To describe the etiology of hypergonadotropic amenorrhea (HA) and outline the subgroup of infertile women that might achieve pregnancy with their own eggs despite premature ovarian failure. In this retrospective study we enrolled 70 women aged 32.5 +/- 5.71 years. After a detailed history of the disease, measurements of follicle-stimulating hormone, estradiol, prolactin and thyroid-stimulating hormone levels, determination of the karyotype and fragile X premutation syndrome, and a quick ACTH test, estrogen-progestin replacement therapy was introduced. In 17 of the 70 women, HA was due to chromosomal abnormalities, in 16 to extensive gynecologic surgery, in ten to oral contraceptive use, in four to chemo- and radiotherapy; in 23 HA was idiopathic. After estrogen-progestin replacement therapy, three women with idiopathic HA conceived and delivered healthy babies. Estrogen-progestin replacement therapy in pharmacological doses might be beneficial to women with idiopathic HA, having normal prolactin levels, adrenal and thyroid function, and a normal karyotype.