Primary Ovarian Failure

(Primary Ovarian Insufficiency, Premature Menopause)

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Primary ovarian failure (POF) is the reduction of ovarian function and/or stoppage of ovulation before menopause has started. Ovaries make certain hormones called estrogen and progesterone that affect many parts of the body. Loss or changes in these hormones can affect the health of the bones, heart, and blood vessels.

Female Reproductive Organs

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POF is caused by damage or destruction of the ovaries.

In most women, the cause is known. Other common reasons include:

Risk Factors

Factors that may increase your chances of POF:

  • Cancer treatments such as chemotherapy and radiation therapy
  • Viral infections such as mumps, tuberculosis, and malaria
  • Certain metabolic diseases, such as galactosemia
  • Family history of POF or premature menopause
  • Eating disorders


When symptoms develop, they may include:

  • Missed or irregular periods for more than 3 months
  • Difficulty having a child
  • Failure to achieve puberty
  • Hot flashes
  • Night sweats
  • Decreased interest in sex
  • Irritability
  • Difficulty sleeping
  • Vaginal dryness


You will be asked about your symptoms and medical history. A physical exam and a pelvic exam may also be done.

Tests may include:

  • Blood tests to check hormone levels
  • A pelvic ultrasound


The goal of treatment is to manage any problems caused by the change in hormones. You and your doctor can talk about the best treatment plan for you. Options include:

  • Hormone replacement therapy (HRT) or estrogen/progestogen contraceptive pills—To replace hormones until the age of natural menopause.
  • Vitamin D and calcium supplement—To support bone health and reduce the risk of osteoporosis.

Infertility is a common problem with POF. In vitro fertilization (IVF) may be an option for some who wish to have a pregnancy.

Women who are planning a procedure or treatment with a risk of POF may consider fertility preservation and family planning options before undergoing treatment. One option is to preserve healthy eggs to be used during IVF at a later date.

Women with POF may will also need to be followed for the development of other endocrine problems and heart disease.


Women with cancer should discuss treatment options with their doctors.


RESOLVE—The National Infertility Association

The American Congress of Obstetricians and Gynaecologists


Health Canada

The Society of Obstetricians and Gynecologists of Canada


Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. Obstet Gynecol. 2014;124(1):193-197. Reaffirmed 2016. Available at:

Premature ovarian failure: Premature menopause. American Pregnancy Association website. Available at: Updated August 2015. Accessed December 20, 2017.

Premature ovarian insufficiency. Patient website. Available at: Updated January 19, 2016. Accessed December 20, 2017.

Primary ovarian insufficiency (POI). EBSCO DynaMed Plus website. Available at: Updated September 29, 2017. Accessed December 20, 2017.

Primary ovarian insufficiency (POI). National Institute of Child Health and Human Development website. Available at: Updated December 1, 2016. Accessed December 20, 2017.

Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Last updated: 12/20/2017