Menopause guideline appraisal and algorithm development for premature ovarian insufficiency

Area of Science:

• Medical Guidelines
• Women's Health
• Endocrinology

Background:

• Clinical practice guidelines (CPGs) are essential for evidence-based healthcare.
• Menopause management CPGs aim to standardize clinical decision-making.
• The quality and consistency of these guidelines, particularly for early menopause (EM) and premature ovarian insufficiency (POI), require systematic evaluation.

Purpose of the Study:

• To systematically evaluate the quality of menopause management CPGs.
• To identify key menopause topics covered within these guidelines.
• To develop EM/POI management algorithms based on high-quality CPG recommendations.

Main Methods:

• A systematic literature search identified CPGs published between 2012 and 2017.
• The Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument was used by four independent reviewers to assess guideline quality.
• Inter-rater reliability was calculated, and recommendations for EM/POI were extracted to formulate management algorithms.

Main Results:

• Twenty-two CPGs were reviewed, with only two deemed high quality; ten were average and ten were low quality.
• Scope and purpose, and clarity of presentation scored highest, while applicability scored lowest.
• The National Institute for Health and Care Excellence (NICE), International Menopause Society (IMS), and European Menopause and Andropause Society (EMAS) produced the most comprehensive guidelines.

Conclusions:

• The majority of menopause CPGs exhibit poor to average quality, indicating a need for improvement.
• There is considerable variability in recommendations for managing early menopause (EM) and premature ovarian insufficiency (POI).
• Management algorithms for EM/POI were successfully developed from the highest-scoring CPGs.