Premature ovarian insufficiency (failure) is defined when ovarian failure occurs before the age of forty.

It occurs in about 1% of the female population. During Intrauterine life either there is failure of germ cell migration or there may be normal germ cell migration but an accelerated rate of germ cell depletion (apoptosis) due to various reasons (see below). This results in either no follicle or only few follicles left behind in the ovary by the time they reach puberty.



(i) Turner’s syndrome (45X0), (45X/46XX),

(ii) Gonadal dysgenesis 46XX, 46XY,

(iii) Trisomy 18 and 13,

(iv) X-chromosome deletion, translocation.


(i) Autoantibodies: antinuclear antibodies

(ANA), Lupus anticoagulant,

(ii) Polyglandular autoimmune syndrome (antibodies against thyroid, parathyroid, adrenal, islet cells of pancreas).

  • Infections: Mumps, tuberculosis.
  • Iatrogenic: Radiation therapy, Chemotherapy (cyclophosphamide), Surgery.
  • Metabolic: Galactosemia, 17α hydroxylase deficiency.

In galactosemia, the enzyme galactose-1-phosphate uridyl

transferase is absent. Follicles are destroyed to the toxic

effects of galactose.

  • Environmental: Smoking.
  • FSH receptor absent or postreceptor defect (Savage’s syndrome).
  • Idiopathic


  • History of amenorrhea in less than 35 years of age.
  • Serum gonadotropin level (FSH > 40 mIU/ml) is high.
  • Serum E2
  • level is low (< 20 pg/ml).
  • Karyotype abnormality (see above).
  • Organ specific humoral antibody (antithyroid commonest).
  • Ovarian biopsy (afollicular, follicular and autoimmune variety) is not essential to the diagnosis. In autoimmune variety, there is perifollicular lymphocyte infiltration. In resistant ovarian syndrome, follicles are present. FSH receptor is either absent or defective.
  • Patient presents with amenorrhea — primary (25%) or secondary (75%). Features of hypoestrogenic state like hot flushes, vaginal dryness, dyspareunia and psychological symptoms are there.
  • The possibility of autoimmune disorders should be considered below the age of 35. For this, antithyroid antibodies, rheumatoid factor and antinuclear antibodies should be measured.
  • In younger patients (age below 30) karyotype is to be done to rule out chromosomal abnormality.


Sepia:- One of the top remedies for managing anovulation. The menstrual symptom is late and scanty menses. In most cases, this is accompanied by bearing down sensation in the Pelvic region. The ovaries remain enlarged with fluid filled cysts in them.

Pulsatilla:- Specially beneficial for managing PCOS cases in females who suffer from suppressed periods for a long duration. The physical general symptoms include total absence of thirst and a desire for open cool air.

Calcarea carb:- It is of great help in managing anovulation and is particularly suited when a women suffers from profuse periods that are prolonged.

Natrum Mur:- Should be considered for women with difficulty in conception due to PCOS. The important symptoms are excessively hot sensation, aversion to heat of sun, and craving for extra salt in the diet.

Thuja Occidentalis:- When the woman suffers from retarded menstrual flow with cysts in ovaries. Thuja has the innate ability to dissolve abnormal growth or accumulation anywhere in the body.

Kali carb:- Very beneficial medicine for anovulation when the menses are suppressed altogether for several months. Backs and legs give out. Violent backache, relieved by sitting and pressure.