Evidence-based guideline: Premature Ovarian Insufficiency

Area of Science:

• Reproductive Endocrinology
• Women's Health
• Clinical Guidelines

Background:

• Premature ovarian insufficiency (POI) significantly impacts women's physical and emotional well-being, 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.
• The prevalence of POI is now estimated at 3.5%, highlighting its importance in women's health.

Purpose of the Study:

• To provide evidence-based recommendations for the diagnosis and management of premature ovarian insufficiency (POI).
• To update clinical practice guidelines for healthcare professionals caring for women with POI.
• To address emerging knowledge and clinical questions in POI, including fertility preservation and specific treatment considerations.

Main Methods:

• Development of ESHRE guidelines using structured methodology, including expert consensus and literature review up to January 30, 2024.
• Scoping survey of women with POI and healthcare professionals to inform key clinical questions.
• Inclusion of women with lived experience to guide recommendations on care provision.

Main Results:

• The updated guideline includes 145 recommendations covering 40 clinical questions on POI diagnosis, sequelae (bone, cardiovascular, neurological, sexual function), fertility, and treatment.
• Key changes include requiring only one elevated FSH >25 IU/L for POI diagnosis and guidance on AMH testing for diagnostic uncertainty.
• Updated recommendations cover genetic testing, hormone therapy (HT) doses and regimens, oral contraceptives, and testosterone therapy; complementary and non-hormonal treatments are also expanded.

Conclusions:

• The guideline offers clear, best-practice advice for POI care based on available evidence, though evidence supporting many management options is limited.
• It provides a framework for healthcare professionals to improve care for women with POI.
• The guideline also identifies research priorities to advance understanding and treatment of POI.