Synopsis
Identify ovarian and central oestrogen deficiency early, establish the cause and fertility implications, and provide physiological sex-steroid replacement that protects bone, cardiovascular and genitourinary health.
- Female hypogonadism means inadequate ovarian sex-steroid action from ovarian failure, deficient hypothalamic-pituitary stimulation or treatment-related suppression; amenorrhoea is a presentation, not the complete diagnosis.
- Premature ovarian insufficiency is ovarian dysfunction before age 40 with disordered cycles and biochemical evidence; ovarian activity may be intermittent, so the term does not mean irreversible absence of every ovulation.
- NICE advises against diagnosing POI from one blood test and uses two elevated FSH results obtained four to six weeks apart after clinical assessment; hormonal treatment can make the tests uninterpretable.
Key red flags
Headache, visual field loss, diplopia, galactorrhoea, polyuria or additional cortisol and thyroid deficits suggests sellar disease; abrupt severe symptoms may represent apoplexy.
Investigation priorities
Exclude pregnancy before interpreting amenorrhoea or prescribing replacement and progestogen.
Management branches
Disordered cycles or oestrogen-deficiency symptoms before age 40 with no physiological explanation.
- Exclude pregnancy, record hormonal treatment, surgery, cancer therapy, autoimmune and family history, and assess pubertal development, vasomotor, genitourinary and fertility concerns.
- Obtain FSH on two occasions four to six weeks apart under current NICE guidance, with oestradiol, LH, thyroid and prolactin as clinically useful.
Key medicines
Transdermal oestradiolUse the licensed patch or gel regimen titrated to physiological replacement and symptom control through specialist guidance.
Oral micronised progesterone or alternative progestogenGive continuously or cyclically in the licensed or specialist regimen matched to systemic oestrogen exposure.