Last reviewed: November 2017
Last updated: November  2017



History and exam

Key diagnostic factors

  • age <40 years
  • FHx of primary ovarian failure
  • toxic exposures
  • menstrual irregularities

Other diagnostic factors

  • hot flushes
  • sleep disturbance
  • irritability
  • vaginal dryness
  • infertility
  • vaginal atrophy
  • small uterus with non-palpable ovaries
  • cognitive abnormalities
  • signs of thyroid dysfunction
  • signs of adrenal dysfunction
  • signs of hyperprolactinaemia
  • signs of genetic syndromes

Risk factors

  • FHx of premature ovarian failure (POF)
  • exposure to chemotherapy or radiation
  • autoimmune disease
  • FHx of fragile X syndrome
  • galactosaemia
  • hysterectomy
  • uterine artery embolisation
  • smoking
  • lower socioeconomic status, higher education level, nulliparity
  • presence of specific genetic variants
  • ovarian surgery

Diagnostic investigations

1st investigations to order

  • pregnancy test
  • serum FSH level
  • serum LH level
  • serum estradiol level
  • serum antimullerian hormone (AMH) level
  • TFTs
  • serum prolactin level
  • transvaginal ultrasound
Full details

Investigations to consider

  • thyroid peroxidase antibody
  • serum fasting glucose level
  • electrolytes, urea, creatinine
  • karyotype
  • fragile X premutation
  • ACTH stimulation test
  • serum adrenal antibodies
  • baseline DEXA scan
Full details

Treatment algorithm



Authors VIEW ALL

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

Reproductive Medicine

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.

Peer reviewers VIEW ALL

Professor and Director

Division of Reproductive Endocrinology and Infertility

Department of Obstetrics and Gynecology

University of Michigan Health System

Ann Arbor



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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