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-oestrogenism such as hot flushes, sleep disturbance, irritability, and vaginal dryness.
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.
History and exam
Key diagnostic factors
- age <40 years
- family history of primary ovarian failure
- menstrual irregularities
- toxic exposures
Other diagnostic factors
- hot flushes
- sleep disturbance
- vaginal dryness
- 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
- family history of POF
- exposure to chemotherapy or radiation
- autoimmune disease
- family history of fragile X syndrome
- uterine artery embolisation
- lower socioeconomic status, higher education level, nulliparity
- presence of specific genetic variants
- ovarian surgery
1st investigations to order
- pregnancy test
- serum follicle-stimulating hormone (FSH) level
- serum luteinising hormone (LH) level
- serum estradiol level
- anti-Müllerian hormone (AMH) level
- thyroid function tests
- serum prolactin level
- transvaginal ultrasound
Investigations to consider
- thyroid peroxidase antibody
- serum fasting glucose level
- electrolytes, urea, creatinine
- fragile X premutation
- adrenocorticotropic hormone (ACTH) stimulation test
- serum adrenal antibodies
- baseline dual-energy x-ray absorptiometry scan
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
WL is the author of one reference cited in this topic.
Rachael Rodgers, BA, BSc, MBBS, MScMed (RHHG)
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 topic.
WH, RF, and NG declare that they have no competing interests.
John F. Randolph Jr., MD
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.
Edward Morris, MD
Honorary Senior Lecturer and Clinical Director
Department of Obstetrics and Gynaecology
Norfolk and Norwich University Hospital
EM declares that he has no competing interests.
- Polycystic ovary syndrome
- Anorexia nervosa
- The British Menopause Society and Women's Health Concern recommendations on the management of women with premature ovarian insufficiency
- The 2017 hormone therapy position statement of the North American Menopause Society
Menopause: should I take HRT?
Menopause: what is it?More Patient leaflets
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