To compare body composition between women with premature ovarian insufficiency (POI) using hormone therapy and controls with normal ovarian function, and to correlate body composition with cardiovascular risk markers in the POI group.A case-control study of 70 women with POI matched by age and body mass index with 70 controls.All were submitted to whole body dual-energy x-ray absorptiometry (DXA) to analyze body composition. In the POI group, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, triglycerides, glucose, insulin, transaminases and C-reactive protein levels were measured, as well as the thickness of the carotid artery intima-media complex.Total mass, fat mass, lean mass (total, percentage and index), and the android/gynoid (A/G) ratio were similar in both groups; however, bone mineral content was lower (p<0.001) in the POI group. Lean and fat mass indexes were 14.19±1.63 and 11.04±3.58, respectively, and the percentage of gynoid to android fat was higher (51.17±6.71% versus 47.74±9.19%; A/G ratio=0.93±0.15) in the POI group. In addition, the increase in total mass correlated positively with glucose and ALT levels and negatively with HDL-cholesterol. Increased A/G ratio was the measurement most frequently associated with cardiovascular risk markers.The body composition of women with POI using hormone therapy is similar to that of women with normal ovarian function with regard to lean and fat mass content and fat distribution. In women with POI, the higher the A/G ratio, the worse the cardiovascular risk markers.