“Premature ovarian failure” (POF), sometimes termed premature menopause, is an enigmatic disorder. Although generally defined as consisting of the triad of amenorrhea (primary or secondary), hypergonadotropinism, and hypoestrogenism in women younger than forty years, it is now apparent that many affected women will ovulate and even conceive after the diagnosis is established. Thus, the name itself, implying permanent ovarian dysfunction, is actually inappropriate. In this regard, suggestions that the disorder be referred to as (primary) ovarian insufficiency, hypergonadotropic hypogonadism, or hypogonadotropic amenorrhea may be more accurate.

Definitive criteria for diagnosis have not been established. However, several groups have suggested that at least four months of amenorrhea in association with menopausal levels of gonadotropins on two or more occasions should qualify as an operational definition for the disorder (1, 2).

It has become clear that clinicians who provide reproductive care for women are likely to identify individuals with POF. Estimates of the prevalence of the disorder have varied. In one study, 7 of 300 consecutive women presenting with amenorrhea had POF (3). An estimate based on several studies concluded that 0.3 percent of reproductive-aged women (or approximately 200,000 in the United States) have POF (4). The risk of experiencing menopause prior to age forty was calculated as 0.9 percent in Rochester, Minnesota, based on 1950 data (5).

THE CLINICAL SPECTRUM OF PREMATURE OVARIAN FAILURE

We compiled data from 115 consecutive women with hypergonadotropic amenorrhea seen over a ten-year period in order to characterize the clinical presentation of affected individuals (1).