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Premature ovarian insufficiency (POI) is a harmful disease that leads to decreased fertility and osteoporosis and an increased risk of cardiovascular disease. POI seriously affects women's physical and mental health. Currently, the incidence of POI is rising; however, the etiology of most cases remains unclear, and these cases are referred to as idiopathic POI. Understanding the risk factors for idiopathic POI is beneficial for preventing and recognizing POI early on, as well as for improving treatment outcomes. This paper describes the etiology and pathogenesis of idiopathic POI from five perspectives: genetic and familial factors; environmental factors (including endocrine-disrupting chemicals, persistent organic pollutants, and heavy metals); gut microbial disorders; lifestyle factors (including smoking, diet, physical activity, and pathological sleep); and psychological and social factors. Furthermore, this review discusses the interactions among these risk factors and provides clinical prevention recommendations. This study aims to improve clinical diagnosis and treatment of idiopathic POI and women's health.