Causes

In women with a diagnosis of premature ovarian insufficiency (POI), there should be consideration for the underlying cause. The underlying cause may be primary or secondary, although the majority of cases are idiopathic (85-90%).

PRIMARY:

• Genetic: chromosome abnormalities. The majority of cases are linked with the X chromosome such as FMR1 pre-mutations, Turners syndrome and Fragile X.
• Enzyme deficiencies.
• Autoimmune diseases.
• FSH receptor polymorphism.
• Idiopathic.

SECONDARY:

• Chemotherapy and radiotherapy.
• Bilateral oophorectomy or surgical menopause.
• Hysterectomy with ovarian conservation.
• Endometriosis involving the ovaries.
• Uterine artery embolisation.
• Mumps oophoritis.
• Some studies suggest age at menopause may be lower in HIV positive women. This observation, however, does not show that HIV causes POI. The lower age may be explained by other factors, such as low body weight.
• There is limited evidence on the effect of smoking on the risk of POI. However, studies have suggested an association between smoking and early menopause.

For information on how to diagnose premature ovarian insufficiency (POI) see diagnosis section.