Premature ovarian insufficiency

Premature menopause - more accurately known as premature ovarian insufficiency (POI) - is a syndrome consisting of amenorrhoea, elevated gonadotrophins and oestrogen deficiency due to the transient or permanent loss of ovarian function. It is also defined as menopause occurring in women prior to the age of 40 years. At least 1% of women under the age of 40 are affected by POI, with 0.1% of women aged under 30 and 0.01% of women aged under 20 also affected (1).

POI can be spontaneous or induced

• induced premature menopause could be as a result of medical interventions such as chemotherapy or surgical interventions such as bilateral oophorectomy.

Women who experience oestrogen deficiency at an early age before the natural menopause are now recognized to be at increased risk for premature morbidity and mortality

Diagnosis requires elevated gonadotrophins - FSH above 40 IU per litre together with raised LH and low oestradiol (less than 100 pmol per litre) on at least two occasions (2).

Ultrasound usually reveals small ovaries, a small uterus and a thin endometrium.

Note that reference ranges may vary between laboratories.

Reference:

1. Maclaran K, Panay N. Current concepts in premature ovarian insufficiency. Womens Health (Lond Engl). 2015 Mar;11(2):169-82.
2. Menopause: diagnosis and management. NICE Guideline (November 2015 - last updated December 2019)