Diagnosis of primary ovarian insufficiency

COCs: combined estrogen-progestin oral contraceptives; hCG: human chorionic gonadotropin; TSH: thyroid-stimulating hormone; PRL: prolactin; FSH: follicle-stimulating hormone; E2: estradiol; POI: primary ovarian insufficiency; PMW: postmenopausal women.
* If patient is having menses, draw labs on day 3 of a cycle (important for FSH); if not, draw labs on a random day.
¶ Low/normal FSH and E2 can be seen in women with functional hypogonadotropic hypogonadism/functional hypothalamic amenorrhea. However, hot flashes are very uncommon in this population. This same FSH/E2 pattern may be seen in women with POI who have recently ovulated. If intermittent menstrual dysfunction and/or hot flashes persist, POI is likely, and can be confirmed with repeat labs. Refer to UpToDate content on primary ovarian insufficiency and functional hypothalamic amenorrhea.
Δ Criteria for POI diagnosis: FSH >25 IU/L on 2 measurements, irregular menses for greater than 4 months, without another endocrine disorder (thyroid disease, hyperprolactinemia). Of note, some women with POI first present with infertility. Refer to related UpToDate content on primary ovarian insufficiency.