Evidence-based guideline: premature ovarian insufficiency

• Published in: Climacteric : the journal of the International Menopause Society 2024-12, Vol.27 (6), p.510-520
• Main Authors: Panay, Nick, Anderson, Richard A, Bennie, Amy, Cedars, Marcelle, Davies, Melanie, Ee, Carolyn, Gravholt, Claus H, Kalantaridou, Sophia, Kallen, Amanda, Kim, Kimberly Q, Misrahi, Micheline, Mousa, Aya, Nappi, Rossella E, Rocca, Walter A, Ruan, Xiangyan, Teede, Helena, Vermeulen, Nathalie, Vogt, Elinor, Vincent, Amanda J
• Format: Article
• Language: English
• Subjects: Evidence-Based Medicine; Female; Fertility; Humans; Medical personnel; Ovaries; Practice Guidelines as Topic; Primary Ovarian Insufficiency - therapy; Quality of Life
• ISSN: 1369-7137; 1473-0804; 1473-0804
• DOI: 10.1080/13697137.2024.2423213

How should premature/primary ovarian insufficiency (POI) be diagnosed and managed, based on the best available evidence from published literature? The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI. POI presents a significant challenge to women's health, with far-reaching implications, both physically and emotionally. The potential implications include adverse effects on quality of life, on fertility and on bone, cardiovascular and cognitive health. Although hormone therapy (HT) can mitigate some of these effects, many questions still remain regarding the optimal management of POI. The guideline was developed according to the structured methodology for development of European Society of Human Reproduction and Embryology (ESHRE) guidelines. Key questions were determined by a group of experts and informed by a scoping survey of women and healthcare professionals. Literature searches and assessment were then performed. Papers published up to 30 January 2024 and written in English were included in the guideline. An integrity review was conducted for the randomized controlled trials on POI included in the guideline. Based on the collected evidence, recommendations were formulated and discussed within the guideline development group until consensus was reached. Women with lived experience of POI informed the recommendations in general, and particularly those on provision of care. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline development group and the ESHRE Executive Committee. New data indicate a higher prevalence of POI, 3.5%, than was previously thought. This guideline aims to help healthcare professionals apply best practice care for women with POI. The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including bone, cardiovascular, neurological and sexual function, fertility and general well-being, and treatment options, including HT. The list of clinical questions was expanded from the previous iteration of the guideline (2015) based on the scoping survey and appreciation of emerging knowledge of POI. Questions were added on the role of anti-Müllerian hormone (AMH) in the diagnosis of POI, fertility preservation, muscle health and specific considerations for HT in iatrogenic POI. Additionally, the topic on complementary treatments was extended with specifi