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
- 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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