A 28-year-old woman has not menstruated for 8 months. Investigations show FSH 78 IU/L, LH 65 IU/L, estradiol 22 pmol/L, and normal TSH/prolactin. What is the MOST likely diagnosis?

• A Hypothalamic amenorrhoea (functional)
• B Premature ovarian insufficiency (POI) ✓
• C Hyperprolactinaemia
• D Polycystic ovary syndrome

Explanation

Premature ovarian insufficiency (POI) is defined as loss of normal ovarian function before age 40, characterised by hypergonadotrophic hypogonadism: elevated FSH (> 25–40 IU/L on two measurements at least 4 weeks apart) with low estradiol and amenorrhoea for ≥ 4 months. This patient's FSH of 78 IU/L with very low estradiol confirms ovarian failure. PCOS causes low/normal FSH with elevated LH. Hypothalamic amenorrhoea causes low/normal FSH and LH.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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