Premature ovarian insufficiency: Evidence-practice gaps and key management challenges among clinicians

Premature ovarian insufficiency (POI) carries substantial long-term health risks, yet clinical practice regarding management of the condition varies widely, and relevant research data is scarce. This study evaluated physicians' knowledge and diagnostic and management practices of POI patients, and assessed their alignment with international recommendations.

A cross-sectional electronic survey was conducted among practising physicians in the United Arab Emirates between February and October 2025, including primary care physicians and relevant specialists who may encounter women with symptoms suggestive of premature ovarian insufficiency or be involved in their diagnosis and management. The structured questionnaire evaluated diagnostic approaches based on British Menopause Society guidance, as well as management, follow-up practices, and adherence to recent international clinical guidelines. A total of 411 responses were analysed, and associations between categorical variables were examined using chi-square analysis, with statistical significance set at p ≤ 0.05.

Respondents identified multiple symptoms of varying relevance to premature ovarian insufficiency to raise diagnostic suspicion, most frequently reporting amenorrhea and hot flashes (84.9%, 78%0.6, respectively), with 92 % recognising more than one symptom. However, only 20.4% applied current evidence-based criteria to confirm the diagnosis. At initial assessment, fewer than half evaluated urogenital and sexual symptoms. Specialists initiated hormone therapy more often than primary care physicians (65.2% vs 29.2%, p < 0.001). Broader aspects of care were inconsistently implemented: only 55.4% recommended baseline bone mineral density screening using dual-energy X-ray absorptiometry, and fewer than half routinely referred women for psychological support despite 79.3% reporting encountering frequent psychological distress. Moreover, 8% indicated they would prescribe hormone therapy for patients with a history of breast cancer, and 21% would prescribe it in "certain types". One-third of respondents endorsed non-evidence-based, potentially ineffective or unsafe interventions, including natural vitamins, traditional medicine, platelet-rich plasma, and stem cell therapy.

The findings of this study reveal a significant gap between the current evidence-based management of premature ovarian insufficiency and clinical practice. This highlights the need for targeted professional education to ensure safe and effective care for this group of young women.