Evidence-based guideline: premature ovarian insufficiency

• Published in: Human reproduction open 2024-12, Vol.2024 (4), p.hoae065
• 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: ESHRE Pages
• ISSN: 2399-3529; 2399-3529
• DOI: 10.1093/hropen/hoae065

STUDY QUESTION How should premature/primary ovarian insufficiency (POI) be diagnosed and managed based on the best available evidence from published literature? SUMMARY ANSWER The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae, and treatment of POI. WHAT IS KNOWN ALREADY Premature ovarian insufficiency (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; fertility; and 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. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. Key questions were determined by a group of experts and informed by a scoping survey of women and health care professionals. Literature searches and assessments 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 (RCTs) on POI included in the guideline. PARTICIPANTS/MATERIALS, SETTING, METHODS 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 on 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. MAIN RESULTS AND THE ROLE OF CHANCE New data indicate a higher prevalence of POI, 3.5%, than was previously thought. This guideline aims to help health care professionals to 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 preservatio