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
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.
References
Key articles
North American Menopause Society. Early menopause guidebook. 6th edition. Cleveland, OH: North American Menopause Society; 2006.
Chen H, Li J, Cui T, Hu L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women. Cochrane Database Syst Rev. 2011;(11):CD008018.Full text Abstract
The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-94. Abstract
Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009 Jan;6(1):8-18. Abstract
van Kasteren YM, Schoemaker J. Premature ovarian failure: a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy. Hum Reprod Update. 1999 Sep-Oct;5(5):483-92. Abstract
Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14. Abstract
Toulis KA, Tzellos T, Kouvelas D, et al. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin Ther. 2009 Feb;31(2):221-35. Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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