Evidence-based guideline: premature ovarian insufficiency

Area of Science:

• Reproductive Endocrinology and Women's Health
• Clinical Guideline Development
• Evidence-Based Medicine

Background:

• Premature 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 the benefits of hormone therapy (HT), highlighting the need for updated clinical guidance.

Purpose of the Study:

• To provide evidence-based recommendations for the diagnosis and management of premature ovarian insufficiency (POI).
• To update healthcare professionals on best practices for POI care, incorporating new research and clinical insights.

Main Methods:

• Development of a guideline following ESHRE methodology, involving expert consensus and informed by surveys of women with POI and healthcare professionals.
• Comprehensive literature searches up to January 2024, including integrity reviews of randomized controlled trials (RCTs) on POI.
• Formulation of recommendations through discussion and consensus, with input from women with lived experience and stakeholder reviews.

Main Results:

• Identified a higher prevalence of POI (3.5%) than previously estimated.
• Updated recommendations include simplified diagnostic criteria (one elevated FSH >25 IU/L), guidance on AMH testing, and updated information on fertility preservation, HT, and complementary treatments.
• Expanded clinical questions cover diagnosis, sequelae (bone, cardiovascular, neurological, sexual function, well-being), and treatment options, including specific considerations for iatrogenic POI.

Conclusions:

• The guideline provides 145 clear, best-practice recommendations for POI care based on current evidence.
• Acknowledges limited supporting evidence for many management options, emphasizing the need for clinical judgment.
• Includes research recommendations to guide future studies in POI.