Primary Ovarian Insufficiency (POI) and Mental Health

Primary ovarian insufficiency (POI) is when the ovaries stop working properly before the age of 40. This means they produce fewer eggs and lower levels of important hormones, especially oestrogen. POI can happen suddenly or gradually, and it often brings with it symptoms similar to menopause, such as hot flushes, irregular periods, and fertility problems.

What is less often talked about—but just as important—is the impact of POI on mental health.

Why does POI affect mental health?

1. Hormonal changes

   • Oestrogen and other ovarian hormones (like progesterone and testosterone) don’t just control the menstrual cycle—they also affect the brain.

   • Oestrogen helps regulate mood, energy levels, memory, and even sleep. Low levels can increase the risk of low mood, anxiety, and “brain fog.”

   • Testosterone, which also falls in POI, is linked with motivation, energy, and sexual wellbeing.

     
     

2. Life impact

   • POI often comes at a stage of life when women are planning careers, relationships, and families. A sudden diagnosis can feel like a loss of control, raising feelings of grief, sadness, or even anger.

   • Fertility difficulties can add an emotional burden, and women may also feel isolated, especially if they don’t know others going through the same thing.

     
     

3. Increased risk of depression and anxiety

   • Research shows women with POI are at higher risk of depression and anxiety compared with women who go through menopause at a natural age.

   • Around one in three women with POI report significant depressive symptoms.

What helps?

1. Hormone replacement therapy (HRT)

   • Replacing oestrogen (and sometimes progesterone and testosterone) can help not just with physical symptoms, but also with mood, sleep, and cognition.

   • Evidence shows that HRT improves quality of life and reduces the risk of depression linked to hormone deficiency.

     
     

2. Mental health support

   • Talking therapies such as cognitive behavioural therapy (CBT) can help with anxiety, low mood, and coping with a diagnosis.

   • Peer support—connecting with others who have POI—reduces feelings of isolation and validates shared experiences.

     
     

3. Lifestyle measures

   • Regular exercise, good sleep, and balanced nutrition support both hormone health and mental wellbeing.

   • Mind-body practices such as mindfulness or yoga can help manage stress and improve resilience.

     
     

4. Specialist care

   • Guidelines recommend care from a multidisciplinary team: gynaecologists, endocrinologists, psychologists, and fertility specialists.

   • This joined-up approach recognises that POI is not just a medical condition but one that affects emotional and social wellbeing too.

Myth-busting: Common misconceptions about POI and mental health

• “It’s all in your head.”False. Hormonal changes directly affect brain chemistry. Feeling low or anxious is a biological and psychological response—not a weakness.

• “HRT isn’t safe for young women.”False. For women with POI, HRT is recommended until at least the natural age of menopause (around 51). It helps protect mental health, bone health, and heart health.

• “If I can’t have children, there’s no point in treatment.”False. Treatment is not just about fertility—it’s about protecting your overall health and wellbeing, including mental health.

• “I’m the only one going through this.”False. POI affects 1-4 in 100 women under 40. Support groups, charities, and online communities can connect you with others who truly understand.

Key take-home message

POI is not just about hormones or fertility—it affects the whole person, including mental health. The combination of hormonal changes, life impact, and uncertainty can increase the risk of depression and anxiety. But with the right support—HRT, counselling, peer networks, and healthy lifestyle choices—women with POI can manage symptoms, protect their mental health, and continue to thrive.