New guidelines developed for the diagnosis and management of premature ovarian insufficiency

New guidelines for the diagnosis and treatment of premature ovarian insufficiency (POI) – developed by the Center for Research Excellence in Women’s Health in Reproductive Life (CRE-WHiRL) at Monash University, and key international women’s health organizations with an international team of experts including women with lived experience – will be published today (TBC) simultaneously in three leading journals.

POI is defined as loss of ovarian function before the age of 40. This is much earlier than the usual age of menopause; occurs in women worldwide at an average age of 48-51 years.

POI affects approximately 4 percent of women worldwide and is associated with infertility, psychological problems and an increased risk of osteoporosis, cardiovascular disease, mortality, dementia and cognitive impairment. Although hormone therapy has been shown to attenuate some of these effects, treatment of POI remains suboptimal worldwide with delayed diagnosis, variability in care, and patient dissatisfaction.

The guidelines were last updated in 2015 and the 2024 update of the European Society of Human Reproduction and Embryology (ESHRE) POI guidelines was the first to involve an international partnership between ESHRE and the International Menopause Society, American Society for Reproductive Medicine. and NHMRC-funded CRE-WHiRL, which is led by the Monash Center for Health Research and Implementation (MCHRI), at Monash University.

The 2024 guidelines provide 145 recommendations on symptoms, diagnosis, cause, consequences and treatment of POI. The recommendations are developed based on the best available evidence and assessed based on the strength of that evidence. The topics covered in the guideline are based on an international survey of women and healthcare professionals. New information is provided on the genetic causes of POI, the impact of POI on muscle health, the use of anti-mullerian hormone, non-hormonal therapies, lifestyle interventions and complementary therapies.

According to guideline development group co-chair Associate Professor Amanda Vincent, from CRE-WHiRL, a significant change in the updated 2024 guidelines is the recommendation regarding the diagnosis of POI; All it takes is one elevated follicle-stimulating hormone (FSH) level, combined with irregular or absent periods for at least four months. The FSH level only needs to be repeated if the diagnosis remains unclear. Women with experience provided recommendations on how to convey the diagnosis and care of women with POI.

The new guideline means faster diagnosis of POI, conveyed sensitively and with shared decision-making between the healthcare provider and the woman experiencing POI.”

Associate Professor Amanda Vincent, from CRE-WHiRL

A comprehensive clinical evaluation requires more than assessing symptoms, “it should also include asking a patient about her sexual well-being, fertility needs, psychological health, cardiovascular and osteoporosis risks, and comorbidities,” she said.

The updated guideline emphasizes the importance of personalized hormone therapy, unless contraindicated, for symptom relief and prevention of chronic diseases; with the need for rapid institution and continuation until the usual age of menopause.

“This provides healthcare professionals with clear advice on best practice in POI care, based on the best evidence currently available,” said Associate Professor Vincent.

The POI guidance is accompanied by co-designed consumer resources, including an updated Ask Early Menopause app (www.askearlymenopause.org) and a toolkit for healthcare professionals

The Ask Early Menopause App – www.askearlymenopause.org – informs and supports women in managing early menopause with evidence-based resources, a personalized dashboard and a discussion forum. The app has more than 9,000 users worldwide.