see” situation.
The standard of care is clear
Hormone replacement is the standard of care in POI, regardless of whether symptoms are present. The benefits of replacing estrogen at this age clearly outweigh the risks, and treatment should generally continue at least until the average age of natural menopause — around 51 — and then be reassessed. Importantly, hormone replacement in POI does not raise breast cancer risk above the age-adjusted general population risk; it restores what the body would ordinarily still be producing.