ESHRE Criteria (Premature Ovarian Insufficiency)

What the result means

Under 40

The definition applies below 40 years of age. At or above it, these criteria do not apply.

Oophorectomy

Bilateral oophorectomy under 40 IS the diagnosis, and the guideline states no further testing is needed. An FSH there cannot change the answer.

Standard route

At least 4 months of amenorrhea or oligomenorrhea, with an FSH above 25 IU/L.

No cycle timing

FSH testing does not have to be timed to a particular day of the menstrual cycle - a common and costly misconception.

Hormonal therapy

Cuts both ways. It can conceal the menstrual disturbance or cause amenorrhea itself, and it lowers FSH; stop a combined oral contraceptive for 2 to 6 weeks before measuring.

Not diagnostic

Estradiol does not make the diagnosis, though a low level adds confirmation. Ultrasound is not required, and anti-Mullerian hormone should not be the primary diagnostic test.

A repeat sample

The 2016 guideline asked for two raised levels 4 weeks apart; the 2024 algorithm does not repeat that. Ovarian activity fluctuates, so a repeat stays clinically meaningful either way.