New guidelines aim to revolutionize POI diagnosis and management

New guidelines aim to revolutionize POI diagnosis and management | Image Credit: © Kzenon - © Kzenon - stock.adobe.com.

New evidence-based guidelines have been revealed for the management of premature ovarian insufficiency (POI), according to the Centre for Research Excellence in Women’s Health in Reproductive Life (CRE-WHiRL).¹

POI, defined as loss of ovarian function when aged under 40 years, is reported in approximately 4% of women worldwide. Adverse outcomes of POI include psychological distress, infertility, and increased osteoporosis, cardiovascular disease, dementia, cognitive dysfunction, and mortality risks.¹

POI occurs significantly earlier than the average age of menopause, reported as the age of 48 to 51 years. Poor outcomes of POI may be mitigated using hormone therapy, but data has indicated sub-optimal management worldwide because of delayed diagnosis, variation in care, and patient dissatisfaction.¹

The new guidelines provide the most recent update since 2015, including a partnership between the European Society of Human Reproduction and Embryology (ESHRE), CRE-WHiRL, American Society for Reproductive Medicine, and the International Menopause Society.¹

These guidelines include 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment in patients with POI based on the best available evidence. Topics were chosen based on an international survey of women and health care professionals.¹

The guidelines include new information about genetic causes of POI, how POI influences muscle health, non-hormonal therapeutic options, the use of anti-mullerian hormone, lifestyle interventions, and complementary therapies.¹

A key change was highlighted by Amanda Vincent, associate professor at CRE-WHiRL and co-chair of the guideline development group. This change is a recommendation for POI diagnosis, stating that only 1 elevated follicle stimulating hormone (FSH) level is necessary for diagnosis when combined with at least 4 months of irregular or absent menstrual periods.¹

These diagnosis and care recommendations were provided by women with lived experiences of POI. With this new recommendation, FSH level should only be repeated in cases of unclear diagnosis.¹

“The new Guideline means faster diagnosis of POI, conveyed in a sensitive manner and involving shared decision making between the health care professional and the woman experiencing POI,” said Vincent.¹

The guideline also reported an increase in POI prevalence by 3.5% when compared to the previous report.² Issues that may arise from this condition may be answered within the 40 clinical questions answered by the guideline.

Alongside the discussed recommendations, updates were also made regarding estrogen doses and regimens, testosterone therapy, genetic testing, and combined oral contraceptive use. However, investigators noted that despite multiple management options being discussed, many of these options have limited evidence pertaining to POI.²

Research recommendations were also provided to support further research about POI. Currently, health care professionals may rely on the guidelines to provide clear advice about best practice in POI care. This can address patient dissatisfaction, care variation, non-adherence to therapy, and poor outcomes.²

Vincent noted that alongside addressing symptoms, clinical evaluations should also ask patients about their fertility needs, sexual wellbeing, cardiovascular and osteoporosis risks, psychological health, and comorbidities.¹ The guideline has been published alongside co-designed resources for consumers such as a toolkit for health care professionals.

“This provides healthcare professionals with the clear advice on best practice in POI care, based on the best evidence currently available,” said Vinent.¹

References

1. New international guidelines announced for Premature Ovarian Insufficiency (POI). Monash University. December 8, 2024. Accessed December 20, 2024. https://www.eurekalert.org/news-releases/1066993
2. Panay N, Anderson RA, Bennie A, et al. Evidence-based guideline: premature ovarian insufficiency. Climacteric. 2024;27(6):510–520. doi.org:10.1080/13697137.2024.2423213