Cessation of menses for more than 1 year before 40 years of age secondary to loss of ovarian function.
Symptoms include amenorrhoea and symptoms of hypo-oestrogenaemia such as hot flushes, sleep disturbances, and irritability.
Usually results in infertility, although spontaneous ovulation and pregnancy can occur rarely after its diagnosis.
Differential diagnosis includes genetic/chromosomal abnormalities, autoimmune disorders, infections, and toxic and idiopathic causes.
Screening for underlying medical conditions is recommended (as is karyotyping), especially in women younger than 30 years of age.
Hormone replacement therapy is recommended for treatment of symptoms and prevention of diseases including osteoporosis.
Premature ovarian failure (POF) is the cessation of menses for more than 1 year before 40 years of age secondary to loss of ovarian function. 
Professor of Obstetrics and Gynaecology
Academic Unit of Reproductive & Developmental Medicine
The University of New South Wales
WL declares that he has no competing interests.
Fellow in Reproductive Endocrinology
Royal Hospital for Women
RR declares that she has no competing interests.
Dr William Ledger would like to gratefully acknowledge Dr William Hurd, Dr Rebecca Flyckt, and Dr Nichole Giannios, the previous contributors to this monograph. WH, RF, and NG declare that they have no competing interests.
Professor and Director
Division of Reproductive Endocrinology and Infertility
Department of Obstetrics and Gynecology
University of Michigan Health System
JFR declares that he has no competing interests.
Honorary Senior Lecturer and Clinical Director
Department of Obstetrics and Gynaecology
Norfolk and Norwich University Hospital
EM declares that he has no competing interests.
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