According to current diagnostic criteria for premature ovarian insufficiency (POI), which combination establishes the diagnosis?

• A FSH above 10 IU/L on a single occasion in a woman under 40 years with oligomenorrhoea
• B Estradiol below 50 pg/mL with LH above 10 IU/L on one occasion before age 40 years
• C AMH below 1 ng/mL on a single occasion in a woman under 35 years
• D Menstrual disturbance of at least 4 months with FSH above 25 IU/L on two occasions at least 4 weeks apart, before age 40 years ✓

Explanation

POI is defined as loss of ovarian activity before age 40 years, diagnosed by at least 4 months of menstrual disturbance plus FSH above 25 IU/L measured on two separate occasions at least 4 weeks apart. A single FSH estimation is insufficient because levels fluctuate during the menopausal transition. AMH supports assessment but is not a standalone diagnostic criterion.

Reference: Williams Gynecology, 3rd ed.

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