Primary Ovarian Insufficiency

Primary ovarian insufficiency (POI), affecting ~1% of women under 40, is marked by amenorrhea, elevated FSH, and hypoestrogenism, leading to infertility and long term health risks (e.g., osteoporosis, cardiovascular disease). This clinical review outlines diagnostic criteria confirmed by two elevated FSH and low estradiol measurements and emphasizes identifying underlying causes (genetic, autoimmune, iatrogenic, or idiopathic). Key management strategies include:

1. Psychological support for distress over infertility.

2. Hormone replacement therapy (HRT) at higher doses than postmenopausal regimens, continued until the average age of natural menopause (e.g., transdermal estradiol 100–150 µg/day with cyclical progesterone).

3. Contraception counseling, as spontaneous ovulation occurs in 5–10% of cases.

Primary ovarian insufficiency (POI), affecting ~1% of women under 40, is marked by amenorrhea, elevated FSH, and hypoestrogenism, leading to infertility and long term health risks (e.g., osteoporosis, cardiovascular disease). This clinical review outlines diagnostic criteria confirmed by two elevated FSH and low estradiol measurements and emphasizes identifying underlying causes (genetic, autoimmune, iatrogenic, or idiopathic). Key management strategies include:

1. Psychological support for distress over infertility.

2. Hormone replacement therapy (HRT) at higher doses than postmenopausal regimens, continued until the average age of natural menopause (e.g., transdermal estradiol 100–150 µg/day with cyclical progesterone).

3. Contraception counseling, as spontaneous ovulation occurs in 5–10% of cases.