Premature Ovarian Failure

Abstract

Premature ovarian failure (POF) is the condition of hypergonadotropic, hypoestrogenic oligomenorrhea or secondary amenorrhea lasting for greater than 6 months that occurs in women after menarche and before 40 years of age. A serum follicle-stimulating hormone (FSH) level greater than 40 mIU/ml on two occasions drawn more than 1 month apart defines the hypergonadotropic state. Premature ovarian failure occurs in 1/100 women before the age of 40 and in 1/1000 women before the age of 30. In developed countries, 4–18% of women with secondary amenorrhea will be diagnosed with POF and 10–28% of women with primary amenorrhea will have POF, although these are probably underestimates of the true incidence of this condition. In the past, the absence of ovarian follicles on an ovarian biopsy was necessary for the diagnosis of POF. However, it has been shown that 40–60% of women who meet the criteria noted above still have ovarian follicles visible on ultrasound. A pregnancy rate of up to 4.8% has also been reported in women with the diagnosis of POF. Therefore, it has been proposed that a more appropriate term for this condition might be premature ovarian dysfunction, signifying a premature decline, rather than a failure in ovarian function, below the limit associated with fertility and steroidogenesis.