Premature ovarian failure


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Premature ovarian failure


Adrenal gland disorders

Congenital adrenal hyperplasia

Primary adrenal insufficiency

Waterhouse-Friderichsen syndrome


Adrenal cortical carcinoma

Cushing syndrome

Conn syndrome

Thyroid gland disorders

Thyroglossal duct cyst


Graves disease

Thyroid eye disease (NORD)

Toxic multinodular goiter

Thyroid storm


Euthyroid sick syndrome

Hashimoto thyroiditis

Subacute granulomatous thyroiditis

Riedel thyroiditis

Postpartum thyroiditis

Thyroid cancer

Parathyroid gland disorders





Pancreatic disorders

Diabetes mellitus

Diabetic retinopathy

Diabetic nephropathy

Pituitary gland disorders


Pituitary adenoma






Growth hormone deficiency

Pituitary apoplexy

Sheehan syndrome


Constitutional growth delay

Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Gonadal dysfunction

Precocious puberty

Delayed puberty

Premature ovarian failure

Polycystic ovary syndrome

Androgen insensitivity syndrome

Kallmann syndrome

5-alpha-reductase deficiency

Polyglandular syndromes

Autoimmune polyglandular syndrome type 1 (NORD)

Endocrine tumors

Multiple endocrine neoplasia

Pancreatic neuroendocrine neoplasms

Zollinger-Ellison syndrome

Carcinoid syndrome



Opsoclonus myoclonus syndrome (NORD)

Endocrine system pathology review

Adrenal insufficiency: Pathology review

Adrenal masses: Pathology review

Hyperthyroidism: Pathology review

Hypothyroidism: Pathology review

Thyroid nodules and thyroid cancer: Pathology review

Parathyroid disorders and calcium imbalance: Pathology review

Diabetes mellitus: Pathology review

Cushing syndrome and Cushing disease: Pathology review

Pituitary tumors: Pathology review

Hypopituitarism: Pathology review

Diabetes insipidus and SIADH: Pathology review

Multiple endocrine neoplasia: Pathology review

Neuroendocrine tumors of the gastrointestinal system: Pathology review


Premature ovarian failure


0 / 9 complete

USMLE® Step 1 questions

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High Yield Notes

9 pages


Premature ovarian failure

of complete


USMLE® Step 1 style questions USMLE

of complete

A 35-year-old woman comes to the office with complaints of irregular menstruation. She has had only two periods in the last year. Menarche was at age 12, and she had a regular menstrual cycle until 12 months ago. The patient also reports feeling flushed at night without provocation and experiencing occasional dyspareunia with post-coital spotting. Past medical history is noncontributory. Temperature is 36.9°C (98.5°F), pulse is 70/min, respirations are 13/min, and blood pressure is 118/76 mmHg. Cardiopulmonary and abdominal exams are unremarkable. The patient has Tanner stage V breasts and pubic hair. Pelvic examination reveals a small anteverted uterus and minimal vaginal rugations. Abdominal examination is within normal limits. Urine pregnancy test is negative. Serum TSH is 3.2 µU/mL. Which of the following set of hormonal changes will most likely be observed in this patient?

External References

First Aid








Estrogen p. 654, 680

premature ovarian failure p. 652, 669

Follicle-stimulating hormone (FSH)

premature ovarian failure p. 652, 669

Luteinizing hormone (LH)

premature ovarian failure p. 652, 669

Premature ovarian failure p. 652, 669

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Content Reviewers

Rishi Desai, MD, MPH


Antonia Syrnioti, MD

Sarah Clifford, BMBS, BSc (Hons)

In premature ovarian failure, which is also called primary ovarian insufficiency, the ovaries stop functioning normally, and this means that they stop ovulating, or releasing egg cells, and they also stop producing hormones, mainly estrogen and progesterone, and this all happens before a woman is 40 years old. It’s considered a “primary” problem because the problem is with the ovaries themselves, rather than glands or hormones that act on the ovaries.

Normally, the hypothalamus, which is located at the base of the brain, secretes gonadotropin-releasing hormone, or GnRH. GnRH makes the nearby pituitary gland secrete two hormones of its own, called gonadotropins. These are follicle stimulating hormone, or FSH, and luteinizing hormone, or LH. These hormones travel to the follicles within the ovaries. The follicles are small clusters of granulosa and theca cells that protect the developing egg cell.

FSH acts on the granulosa cells, making the follicles grow and mature, as well as secrete estrogen, while LH stimulates theca cells to secrete progesterone and small amounts of androstenedione, which is a precursor of testosterone. All three of these hormones belong to a class of steroids, or lipid-soluble hormones.

At birth, a woman has millions of follicles, each ready and excited to do its job. During puberty, the monthly menstrual and ovarian cycles begin, which is when the endometrium, or inner lining of the uterus, goes through cyclic changes in response to the ovarian hormones.

During the ovarian cycle, the ovarian hormones also help a handful of follicles to start growing. Eventually, there’s ovulation which is when a single follicle fully matures and ruptures, releasing its egg cell, while the other follicles degenerate and die off.


Premature ovarian failure (POF) is a condition in which a woman's ovaries stop functioning before age 40. This can lead to symptoms that mimic menopause, but some women with intermittent ovarian function are still able to spontaneously get pregnant. Some cases of POF are attributed to autoimmune disorders, others to genetic disorders such as Turner syndrome and Fragile X syndrome. Symptoms of POF can include irregular or absent menstrual periods, hot flashes, night sweats, vaginal dryness, and reduced fertility. Treatment involves the replacement of the hormones that the ovaries have stopped producing, especially estrogen and progesterone. For women who struggle with infertility, in-vitro fertilization can be used.


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  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
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  5. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  6. "Premature ovarian insufficiency (POI) and autoimmunity-an update appraisal" Journal of Assisted Reproduction and Genetics (2019)
  7. "Primary ovarian insufficiency: a more accurate term for premature ovarian failure" Clinical Endocrinology (2008)

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