Premature ovarian insufficiency (POI)

Specialty
Gynaecology · Endocrinology & cycle
Images
Histology & cytology 1
Last updated
10/2026 · Dr. Pascal Bafteh
Contents
  1. Images (1)
  2. Definition
  3. Occurrence & epidemiology
  4. Aetiopathogenesis
  5. Clinical features
  6. Diagnosis
  7. Keep learning in the app
  8. Further reading (selection)
  9. Cross-references

Images (1)

Premature ovarian insufficiency (POI) – Histology & cytology: Karyotype (G-banding): Turner syndrome variant 46,X,i(X)(q10) – one normal X and an isochromosome of the long X arm (red box, arrow); a chromosomal cause of premature ovarian insufficiencyHistology & cytology
Karyotype (G-banding): Turner syndrome variant 46,X,i(X)(q10) – one normal X and an isochromosome of the long X arm (red box, arrow); a chromosomal cause of premature ovarian insufficiencyImage: Saideekshit T, S N MS, Govindan S, Prakash S, Radhika M (Cureus 2024) (Wikimedia Commons) · CC BY 4.0 · Source · cropped

Definition

  • Premature ovarian insufficiency is a loss of ovarian function before the age of 40, with amenorrhoea, low oestradiol and raised FSH.
  • Because the degree of ovarian impairment may fluctuate over time, the former term premature ovarian failure has largely been abandoned.

Occurrence & epidemiology

Epidemiology

  • The prevalence of non-iatrogenic POI is reported as about 1% in older studies and about 3.5% in recent publications.

Aetiopathogenesis

Aetiology and pathogenesis

  • The cause often remains unclear: idiopathic cases are estimated at about 39–67%, genetic causes at 10–30%, autoimmune causes at 5–17% and iatrogenic causes at 6–47%.
  • Genetic causes include Turner syndrome and FMR1 premutation; associated autoimmune diseases include Addison disease, Hashimoto thyroiditis and type 1 diabetes.
  • Further causes are iatrogenic gonadotoxic exposure, metabolic disorders such as galactosaemia and infections such as mumps or tuberculosis.

Clinical features

  • The leading symptom is primary or secondary amenorrhoea, sometimes with irregular bleeding, often with oestrogen-deficiency symptoms such as hot flushes, vaginal dryness and decreased libido.
  • Oestrogen deficiency reduces bone density with increased fracture risk and raises cardiovascular risk; spontaneous pregnancy is possible but occurs in only about 5–10% of affected women.

Diagnosis

  • According to the 2024 ESHRE guideline, disordered cycles (amenorrhoea or irregular cycles) for at least 4 months and an FSH above 25 IU/L are diagnostic; FSH is measured again after 4–6 weeks if the result is unclear.
  • Other causes of secondary amenorrhoea such as pregnancy and hypothyroidism are excluded beforehand.
  • AMH is not a primary diagnostic test but can support the diagnosis when FSH results are inconclusive; in non-iatrogenic POI, chromosomal analysis, for example to detect Turner syndrome, and FMR1 testing are part of the work-up.

Keep learning in the app

In the GynFuchs app you can learn Premature ovarian insufficiency (POI) with flashcards, exam questions and image tasks (colposcopy, ultrasound, CTG) – free, in your browser or as an app.

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Further reading (selection)

  1. Evidence-based guideline: premature ovarian insufficiency (Hum Reprod Open 2024, PubMed Central)
  2. MSD Manual Professional: Primary Ovarian Insufficiency
  3. StatPearls: Primary Ovarian Insufficiency (NCBI Bookshelf)

Cross-references

More topics: Endocrinology & cycle

Note: Learning content from the GynFuchs app (flashcards, exam questions, image cases) for medical education – not a treatment recommendation and no substitute for diagnosis or treatment decisions in individual cases. Treatment and management are deliberately not covered on this page.