U.S. Department of Health and Human Services

Public Health Service

National Institutes of Health

Do I Have

Premature

Ovarian

Failure?
1 2

What is premature ovarian

failure (POF)?

Health care providers use the term POF 

to describe a stop in normal functioning 

of the ovaries in a woman under the age 

of 40. Many women naturally experience 

a decline in fertility at age 40; this age may

also mark the beginning of irregularities in

their menstrual cycles that signal the onset

of menopause. For women with POF, the

fertility decline and menstrual irregularities

occur before age 40, sometimes even in 

the teens. Some health care providers also

use the term primary ovarian insufficiency

to describe this condition. 

In the past, health care providers called 

this condition premature menopause, but

this term is not an accurate description 

of what happens in a woman with POF. 

A woman who has gone through natural

menopause will rarely ever have another

period; a woman with POF is much more

likely to have periods, even though they

might not come regularly. There is virtually

no chance for a woman who has gone

through menopause naturally to get

pregnant; in some cases, a woman with

POF can still get pregnant. 

What causes POF?

Although researchers have a general idea

of what causes POF, in most cases the

exact cause remains unclear. 

To understand what happens in POF, you

need to understand what happens in a

woman’s body when it’s functioning normally.

Premature ovarian failure (POF) has baffled researchers and health care

providers for decades. Scientists have yet to uncover why, in some women,

normal functioning of the ovaries stops before these women naturally 

reach menopause, even though they seem otherwise healthy.

The National Institute of Child Health and Human Development (NICHD),

part of the National Institutes of Health (NIH), is trying to learn more 

about POF through research into its causes, its symptoms, and its patterns.

Hormones, genes, the immune system, and other factors may all play a role

in POF. The NICHD hopes that its research will lead to advances in treatment

for POF, so that this disorder will no longer be a factor in women’s lives.

FAST FACTS:

Common Name:

Medical Name: Premature Ovarian Failure, Primary Ovarian Insufficiency

Number of Women

Affected:

Approximately 250,000 women under the age of 40 in

the United States have POF.

Common Symptoms: Absent or irregular periods, hot flashes, night sweats,

irritability, poor concentration, decreased sex drive,

painful sex, drying of the vagina, and infertility.

Women with POF are also more likely to develop certain

conditions, including osteoporosis,Addison’s disease, and

low thyroid function.

Common Treatments: Doctors often prescribe hormone replacement therapy to

relieve some of the symptoms of POF. Currently, there is

no treatment that is proven safe and effective in restoring

normal function of the ovaries or improving fertility.

Does This Disorder

Affect Fertility/

Childbearing?

It is difficult for women with POF to become pregnant

because their ovaries are not functioning properly. But,

between 5 percent and 10 percent of women with POF

become pregnant without treatment.

Premature Ovarian Failure or POF
3 4

The Normal Menstrual Cycle

In general, a woman’s reproductive health

involves her:

• Hypothalamus (pronounced high-poeTHAL-amus)—part of the brain that

functions as the main control for 

the body’s reproductive system. The

hypothalamus works like a thermostat in

a furnace, in that it controls the levels of

different hormones and other chemicals

in the body. If the hypothalamus detects

that there is too little of a hormone in 

the body, it orders the body to make more.

• Pituitary (pronounced pitt-OO-ih-terry)

gland—the body’s master gland. The

pituitary sends out hormones, or chemical

signals to control the other glands in the

body. The pituitary gets orders from the

hypothalamus about what the body needs. 

• Ovaries—the source of eggs in a woman’s

body. The ovaries have follicles, which are

tiny, fluid-filled sacs that hold the eggs.

The ovaries also make hormones that

help to maintain a woman’s health, 

such as estrogen, progesterone, and

testosterone. The ovaries receive the

chemical signals from the pituitary and

respond by making certain hormones. 

In POF, the ovaries stop working correctly

in both their egg production role, and 

in their hormone production role. 

• Uterus—where a woman carries a baby,

also called the “womb.” The uterus has

different layers; its innermost layer or

lining is called the endometrium—endo

means “inside” and metrium (pronounced

MEE-tree-um) means “womb.” The

endometrium functions as a bed for an

embryo when a woman is pregnant. If no

pregnancy occurs during the cycle, then

the endometrium is shed as a menstrual

flow, or a period, and the cycle starts all

over again.

These parts interact with one

another to coordinate a woman’s

monthly menstrual cycle.

• The hypothalamus keeps track of the level

of estradiol (pronounced ess-trah-DYEawl) in the body. Estradiol is the natural

estrogen that a woman’s body makes, 

so we’ll call it estrogen from now on. 

• When the level gets low, the

hypothalamus sends an order to the

pituitary gland telling it that the body

needs more estrogen.

• The pituitary gets the order and responds

by sending out follicle stimulating

hormone (FSH), a hormone that causes

the follicles on the ovary to grow and

mature. Mature follicles make estrogen

and other substances, such as inhibin.

The pituitary continues to make FSH 

until the mature ovarian follicles make

enough estrogen. If the follicles don’t

make enough estrogen, the level of FSH

goes even higher. 

• When the level of estrogen gets high

enough, the hypothalamus and pituitary

know that there is a mature egg in 

one of the follicles. To get this egg to 

the uterus so that it can be fertilized, 

the pituitary sends out a large burst 

of luteinizing hormone (LH). LH breaks

open the mature follicle to release the

egg, which allows it to move toward 

the uterus. The level of LH is only high

during the time an egg is being released.

This LH burst is the basis for home

ovulation detection kits. Because LH may

be high throughout much of the

menstrual cycle in women who have POF,

home ovulation detection kits are

unreliable in these women. 

• The empty follicle is then transformed

into a yellowish, corpus luteum

(pronounced CORE-puss loo-TEE-um).

Corpus means “body” and luteum 

means “yellow.” The corpus luteum 

makes progesterone, the hormone 

that prepares the uterus for pregnancy.

• Increased levels of progesterone cause the

endometrium to change in preparation

for pregnancy, should it occur. Once 

the endometrium is properly prepared, 

it can support an embryo and allow the

embryo to grow. 

• If the egg is fertilized, it sends out a

hormone called HCG to let the body

know that it’s there. HCG causes the

corpus luteum to continue to make

progesterone, the hormone needed for

pregnancy. Pregnancy tests measure 

the level of HCG. If HCG is present, 

then it’s likely that a woman is pregnant. 

• If there is no signal, that is, no HCG 

is present because the egg wasn’t

fertilized, the corpus luteum stops

making progesterone. Without

progesterone, the endometrium starts 

to break down, and the woman’s body

sheds it as her period. 

Hypothalamus

Pituitary Gland

Ovaries

Uterus
on their own. This spontaneous function

can cause ovulation or a menstrual

period; if insemination occurs, this function

could lead to pregnancy, although such a

situation is uncommon. Currently, health

care providers can’t predict which women

with POF will experience this recovery of

ovarian function. 

Follicle Dysfunction

A woman with follicle dysfunction still 

has follicles in her ovaries, but for unknown

reasons they are not working properly.

Currently, scientists do not have a safe 

and effective way to make follicles start

working normally again. Although they

have yet to identify all the causes of follicle

dysfunction, some known causes include:

• An autoimmune attack—the immune

system normally protects the body from

invading bacteria and viruses. In some

women, though, for reasons researchers

don’t understand, the immune system

attacks developing follicles, which prevents

the follicles from working the way they

should. Current research suggests that

this type of problem occurs in 5 percent

of women with POF. 

• A low number of follicles—even though

only one mature follicle releases an egg

each month, that follicle usually has less

mature follicles developing along with it.

Scientists don’t understand exactly how,

but these supporting follicles seem to

play a role in helping the mature follicle

function normally. If these extra follicles

are missing, the dominant follicle

becomes luteinized and will not mature

and release an egg properly. Current

research estimates that this problem may

occur in up to 60 percent of women with

POF, but this is not a definite number. 

Research also shows that 10 percent to 20

percent of women with POF have a family

history of the condition, which could mean

that some cases of POF have a genetic

component. But, inheritance patterns show

that POF is not a purely genetic disorder.

Research into the causes of POF is ongoing,

in hopes that knowing why it occurs will

also help in developing treatments for the

disorder.

5

What happens differently in

POF?

Currently, researchers are unable to pinpoint

exactly what happens in POF to stop normal

function of the ovaries in most cases.

Remember that the FSH levels are high

when the ovaries fail to produce enough

estrogen. LH levels also stay high in many

cases, even during the occasional times 

that follicles successfully grow. Mature

follicles in the ovaries make estrogen, 

as well as other substances, including the

protein inhibin. Because women with POF

have low levels of estrogen, scientists are

focusing their attention on the follicles 

in the ovary in their study of POF.

Follicles in the ovaries start out as

microscopic seeds, called primordial

(pronounced prime-OR-dee-ul) follicles.

These seeds are not yet follicles, but can

grow into them. In general, a woman is born

with about two million primordial follicles,

which should be enough to last her until she

goes through menopause. But this may not

be the case for a woman with POF. Women

with POF may fall into one of two groups.

Follicle Depletion

A woman with follicle depletion has 

no responsive follicles left in her ovaries.

There is no way for the body to make more

primordial follicles. And, currently, there is

no way for scientists to make primordial

follicles. Although scientists haven’t

identified all the causes of follicle

depletion, some known causes include:

• Chemotherapy or radiation therapy—

strong treatments for cancer

• An abnormal or missing X chromosome—

the X chromosome stores genetic

material that helps “build” a person. It

also helps to determine whether a person

is a male or a female. Females need two

normal X chromosomes to make enough

primordial follicles, and to use them

properly. If a critical part of either X

chromosome is missing, or if an entire X

chromosome is missing, the body may

not make enough primordial follicles to

begin with, or it may use them up too

quickly. This problem is the cause of POF

in 2 percent to 3 percent of women with

the condition.

• Even when it appears that all a woman’s

follicles are depleted, it is possible that a

very small number of surviving follicles

can, without warning, begin to function

6

How many women have POF?

POF affects approximately:

• One in 10,000 women by age 20 

• One in 1,000 women by age 30

• One in 250 women by age 35 

• One in 100 women by age 40 
7 8

What are the symptoms of

POF?

The most common first symptom of POF 

is having irregular periods. Health care

providers sometimes dismiss irregular or

skipped periods (sometimes called

amenorrhea—pronounced AY-men-or-ee-uh)

as being related to stress; but a woman’s

monthly cycle is actually an important sign

of her health, in the same way that blood

pressure or temperature are signs of health.

If you have irregular periods or skip periods,

you should tell your health care provider, so

that he or she can begin to determine the

cause of these problems. 

Some women with POF also experience

other symptoms with POF. These symptoms

are similar to those experienced by women

who are going through natural menopause

and include (but are not limited to): 

• Hot flashes

• Night sweats

• Irritability

• Poor concentration

• Decreased interest in sex

• Pain during sex

• Drying of the vagina

• Infertility

How do I know if I have POF?

One of the most common signs of POF 

is having irregular periods. Women should

pay close attention to their menstrual

cycles, so that they can alert their health

care provider when changes occur in their

periods. 

If you are under age 40 and your periods 

are irregular, or if you miss your period

altogether for three months or more, your

health care provider may measure the level

of FSH in your blood, to determine if you

have primary ovarian insufficiency in its

early stages, or possibly even fully developed

POF. Remember that FSH signals the ovaries

to make estrogen. If the ovaries are not

working properly, as is the case in POF, the

level of FSH in the blood increases. A higher

level of FSH in the blood is a strong sign of

POF. But, irregular periods alone are not a

sure sign that you have POF—research

shows that fewer than 10 percent of women

who have irregular or skipped periods have

high FSH levels and POF. 

To do an FSH test, your health care provider

will collect some of your blood and send it

to a laboratory. At the lab, a technician will

check the level of FSH. If the level of FSH 

is in the menopausal range, it is likely that

you have POF. 

Are there treatments for 

the symptoms of POF?

Currently, no proven treatment will restore

normal function to a woman’s ovaries. But,

health care providers can suggest treatments

for some of the symptoms of POF. 

One of the most common treatments for

women with POF is hormone replacement

therapy (HRT). In women with POF, HRT

gives their bodies the estrogen and other

hormones that their ovaries are not making.

Replacing these hormones causes a woman

with POF to start having regular periods

again. In addition, HRT may help women

with POF lower their risk for the bone

disease osteoporosis. 

HRT is usually a combination of the

hormones estrogen and progesterone (or

the man-made form of progesterone, called

progestin). Women can take the therapy as

a pill, or they can wear a patch that sticks

to their skin to get the hormones into their

bodies. Many health care providers suggest

the patch for women with POF because it

offers a continuous flow of hormones into

the blood stream, which mimics the way

the body naturally releases estrogen. The

combination and amount of hormones

used in HRT may differ for different

women. If you have questions about HRT 

as a treatment for POF, talk to your health

care provider.

Most health care providers suggest that

women with POF take HRT until they are 

50 years old. After that time, women

should talk with their health care provider

about stopping HRT because of risks

associated with older women taking 

the therapy after menopause. 

Current research is also looking into 

the benefits of replacing the hormone

testosterone to prevent bone loss in

women with POF. Most people think of

men’s health when they hear the word

testosterone, but women’s bodies also

make testosterone, at a level about oneseventh that of men. Testosterone helps 

to maintain muscle and bone mass, and

may be related to a woman’s sex drive. 

The ovaries make testosterone, and its level

is lower in women with POF. But, unlike

estrogen and progesterone, testosterone

is not usually replaced as part of HRT. A

clinical trial is now underway to see if

raising the level of testosterone in women

with POF to that found in a woman with

healthy ovaries can slow or stop bone loss.

The results of this study could benefit not

only women with POF, but also other young

women who are at risk for osteoporosis.

For more information on this or other 

NICHD clinical trials related to POF, contact

the Unit on Gynecologic Endocrinology, at 

1-877-206-0991, or visit the Unit’s 

Web site at http://pof.nichd.nih.gov. 
The type and amount of HRT prescribed 

to women with POF is different from 

the hormone therapy taken by women 

in the Women’s Health Initiative study. 

For example, women with POF usually take

full-dose estrogen replacement therapy,

meaning the amount of estrogen is nearer

or equal to the level normally found in 

a young healthy woman, whose ovaries 

are working properly, before menopause.

Hormone therapy for women who have

already gone through menopause is a

much lower dose. And, women with 

POF typically use a patch to deliver the

hormone estrogen, but take a pill that

provides progestin. This regimen is different

than the one used in the Women’s Health

Initiative, which had women take a pill that

contained both estrogen and progestin. 

Talk to your health care provider if you have

questions about HRT as a treatment for POF.

He or she can explain the benefits and risks

of HRT for your specific situation as a

young woman. It is important to remember

that young women with POF differ from

older menopausal women in many

significant ways. Your health care provider

should consider these issues when deciding

on the best treatment for you.

Go to the Where can I go for more

information on POF? section of this

booklet for more information about 

the Women’s Health Initiative. 

10

Is HRT safe for me to take 

if I have POF? 

Most health care providers believe that HRT

replaces what your body should be making

naturally as a young woman, and that your

body needs these hormones to function

normally. HRT taken by women with POF is

very different from the hormone therapy that

is often taken by women who are going

through or have already gone through

natural menopause.

Recently, a study found that older women,

who had gone through normal menopause,

were at increased risk for certain health

conditions when they took a certain type of

hormone therapy for long periods of time.

The study was part of the Women’s Health

Initiative, a large, multi-center study that

involved more than 161,000 postmenopausal

women in their fifties, sixties, and seventies.

The researchers found that these women,

who went through natural menopause at

the expected age, were at greater risk for

stroke, blood clots, heart disease, heart

attacks, and breast cancer after taking a

specific type of hormone therapy for more

than five years. 

These results do not apply to young women

taking HRT; specifically, these results don’t

apply to young women with POF. Women 

in the study mentioned above were

between the ages of 50 and 79 when 

the study began and had gone through

menopause at the normally expected 

time; their bodies would not normally be

making high levels of hormones. The type

of therapy taken by women in the Women’s

Health Initiative study could be called

hormone extension therapy, rather than

hormone replacement therapy, as is often

reported. These women took the hormones

beyond the time that the hormones would

naturally be present. Women with POF get

hormone replacement therapy; that is, the

HRT is providing something their bodies

would normally be making, if they didn’t

have POF.

9
Low thyroid function

• This problem is also called

hypothyroidism (pronounced high-poeTHIGH-royd-iz-em).

• The thyroid is a gland, like the ovary,

adrenal, and pituitary glands. It makes

and releases hormones. Specifically, the

thyroid makes hormones that control the

body’s metabolism and energy level. Low

levels of the hormones made by the

thyroid can affect metabolism, and can

cause a woman to have very low energy.

• Symptoms include a slow down in 

the body’s normal rate of functioning,

which can lead to mental and physical

sluggishness. Cold feet are also a feature

of low thyroid function.

• A recent study found that 27.0 percent 

of women with POF also had low thyroid

function. In the general population, only

two percent of all people (both men and

women) have low thyroid function.

Are there ways to prevent or treat

low thyroid function in women with

POF?

Replacing the hormone that the thyroid is

not making enough of treats this problem.

Usually, you can take a pill to replace the

hormone.

Addison’s disease 

• Addison’s disease is an autoimmune

disorder, meaning the body’s immune cells,

which normally protect the body from

invading cells and microbes, attack the

adrenal glands, part of the endocrine

system located above the kidneys. The

adrenal glands produce hormones that

regulate the body’s response to stress and

its handling of salt.

• Addison’s disease is also called primary

autoimmune adrenal insufficiency.

• Recent studies suggest that 3.2 percent

of women with POF also have Addison’s

disease, making them much more likely

than members of the general population

to develop the disease.

• Symptoms of Addison’s disease include

loss of appetite, weight loss, dizziness

when standing, and fatigue. In later

stages of Addison’s disease, salt craving,

low blood pressure, and darkening of the

skin may occur. 

• Current research indicates that an adrenal

antibody test is the most effective way to

detect Addison’s disease in women with

POF. If the results of this test are positive,

a health care provider may order a second

test, called an ACTH stimulation test, to

confirm the diagnosis. Both tests involve

collecting blood samples. 

Are there ways to prevent or treat

Addison’s disease in women with

POF?

While there is currently no way to prevent

Addison’s disease, the best way to treat it 

is to find out whether you have it. You can

easily manage the condition with the help

of your health care provider, by taking

medication that replaces the hormones

your adrenal glands are not making. If left

untreated, however, the disease can be life

threatening because the body can’t respond

properly to stressful events, such as severe

illness, injury, or surgery. 

11 12

How will having POF affect

my overall health?

Because of lower hormone levels that

result from POF, you are at greater risk 

for a number of health conditions. These

conditions, and what you can do to stay

healthy, are described below.

Osteoporosis

• Osteoporosis (pronounced OWS-tee-ohpour-oh-siss) is a bone disorder that

decreases bone strength and increases

the risk for breaks and fractures.

• Estrogen helps to conserve calcium and

other minerals in bones and protects

against bone loss. In POF, the ovaries stop

making estrogen, which can cause women

to lose bone density, or bone strength,

one of the major factors leading to

osteoporosis. 

• Even though osteoporosis is more

common in people ages 50 and above,

women with POF may experience the

condition at a much younger age.

Are there ways to prevent or treat

bone conditions in women with POF?

To protect against bone loss, the National

Osteoporosis Foundation1 recommends that

women who are at risk for osteoporosis: 

• Get at least 1200 mg of calcium in 

their diets every day. If it is not possible

to get this amount through diet, take 

a calcium supplement. 

• Get between 400 IU and 800 IU of

vitamin D, which helps the body absorb

calcium, every day.

• Get regular, weight-bearing and musclebuilding physical activity. Weight-bearing

physical activity, such as walking, will help

build bone strength. Activities like yoga or

tai chi help build muscle strength and

improve flexibility. 

An adequate level of estrogen in the body is

an important factor in preventing bone loss

that may lead to osteoporosis. The strategies

listed here may slow bone loss, but none of

them will prevent bone loss entirely.

1 A Physician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation,

Washington, DC; 1998, 2000.
Maintaining a healthy body weight 

and getting regular physical activity are

important in reducing the risk of heart

disease. These factors can affect your

cholesterol level, which, in turn, can 

affect your risk for heart disease. Other 

risk factors for heart disease include:

• Cigarette smoking

• High blood pressure (defined as 140/

90 mm/Hg or higher, or being on blood

pressure medication)

• High blood cholesterol

• Family history of heart disease

• Age: women—55 years or older

Talk to your health care provider about

heart disease to determine what steps, 

if any, you should take to lower your risk.

For information on heart disease and how

to lower your risk of heart disease, see the

Where can I get more information about

POF? section of this booklet.

Are there other health concerns for

women who have POF?

• Among women with POF, studies show

that 13.8 percent of women with a family

history of POF, and 2.1 percent of women

without a family history of POF may also

have a mild form of Fragile X syndrome.

• Fragile X syndrome is a genetic condition

that arises because of an error in a single

gene. In women with an affected gene, 

the symptoms can range from none at all,

to learning disabilities and problems with

math, to a slightly higher risk of anxiety

disorder. Women who have an affected

gene may pass it on to their children, who

may experience learning disabilities and

other problems as a result.

• But, simply having POF is not a sign of

mild Fragile X syndrome. You must have

other characteristics in addition to POF,

such as a family history of unexplained

mental retardation, for your health care

provider to suspect the genetic error. 

If you do not have such a family history,

this problem is likely not an issue for you.

• If you have no family history of

unexplained mental retardation, then 

it is unlikely that you have this genetic

error, and it is probably unnecessary 

for you to be screened for the condition.

If you do have a history of unexplained

mental retardation in your family, and

you have POF, you may want to be

screened for the genetic error associated

with Fragile X syndrome. Your health care

provider can give you more information

about screening, should he or she feel 

it is necessary. 

• For more information about Fragile 

X syndrome, talk to your health 

care provider, or contact the NICHD

Information Resource Center at 

1-800-370-2943.

14

Researchers now recommend that health

care providers screen all women who have

confirmed POF for Addison’s disease using

the adrenal antibody test, although such

screening is not yet standard practice. If

women with undetected Addison’s disease

undergo an exceptional physical stress,

such as surgery or a car accident, they are

at risk for an “adrenal crisis,” a situation

that can lead to shock and even death.

Therefore, screening for the disease is

especially important before a woman with

POF has surgery or undergoes other known

physical stresses.

Heart disease2

• While it is very rare for a young woman

with POF to develop heart disease, certain

factors related to the disorder might

increase her chances of developing heart

disease later in life.

• Lower levels of estrogen in POF can 

lead to higher levels of low-density

lipoprotein (LDL) cholesterol. LDL is

known as “bad” cholesterol because 

it is the main source of the buildup 

and blockage in arteries that can lead 

to heart attacks. 

• Lower levels of estrogen in POF can 

also lead to lower levels of high-density

lipoprotein (HDL) cholesterol, known 

as “good” cholesterol because it helps

prevent buildup and blockage in the

arteries. 

• After some time, buildup of cholesterol 

in the arteries can cause “hardening of

the arteries,” which means that the 

blood flow to the heart is slowed down

or blocked. Blood carries oxygen to 

the heart. If the heart can’t get enough

oxygen, a person may have chest pains. 

If the blood supply to part of the heart 

is cut off completely, because of blockage,

the result is a heart attack.

Are there ways to prevent heart

disease in women with POF?

Getting adequate estrogen therapy 

may help guard against heart disease.

Estrogen helps the body by:

• Keeping the lining of the arteries healthy

• Relaxing muscles that control arteries to

allow better blood flow to tissues

• Normalizing LDL and HDL levels to

decrease cholesterol build up in the

arteries that could lead to blockage

13

2 Adapted from High Blood Cholesterol: What You Need to Know. National Cholesterol Education Program,

NHLBI, 2001.
Does having POF mean that

I’ll be infertile or unable 

to have children?

If you have POF, it will likely be very difficult

for you to become pregnant because your

ovaries aren’t working correctly. At this

time, there is no proven medical treatment

that improves a woman’s ability to have a

baby naturally if she has POF. 

There is a chance that you will become

pregnant without fertility treatment.

Between 5 percent and 10 percent of

women with POF do become pregnant,

even though they have not had fertility

treatment. Sometimes pregnancy can 

occur decades after the initial diagnosis.

Researchers cannot explain why some

women with POF get pregnant, while

others do not. 

Because pregnancy is still possible for

women who have POF, those who do not

want to become pregnant should take 

steps to prevent pregnancy. In some

women with POF, oral contraception 

may not be as effective for pregnancy

prevention as it is in women who don’t

have POF. In some cases, using a “barrier”

method of contraception, such as a

diaphragm or a condom, may be a better

option for women with POF who don’t

want to become pregnant. Discuss your

contraception needs with your health 

care provider, if you have POF and don’t

want to become pregnant.

If you have POF and want to become

pregnant, you and your family have some

options, explained below. You should 

also know, however, that some medical

therapies for infertility have been proven

ineffective, through randomized clinical

trials. These therapies include high-dose

estrogen therapy, gonadotropin-releasing

hormone (GnRH) agonist therapy,

corticosteroid therapy, high-dose GnRH

therapy, and treatment with danocrine.

Health care providers recommend avoiding

unproven fertility treatments because such

methods may actually reduce your chances

of getting pregnant naturally. 

A special note about infertility

associated with POF

Many women involved in POF support

groups reported that, when they were

diagnosed with POF, they felt a sense 

of loss or grief, not unlike the sadness

associated with the death of a loved one.

Others reported that they felt guilty about

not trying to have children earlier in their

lives. They noted that the diagnosis also

affected their partners, spouses, and families.

For women with POF and their families, then,

emotional support may be as important as

medical treatment for dealing with POF. 

Health care providers who care for women

with POF often have to reassure their

patients that these emotional responses are

perfectly natural reactions to the news of

POF. Some health care providers suggest

taking time to deal with the diagnosis and

the emotions that surround it, before making

any decisions about having a family (see 

The Art of Listening for more information).

Many providers recommend that women

with POF and their families work with a

“professional listener” to help deal with the

powerful and sometimes painful emotions

associated with this diagnosis. A social

worker, a psychologist, a psychiatrist, or

another mental health professional can

work with a woman individually, together

with a spouse, partner, or a family member,

or in some combination of these

arrangements. For information on finding 

a professional listener, talk to your health

care provider, or go to the Where can I go

for more information about POF? section

of this booklet.

Many women in support group settings

reported that talking to other women who

had POF was helpful in coming to terms

with their diagnosis. Many hospitals and

health clinics offer support groups for

women and families affected by POF. To learn

more about support organizations, go to the

Where can I go for more information

about POF? section of this booklet.

What are my options for having 

a child?

Families affected by POF do have options

for having a child. As mentioned earlier,

avoid unproven fertility treatments 

and treatments that have been proven

ineffective because such methods may

actually reduce your chances of getting

pregnant naturally.

Adopting a child is one option for starting

a family if you have POF. Adoption can be

one of the most rewarding experiences of 

a lifetime; but the process is not without

risks. Many health care providers recommend

that families considering adoption learn

about the process, its benefits and risks, and

its legal aspects, in addition to the possible

15 16
17 18

The Art of Listening

NICHD researcher Larry Nelson, M.D., has been caring for women who

have POF for decades. As the head of the NICHD’s Unit on

Gynecologic Endocrinology, Dr. Nelson is working to understand POF,

and to help women and families affected by it.

“Many women feel a sense of urgency to act right away when they get

their diagnosis,” Dr. Nelson explains. But, based on his years of

experience, he suggests a slower, more deliberate plan to his patients for

dealing with infertility related to POF.

First, he recommends that women allow themselves time to feel and

deal with the emotions that may accompany a diagnosis of POF. He

explains that getting emotionally healthy, no matter how long it takes, is

the best way to prepare for the tough decisions that may be down the

road.

Next, Dr. Nelson suggests that the women strengthen their relationships

with their spouses, partners, and families. He feels that the help of a

professional listener is very important in building strong, close relationships

after a POF diagnosis.

The options for having a child if a woman has POF are risky, expensive,

and often emotionally draining, he adds. He usually tells his patients and

their families to take some time to really focus so they can make clear,

informed decisions. After taking some time, families may decide that

options for having a child simply aren’t right for them, he explains; or,

they may decide to pursue the options for having a child.

Dr. Nelson received the 2001 Art of Listening Award from the Genetic

Alliance for his commitment and dedication to caring for women with

POF. The Genetic Alliance is a national non-profit organization that

strives to help those affected by genetic disorders. To contact the Unit

on Gynecologic Endocrinology, call 1-877-206-0911.

emotional effects, before making a decision.

For more information on adoption and

adoption resources, go to the Where can 

I go for more information about POF?

section of this booklet.

A certain type of assisted reproductive

technology (ART), known as egg donation,

may also be an option for having a child. 

In POF, the problem is in producing healthy

eggs; the condition does not affect a

woman’s uterus, which means she may be

able to carry a child. Egg donation makes it

possible to combine donor eggs and sperm

in a laboratory, and then place the resulting

embryos into the uterus of a woman who

has POF. 

All forms of ART are complex, and each

carries its own benefits and risks, some 

of them serious. Because few insurance

companies currently provide coverage for

this procedure, families may have to cover

the entire cost of the process. And, many

families have to try ART several times

before it is successful. The Centers for

Disease Control and Prevention (CDC)

provides statistics on success rates of ART

procedures based on different factors. 

Go to the Where can I go for more

information on POF? section of this

booklet for information on how to obtain 

a copy of the CDC report. 

If you and your family are considering

ART, talking with a health care provider

and/or a fertility specialist about the risks

and benefits may help you make your final

decision. The Where can I go for more

information on POF? section provides

information on how to find a fertility

specialist and lists resources on ART. 

In addition, researchers are actively working

to develop methods that improve fertility in

women with POF and other conditions. As

such methods and treatments improve,

women with POF and their families may have

more options for having children naturally.
19 20

What are researchers doing 

to learn more about POF?

Currently, the NICHD is conducting and

sponsoring a number of studies on POF:

• Some researchers are exploring whether 

a low dose of a certain steroid can treat

POF in cases caused by an autoimmune

disorder. The steroid, called prednisone,

decreases the function of the body’s

immune system, which is thought to be

attacking the ovary follicles in some

women with POF.

• Researchers are trying to determine the

best combination and dosage of HRT for

treating POF. Some work is trying to

learn whether adding testosterone to a

woman’s HRT can help to prevent bone

loss. Other studies are trying to find the

amount of estrogen and progestin that

best treats POF without causing too

many side effects. 

• Other research focuses on what happens

in an ovary that is working normally. This

information may help scientists develop 

a test for early detection of POF.

Clinical trials to explore these topics 

are already underway. To find out more

about these studies, contact the NICHD’s

Unit on Gynecologic Endocrinology, at 

1-877-206-0911. You can also learn 

more about all studies on POF by going to

http://clinicaltrials.gov, and doing a search

for “premature ovarian failure.” Or, you can

call the NIH Patient Recruitment and Public

Liaison Office at 1-800-411-1222. 

In addition to these studies, the NICHD 

has a Reproductive Medicine Gynecology

Program in its Reproductive Sciences

Branch that supports research on women’s

health conditions that aren’t cancerous,

including POF. In 1998, the NICHD joined

other Institutes at the NIH in setting up 

12 Women’s Reproductive Health Research

Career Development Centers. These Centers

support obstetricians and gynecologists 

in becoming researchers, so that they can

study topics on women’s health. Eight

additional Centers, started in 1999, will

allow this vital research to continue until

scientists know the causes and treatments

for POF and other reproductive diseases. 

The NICHD’s Reproductive Sciences Branch

also has other programs that support

research on POF, and on other topics that

affect women’s health. The Specialized

Cooperative Centers Program in Reproductive

Research (SCCPRR), established in the late

1990s, relies on multidisciplinary approaches

to research on reproductive health topics.

SCCPRR has a number of basic, translational,

and clinical scientific studies in progress at

14 sites around the country that are aimed

at finding the cause of POF, including

genetics and the factors that cause follicle

depletion and dysfunction. 

The NICHD supports and conducts research on topics related to the

health of children, adults, families, and populations, including POF.The

mission of the NICHD is to ensure that every person is born healthy 

and wanted, that women suffer no harmful effects from the reproductive

process, and that all children have the chance to fulfill their potential for 

a healthy and productive life, free of disease or disability. You can contact

the NICHD at:

The NICHD Information Resource Center

P.O. Box 3006, Rockville, MD 20847

1-800-370-2943

Fax: (301) 984-1473

E-mail: NICHDClearinghouse@mail.nih.gov

Internet: www.nichd.nih.gov 

Additional Resources

• The NIH Women’s Health Initiative is a series of clinical trials and observational studies 

that spans 15 years. The Initiative is designed to test promising, but unproven measures 

for preventing health conditions such as heart disease, breast cancer, and osteoporosis. The

National Heart, Lung, and Blood Institute (NHLBI) sponsors the Initiative, in collaboration with

the National Cancer Institute, the National Institute of Arthritis and Musculoskeletal and Skin

Diseases, the National Institute of Aging, and the NIH Office of Research on Women’s Health.

For more information, visit the Initiative’s Web site at http://www.whi.org.

• The NHLBI provides information about heart disease and lowering your risk for heart disease.

To learn more, call the Heart Health information line at 1-800-575-WELL. You can also

contact the NHLBI Information Center at 301-592-8573 (for TTY call 240-629-3255), or 

at NHLBIinfo@rover.nhlbi.nih.gov.

• To obtain a copy of the CDC report, Assisted Reproductive Technology Success Rates, call 

770-488-5200, or visit http://www.cdc.gov/nccdphp/drh/art.htm.

• For more information about clinical trials related to POF, call 1-800-411-1222, or visit the

NIH Clinical Trials Web site, at http://clinicaltrials.gov.

• For additional information about adoption, visit the National Library of Medicine’s Web site, 

at http://www.nlm.nih.gov/medlineplus/adoption.html.

• The Kaiser Family Foundation and Lifetime Television joined forces to create the Vital Signs Project,

a health policy initiative that focuses on listening to women and their concerns about health care,

including their concerns about reproductive health and health care. For more information about

the Vital Signs Project, go to http://www.kff.org/lifetime/vital_signs_project.html. 

Where can I go for more information about POF? 
22

• The National Adoption Information Clearinghouse (NAIC) is an allinclusive resource on all aspects of adoption that is supported by the

Administration for Children and Families (ACF), part of the federal

government’s Department of Health and Human Services. NAIC services

include technical assistance, a library collection, publications, databases on

adoption resources, and information on federal and state legislation related 

to adoption. You can contact NAIC at:

National Adoption Information Clearinghouse (NIAC)

330 C Street, SW,Washington, DC 20447

1-888-251-0075 or (703) 352-3488

Fax: (703) 385-3206

E-mail: naic@calib.com

Internet: http://www.calib.com/naic/index.htm

• The American Society of Reproductive Medicine (ASRM) is an

organization devoted to advancing knowledge and expertise in reproductive

medicine and biology. For more information, contact:

American Society of Reproductive Medicine

1209 Montgomery Highway, Birmingham, AL 35216-2809

(205) 978-5000 

Fax: (205) 978-5005

E-mail: asrm@asrm.org

Internet: http://www.asrm.org 

The NICHD would like to acknowledge Dr. Nanette Santoro for her valued assistance on this project.

21

A number of other organizations provide information about

POF and offer support to women and families affected by

this disease.

• The POF Support Group is a non-profit organization that offers a

referral list of physicians, mental health professionals and counselors,

adoption agencies, and other professionals for women and families affected

by POF. This group also publishes a quarterly newsletter and holds local

and/or regional support group meetings. You can contact the POF Support

Group at:

POF Support Group

P.O. Box 23643,Alexandria,VA 22304

(703) 913-4787

E-mail: info@pofsupport.org

Internet: http://www.pofsupport.org

• RESOLVE: The National Infertility Association is a non-profit organization

that provides timely, compassionate support and information to women and

men who are affected by infertility. RESOLVE works to increase awareness

of and access to infertility treatment and resolution options through public

education and advocacy for legislative and insurance reform. Through a

nationwide network of chapters, RESOLVE offers a number of benefits,

including a HelpLine for finding fertility specialists and other referrals, a

Member-to-Member contact system, a national magazine, and local chapter

newsletters. You can contact RESOLVE at:

RESOLVE

1310 Broadway, Somerville, MA 02144 

1-888-623-0744 

E-mail: info@resolve.org

Internet: http://www.resolve.org
NICHD Information

Resource Center

1-800-370-2943

www.nichd.nih.gov

NIH Pub. No. 03-5159

August 2003