TABLE 6

Approach to premature ovarian insufficiency (POI) diagnosis and evaluation

Criteria for diagnosis of POIa
History of bilateral oophorectomy or other iatrogenic cause of POI
OR
≥ 4-month history of spontaneous amenorrhea or irregular menstrual cycles
FSH > 25 IU/L (repeat in 4 to 6 weeks if diagnostic uncertainty)
Estradiol concentrationb
Negative serum human chorionic gonadotropin test
Further testing for POI causes (specialist evaluation)
Genetic (karyotype, fragile X premutation testing)
Autoimmune (adrenal antibodies, thyroid screening)
Other (additional testing individualized)

  • ↵aDiagnosis of POI does not require a specialist, but referral is indicated if there is clinical uncertainty. Note that oral contraceptives can skew follicle-stimulating hormone (FSH) and estradiol values and should be stopped for 1 to 2 weeks before hormone testing.

  • ↵bEstradiol levels are often ordered in conjunction with FSH concentration to assist with test interpretation. Typically, the combination of low estradiol levels and elevated FSH is consistent with POI.

  • Based on information from reference 1.