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    Under 40 years
    • 12 Dec 2023
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    Under 40 years

    • Updated on 12 Dec 2023
    • 1 Minute to read
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    Article summary

    NICE says diagnose premature ovarian insufficiency (POI) based on:

    • Age <40 years.
    • Menopause symptoms including no or infrequent periods (consider whether the person has had a hysterectomy).
    • Elevated FSH levels (>30IU/L) on two blood samples taken 4–6 weeks apart. If there are still periods, these blood tests should be taken on day 2-3 of the cycle.
    • Do not diagnose POI on a single blood test.
    • Additional testing of serum LH, estradiol, prolactin, testosterone and TSH levels may be helpful for the diagnostic workup.
    • Do not routinely use anti-Müllerian hormone to diagnose POI.
    • Consider the woman’s history, for example, previous medical, surgical or family history when diagnosing POI.

    NICE states FSH levels should not be checked in a woman using HRT, combined contraception or a high dose progestogen. For more information see section use of FSH levels.

    NOTE:
    • Diagnosis can be more difficult in women using hormone treatments or in women with a prior history of endometrial ablation or hysterectomy. These women will have altered or absent bleed patterns. For more information see flowchart in: The 2023 Practitioners Toolkit for Managing Menopause on page 7.
    • If in doubt, refer to a menopause specialist.
    References and Further Information:
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