HCPs should diagnose POI based on the presence of spontaneous amenorrhea or irregular menstrual cycles and biochemical confirmation.	STRONG ⊕⊕◯◯
The guideline group recommends the following diagnostic criteria: disordered menstrual cycles (spontaneous amenorrhea or irregular menstrual cycles) for at least 4 months and an elevated FSH concentration > 25 IU/l. FSH assessment should be repeated after 4–6 weeks if there is diagnostic uncertainty. FSH testing for the diagnosis of POI does not have to be timed to a specific day of the menstrual cycle.	GPP
The guideline group recommends that HCPs consider these points when diagnosing POI: Pregnancy should be excluded in women presenting with amenorrhea. Use of hormonal therapy (including oral, injectable, or long-acting contraceptives) may conceal or cause amenorrhea or irregular menstrual cycles, and potentially lower FSH concentrations. Some hormonal therapy (e.g. combined oral contraceptive) may need to be ceased before a diagnosis of POI can be confirmed. Women who had bilateral salpingo-oophorectomy (BSO) before age 40 have a diagnosis of POI, and additional diagnostic testing is unnecessary.	GPP
The guideline group does not recommend diagnosing POI based on serum estradiol concentrations. However, a low estradiol concentration indicates hypoestrogenism, and in combination with an elevated FSH concentration, provides additional confirmation of the POI diagnosis.	GPP