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Initial laboratory evaluation for suspected primary ovarian insufficiency includes measurements of basal FSH and basal estradiol levels and tests to rule out causes such as pregnancy, thyroid disease, and hyperprolactinemia. Gonadotropin and estradiol values may be altered by concomitant use of hormonal preparations and thus should only be obtained in patients who are not taking hormonal medications, including OCs. If gonadotropins are elevated into the menopausal range (typically, basal FSH levels will be greater than 30–40 mIU/mL, depending on the laboratory used), a repeat FSH measurement is indicated in 1 month. If the result indicates that FSH is elevated, a diagnosis of primary ovarian insufficiency can be established. Estradiol levels of less than 50 pg/mL indicate hypoestrogenism.

Surrogate markers of ovarian reserve (presence of regular menses, serial serum estradiol levels, and antral follicle count by transvaginal ultrasonography) are highly variable and are not predictive of future fertility or hormonal production in young women who have undergone treatment for cancer PubMed] “>6 PubMed] “>7, but are currently undergoing investigation.