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Premature ovarian failure

Last reviewed: 19 Jun 2025
Last updated: 09 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • age <40 years
  • family history of primary ovarian failure
  • menstrual irregularities
  • toxic exposures
Full details

Other diagnostic factors

  • hot flashes
  • sleep disturbance
  • irritability
  • vaginal dryness
  • infertility
  • vaginal atrophy
  • small uterus with nonpalpable ovaries
  • cognitive abnormalities
  • signs of thyroid dysfunction
  • signs of adrenal dysfunction
  • signs of hyperprolactinemia
  • signs of genetic syndromes
Full details

Risk factors

  • family history of POF
  • exposure to chemotherapy or radiation
  • autoimmune disease
  • family history of fragile X syndrome
  • galactosemia
  • hysterectomy
  • uterine artery embolization
  • smoking
  • lower socioeconomic status, higher education level, nulliparity
  • presence of specific genetic variants
  • ovarian surgery
Full details

Diagnostic investigations

1st investigations to order

  • pregnancy test
  • serum follicle-stimulating hormone (FSH) level
  • serum luteinizing hormone (LH) level
  • serum estradiol level
  • anti-Müllerian hormone (AMH) level
  • thyroid function tests
  • serum prolactin level
  • transvaginal ultrasound
Full details

Investigations to consider

  • thyroid peroxidase antibody
  • serum fasting glucose level
  • electrolytes, BUN, creatinine
  • karyotype
  • fragile X premutation
  • adrenocorticotropic hormone (ACTH) stimulation test
  • serum adrenal antibodies
  • baseline dual-energy x-ray absorptiometry scan
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

William Ledger, MA, DPhil (Oxon), MB, ChB, FRCOG, FRANZCOG, CREI

Professor of Obstetrics and Gynaecology

Academic Unit of Reproductive & Developmental Medicine

The University of New South Wales

Sydney

Australia

Disclosures

WL is the author of one reference cited in this topic.

Rachael Rodgers, BA, BSc, MBBS, MScMed (RHHG)

Fellow in Reproductive Endocrinology

Reproductive Medicine

Royal Hospital for Women

Sydney

Australia

Disclosures

RR declares that she has no competing interests.

Acknowledgements

Dr William Ledger would like to gratefully acknowledge Dr William Hurd, Dr Rebecca Flyckt, and Dr Nichole Giannios, the previous contributors to this topic.

Disclosures

WH, RF, and NG declare that they have no competing interests.

Revisores por pares

John F. Randolph Jr., MD

Professor and Director

Division of Reproductive Endocrinology and Infertility

Department of Obstetrics and Gynecology

University of Michigan Health System

Ann Arbor

MI

Divulgaciones

JFR declares that he has no competing interests.

Edward Morris, MD

Consultant

Honorary Senior Lecturer and Clinical Director

Department of Obstetrics and Gynaecology

Norfolk and Norwich University Hospital

Norwich

UK

Divulgaciones

EM declares that he has no competing interests.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

North American Menopause Society. Early menopause guidebook. 6th edition. Cleveland, OH: North American Menopause Society; 2006.

Chen H, Li J, Cui T, Hu L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women. Cochrane Database Syst Rev. 2011;(11):CD008018.Texto completo  Resumen

The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-94. Resumen

Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009 Jan;6(1):8-18. Resumen

van Kasteren YM, Schoemaker J. Premature ovarian failure: a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy. Hum Reprod Update. 1999 Sep-Oct;5(5):483-92. Resumen

Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14. Resumen

Toulis KA, Tzellos T, Kouvelas D, et al. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin Ther. 2009 Feb;31(2):221-35. Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Diferenciales

    • Pregnancy
    • Polycystic ovary syndrome
    • Anorexia nervosa
    Más Diferenciales
  • Guías de práctica clínica

    • Guideline on premature ovarian insufficiency
    • The 2022 hormone therapy position statement of the North American Menopause Society
    Más Guías de práctica clínica
  • Folletos para el paciente

    Menopause: should I take HRT?

    Menopause: what is it?

    Más Folletos para el paciente
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