93. Hope for POI and Early Menopause: What Restorative Medicine Can Do

Welcome back to Cycle Wisdom with Dr. Monica Minjeur. In this episode, we’re diving deep into a diagnosis that can feel like a door slamming shut—Primary Ovarian Insufficiency (POI), sometimes called early menopause. If you’ve ever been told your AMH is undetectable or your only option is donor eggs, this episode is for you.

We begin with Olivia’s powerful story—misdiagnosed, dismissed, and then restored through the compassionate care of Restorative Reproductive Medicine (RRM). Her journey from hopelessness to holding her healthy baby girl is a testament to what’s possible.

Dr. Minjeur explains:

• What POI really means (and what it doesn’t)
• Why AMH is not the final word
• How cycle tracking and bioidentical hormone support can uncover hidden potential
• The role of low-dose naltrexone and how RRM digs deeper when conventional care stops short
• And yes—pregnancy is still possible, even with POI

If you've been told there's nothing more to do, this episode offers a different story—one grounded in evidence, compassion, and hope.

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. Have you been told you are in early menopause, even though you're still in your twenties or thirties? Maybe you've missed a few periods or had some labs done, and now you're staring at a diagnosis. You don't fully understand primary ovarian insufficiency. Today we're diving into what this really is and what it isn't. We'll break down how primary ovarian insufficiency is diagnosed. We'll also talk about why A MH isn't the whole story, and whether pregnancy is still possible. Most importantly, we'll talk about what restorative reproductive medicine can offer when conventional medicine says there's nothing more to do. So let's get started. As always, with Olivia's story, Olivia was a 33-year-old marketing professional living in a busy metro area. She and her husband had been married for about four years and recently started trying to conceive. Olivia had a fairly demanding job, which included frequent travel and a history of irregular periods since college. She assumed that conceiving might just take some time with the irregular cycles, but months went by then over a year and no positive pregnancy tests. What started out as optimism quickly turned into self-doubt and confusion. Every time someone asked her, when are you going to start a family? It stung a little bit more. Olivia was feeling broken, frustrated by her body, and disappointed that something so natural felt so far out of reach. She told her husband, I just wanna know what's wrong after she had had yet another long cycle with no ovulation. She went to see her primary OB doctor who finally ran some labs and told her over the phone, your A MH level is undetectable. You are in early menopause, and that was it. No explanation, no plan. She was referred on to IVF and recommended to utilize donor eggs, a step that she wasn't emotionally ready for at that moment, Olivia told me she felt like a door had slammed shut in her face. But she couldn't shake the feeling that this wasn't the full picture. Through a friend, she discovered our clinic and restorative reproductive medicine, and for the first time we walked her through her entire health history, charting her cycles and digging deeper than just the a MH lab. Okay. We started off with getting her charting her cycles, working with one of our fertility educators. We then ordered a complete hormone profile to assess for underlying causes, not just checking a day 21 labs, but a full profile that revealed her estradiol levels were sometimes normal and sometimes low. Her FSH or follicle stimulating hormone was high, but it did fluctuate. Her progesterone levels after she ovulated were borderline if ovulation happened at all. And her ultrasound showed small ovaries with minimal visible follicles, but not zero. Most importantly, Olivia did still have some ovarian activity, and with the right support, that activity could be optimized. We started Olivia with some lifestyle changes in addition to medications to help with ovulation. We also provided thyroid and adrenal support, as well as bioidentical hormone support and careful cycle tracking. Over time, Olivia noticed that she was beginning to ovulate more consistently and her cycle shortened from over 45 to 60 days, down to closer to 32 to 34 days apart. And after six months of treatment, Olivia saw her first consistent progesterone level after ovulation, and shortly after that, her very first positive pregnancy test. Today, Olivia is a mom to a healthy baby girl, conceived naturally with her own eggs after being told that was impossible. She continues to monitor her cycle knowing that primary ovarian insufficiency doesn't go away, but she now has the tools and support to care for her body long term. The fear and confusion she once lived with has been replaced with knowledge, empowerment, and hope, and Olivia says, I wish I had found restorative reproductive medicine sooner, but I'm so thankful I didn't give up because the answers were there. I just needed someone to help me look deeper. So what is primary ovarian insufficiency? This is sometimes also called premature ovarian failure or early menopause, but insufficiency really is a more accurate medical term. Primary ovarian insufficiency or POI is defined as a loss of normal ovarian function before the age of 40. It impacts approximately one out of a hundred women under the age of 40 and one in a thousand women under the age of 30. Most women will observe irregular or even absent menstrual cycles. And lab work oftentimes will show a very high FSH or follicle stimulating hormone. And by definition, this number needs to be above 25 on two separate occasions, at least a month apart. We also oftentimes will see very low estradiol levels and possibly low A MH or anti-Mullerian hormone. But I do want to provide a bit of a caution here. A MH levels are not a diagnostic tool for primary ovarian insufficiency. A MH can reflect ovarian reserve, but not function. In fact, as we've discussed on past episodes, A MH is really a tool that was designed for the IVF industry in order to determine if you had ovarian hyperstimulation in order to try and retrieve eggs, how many eggs would be able to be retrieved. A MH levels can be low, even in women who go on to ovulate and conceive, and this is why we don't use a MH as the final word. In fact, colleagues of mine across the world always talk about what's an A MH level that you have seen conception and to date, the lowest a MH level that we have seen conception is at 0.02, which is incredibly low and even so low that IVF would not accept you for treatment if your A MH was that low. So what are the causes of POI and are there things that I can do to change my risk factors? One of the most common causes that we find is autoimmune dysfunction, especially thyroid. This oftentimes can be associated with those low A MH levels, and there is a suspicion that there may be some autoimmune factors that play a role with attacking the ovaries themselves. Other situations can include genetic conditions. Things like Turner Syndrome or Fragile X carriers prior chemotherapy or radiation can also cause primary ovarian insufficiency. And unfortunately, in about 90% of cases, it is completely unknown. We call that. Idiopathic meaning we don't find an underlying medical reason for why the A MH has dropped, why the FSH is elevated and why we have this primary ovarian insufficiency. So the most common question I get asked when women get a diagnosis of POI is, can I still get pregnant? And the answer is yes. Spontaneous pregnancy is still possible, and about five to 10% of women with POI will ovulate on a irregular basis and can conceive naturally. The role of restorative reproductive medicine though is tracking those cycles carefully and helping to detect subtle hormone shifts that can indicate a return of ovulation. Even women who've gone months without a period may ovulate again. So how do we do that? What does that look like? Again, we want to first seek to identify any underlying clauses that may be playing a role with primary ovarian insufficiency. So we check for things like autoimmune dysfunction, nutritional deficiencies, inflammation, and we work to treat those pieces in order to help improve overall health. We also utilize bioidentical hormone support. Now, this is not just replacement. This is not just throwing a whole bucket load of hormones at you, but we're looking at improving both the bioidentical, estrogen and progesterone levels, oftentimes in cyclical regimens in order to mimic what's going on with a natural cycle. Our goal here is to support what's going on under the surface and prevent long-term consequences like bone loss or heart issues. In women who are still cycling occasionally, this support may actually help to preserve and optimize natural ovulatory potential. Another common treatment we utilize is low dose Naltrexone. Now, if you missed my episode, you can go back and listen to episode number 88 where I talk all about low dose naltrexone. But this is a very common tool that we utilize in restorative reproductive medicine for women with suspected or confirmed autoimmune contributors. To primary ovarian insufficiency, low-dose naltrexone helps to modulate immune function. It also helps to decrease inflammation and may indirectly help to support ovarian function in some women. Even with irregular or absent cycles, we still have that very important focus on fertility awareness charting. We want to be able to track ovulation using cervical mucus and be able to understand if you are ovulating because it can happen spontaneously. We also want to make sure that if we are providing medication support that you know very clearly when that door opens and natural conception can occur. Tools like utilizing our chart, Neo app or others allow for consistent long-term monitoring and recognizing patterns over time. And finally, we definitely wanna make sure that we are helping to provide emotional and mental health support. Primary ovarian insufficiency carries a heavy emotional weight, especially when it comes to fertility and identity as a woman. Many restorative reproductive medicine clinics build in support from health coaches or others trained in infertility or grief counseling in order to make sure we are addressing. Both the heart, mind, body connection, as well as what's going on from a physical medical standpoint. So why haven't I heard of this before? Why haven't I been told that there are other options when it comes to a premature menopause diagnosis or primary ovarian efficiency? Unfortunately, many obstetricians and gynecologists receive very limited training in restorative reproductive medicine or informal fertility awareness cycle tracking. Restorative reproductive medicine is a subspecialty requiring additional training outside of traditional medical education In conventional care, if you're not cycling or your A MH level is very low, the next step is often getting referred to IVF, possibly with donor eggs. However, our restorative reproductive medicine model believes in restoring function, not just replacing it or creating a bandaid approach. It's not that most OB doctors don't care. It goes back to the system that they're trained in, not giving them the tools they need in order to understand this life-changing approach. If you've been told you're in early menopause or that you'll never ovulate again, or that your only hope is donor eggs or IVF, I invite you to pause and take a breath. You deserve a second opinion. Compassionate education and evaluation, and a team that's committed to uncovering underlying causes. Imagine if you could understand your body's signals, restore some of your natural hormone function, and still have a chance at pregnancy. That's what we do every day at Radiant Clinic and I can't wait to listen to your situation to walk with you and help to restore your hope to understanding if there is a more natural option that would be effective for you. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach, please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.