Summary
Definition
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
- 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
- family history of POF
- exposure to chemotherapy or radiation
- autoimmune disease
- family history 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 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
- karyotype
- fragile X premutation
- adrenocorticotropic hormone (ACTH) stimulation test
- serum adrenal antibodies
- baseline dual-energy x-ray absorptiometry scan
Treatment algorithm
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.
Peer reviewers
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
Disclosures
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
Disclosures
EM declares that he has no competing interests.
Differentials
- Pregnancy
- Polycystic ovary syndrome
- Anorexia nervosa
More DifferentialsGuidelines
- European Stroke Organisation guidelines on stroke in women: management of menopause, pregnancy and postpartum
- The 2022 hormone therapy position statement of the North American Menopause Society
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