Laboratory investigations (see Table: Laboratory investigations) are necessary to establish the diagnosis, determine aetiology and screen for complications.
The diagnostic criteria for premature ovarian failure (POF) includes greater than 4 months of amenorrhoea and FSH levels >40IU/L on two separate occasions at least one month apart with exclusion of secondary causes of amenorrhoea (see Table: Causes of secondary amenorrhoea).
Measurement of gonadotrophins (LH and FSH) must be performed in the absence of any exogenous hormone therapy (oral contraceptive pill (OCP) should be ceased at least one month prior) otherwise the results will be uninterpretable.
At present there is no test able to predict premature menopause. Studies assessing ovarian reserve during assisted reproduction indicate that women with higher early follicular phase levels of FSH, low serum inhibin B and lower antral follicle count (number of eggs visible on ultrasound) have a poorer response to ovulation induction and an increased risk of premature menopause / early menopause.
Other hormonal and biophysical markers, such as anti-mullerian hormone and ovarian stromal blood flow respectively, remain as research tools. Progesterone withdrawal test, ovarian antibody determination and ovarian biopsy are not routinely performed. Transvaginal or pelvic ultrasound may be useful to exclude outflow obstruction, detect follicles, assess the endometrium and ovarian volume. The presence of ovarian follicles has been reported in 30-50% of women with spontaneous karyotypically normal POF with evidence of intermittent ovarian function. Streak gonads (undifferentiated gonadal tissue) may be observed in patients with gonadal dysgenesis.