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Practice Clinical Updates

Premature ovarian insufficiency

BMJ 2024; 384 doi: (Published 20 March 2024) Cite this as: BMJ 2024;384:e077469
  1. Zachary Nash, clinical research fellow1 2,
  2. Melanie Davies, consultant gynaecologist, professor of reproductive medicine12
  1. 1University College London Hospitals, London, UK
  2. 2EGA Institute for Women’s Health, University College London
  1. Correspondence to Z Nash z.nash{at}

What you need to know

  • Diagnosis of premature ovarian insufficiency (POI) is based on menstrual disturbance and raised follicle stimulating hormone in women under 40

  • Untreated POI affects quality of life and increases long term risk of cardiovascular disease, osteoporosis and fracture, and slightly reduces life expectancy

  • Women with POI should receive hormone therapy and lifestyle advice

  • POI is associated with infertility, and egg donation may be needed

  • Refer women with a diagnosis of POI to a specialist service to manage their physical, psychological, and reproductive health

Premature ovarian insufficiency (POI) is defined as menopause before the age of 40 (two standard deviations below the average age of menopause).123 It is also known as premature menopause or primary ovarian insufficiency, but POI is the preferred term.1 Premature is preferred to primary to avoid confusion with primary amenorrhoea and to highlight the age of onset. Insufficiency is preferred to failure to reflect possible fluctuation in ovarian function and to avoid negative connotations.1

The prevalence of POI has historically been estimated at 1-3% in high income countries based on data from cohort studies.45 A recent meta-analysis of 31 studies estimated the global prevalence of POI to be 3.7% (95% confidence interval (CI) 3.1% to 4.3%) with a higher prevalence in middle and low income countries.6

POI affects wellbeing,13 fertility,13 and if untreated is associated with lower bone mineral density (BMD) and increased risk of osteoporosis,7 cardiovascular disease,8910 possibly dementia (in women with POI after surgical menopause)11 as well as overall increased all-cause mortality.12 This article summarises the diagnosis and management of POI, with reference to guidelines from the UK National Institute for Health and Care Excellence (NICE),2 International Menopause Society (IMS),3 and the European Society of Human …

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