New guidelines focused on the diagnosis and management of premature ovarian insufficiency (POI) are set to be published today (pending confirmation) simultaneously in three leading journals. These guidelines have been developed by the Centre for Research Excellence in Women’s Health in Reproductive Life (CRE-WHiRL) at Monash University, in collaboration with key international women’s health organizations and an international team of experts, which also includes women with lived experience.
POI is characterized by the loss of ovarian function before the age of 40, significantly earlier than the typical age of menopause, which occurs at an average of 48 – 51 years globally for women. It affects around 4 percent of women worldwide and is linked to a host of issues such as infertility, psychological distress, and an increased risk of osteoporosis, cardiovascular disease, mortality, dementia, and cognitive dysfunction. While hormone therapy has been shown to alleviate some of these effects, the global management of POI has been less than ideal, with delayed diagnoses, inconsistent care, and patient dissatisfaction.
The last update to the guidelines was in 2015. The 2024 update of the POI Guidelines, involving a partnership between the European Society of Human Reproduction and Embryology (ESHRE), the International Menopause Society, the American Society for Reproductive Medicine, and the NHMRC-funded CRE-WHiRL (led by the Monash Centre for Health Research and Implementation at Monash University), provides 145 recommendations. These cover aspects like symptoms, diagnosis, causation, sequelae, and treatment of POI. The recommendations were formulated based on the best available evidence and graded according to the strength of that evidence. The topics included in the guideline were informed by an international survey of women and healthcare professionals. New insights are offered regarding the genetic causes of POI, its impact on muscle health, the use of anti-mullerian hormone, non-hormonal therapies, lifestyle interventions, and complementary therapies.
Associate Professor Amanda Vincent, Co-Chair of the guideline development group from CRE-WHiRL, highlighted a key change in the updated 2024 guidelines regarding the diagnosis of POI. Now, only one elevated follicle stimulating hormone (FSH) level combined with irregular or absent menstrual periods for at least four months is needed for diagnosis. The FSH level only requires repeating if the diagnosis remains unclear. Women with lived experience contributed suggestions on how to communicate the diagnosis and care to those with POI. “The new Guideline means faster diagnosis of POI, conveyed in a sensitive manner and involving shared decision making between the healthcare professional and the woman experiencing POI,” said Associate Professor Vincent.
She also emphasized that a comprehensive clinical evaluation should go beyond just assessing symptoms. “It must also include asking a patient about her sexual wellbeing, fertility needs, psychological health, cardiovascular and osteoporosis risks, and co-morbidities,” she stated.
The updated guideline underlines the importance of personalized hormone therapy, unless contraindicated, for symptom relief and chronic disease prevention. It also emphasizes the need for prompt initiation 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,” Associate Professor Vincent added.
The POI guideline comes with co-designed resources for consumers. There’s an updated Ask Early Menopause App (www.askearlymenopause.org), which has over 9,000 users worldwide and provides evidence-based resources, a personal dashboard, and a discussion forum to inform and support women in managing early menopause. Additionally, there’s a toolkit for healthcare professionals.
Related topics
- Childhood Leaded Gasoline Exposure Linked to Mental Health Issues
- Ultra-Processed Foods Tied to Thigh Muscle Fat
- High Vitamin D Doses Don’t Prevent Type 2 Diabetes
