Evidence-based guideline: premature ovarian insufficiency^†‡

Area of Science:

• Reproductive Endocrinology
• Women's Health
• Clinical Guidelines

Background:

• Premature/primary ovarian insufficiency (POI) significantly impacts women's physical and emotional health, affecting quality of life, fertility, and long-term health (bone, cardiovascular, cognitive).
• Optimal management of POI remains a challenge, despite hormone therapy (HT) offering some mitigation of adverse effects.

Purpose of the Study:

• To provide evidence-based recommendations for the diagnosis and management of premature/primary ovarian insufficiency (POI).
• To update clinical practice guidelines for healthcare professionals caring for women with POI, incorporating new evidence and expanded clinical questions.

Main Methods:

• Development of the guideline followed the European Society of Human Reproduction and Embryology (ESHRE) methodology, including expert consensus and literature review up to January 2024.
• Key questions were informed by a survey of women and healthcare professionals; recommendations were formulated and refined through consensus, with input from women with lived experience of POI.

Main Results:

• The updated guideline addresses 40 clinical questions on POI diagnosis, sequelae (bone, cardiovascular, neurological, sexual function, fertility, well-being), and treatments, including HT.
• Key changes include requiring only one elevated follicle stimulating hormone (FSH) >25 IU/L for POI diagnosis, guidance on anti-Müllerian hormone (AMH) testing, and updated recommendations on genetic testing, estrogen/contraceptive use, and testosterone therapy.
• New topics include fertility preservation, muscle health, iatrogenic POI management, and expanded complementary/non-hormonal treatments and lifestyle management.

Conclusions:

• This guideline provides clear, evidence-based advice for best practice in POI care, aiming to improve outcomes for affected women.
• It highlights areas where evidence is limited and provides research recommendations to guide future studies in POI management.