The etiology of premature ovarian insufficiency (POI) is complex, involving genetic factors, autoimmune factors, iatrogenic factors, environmental factors and unhealthy lifestyle, etc. Among genetic factors, chromosomal abnormality and single gene mutation are the main causes of the disease. Autoimmune factors play an important role in the pathogenesis of POI, and common diseases include autoimmune thyroid disease, autoimmune adrenal disease, etc. Iatrogenic factors are mainly ovarian damage caused by chemotherapy, radiotherapy or surgery. Environmental factors (such as environmental endocrine-disrupting chemicals) and unhealthy lifestyle (such as smoking) are also closely related to the occurrence of POI. Idiopathic POI refers to POI with unknown etiology, which may be related to polygenic mutations, epigenetic modifications and environmental-gene interaction. In clinical practice, strengthening multidisciplinary collaboration and early screening are essential to improve the prognosis of POI patients. This paper reviews the etiology of POI combined with recent research progress, so as to provide a reference for reducing the onset risk of POI and improving the quality of life in patients.

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