Four major medical societies released updated clinical guidelines for premature ovarian insufficiency, reporting a 3.5% prevalence rate and providing 145 recommendations for diagnosis and treatment.
The European Society of Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM), Centre for Research Excellence in Women's Health in Reproduction Life (CREWHIRL), and International Menopause Society (IMS) collaborated on the updated guidelines, which were published in Climacteric and offered revisions to the 2015 guidelines.
The diagnostic criteria changed to require one elevated follicle stimulating hormone (FSH) measurement above 25 IU/l, combined with irregular menstrual cycles or amenorrhea for at least 4 months, replacing the previous requirement of two FSH measurements.
The guidelines addressed anti-Müllerian hormone (AMH) testing, indicating it should not serve as a primary diagnostic tool but could help confirm diagnoses in uncertain cases. They included recommendations for genetic testing, including next-generation sequencing where available.
The guidelines recommended hormone therapy (HT) until the typical age of menopause. The document noted an association between untreated premature ovarian insufficiency (POI) and reduced life expectancy as a result of cardiovascular disease.
The recommendations covered fertility preservation, pregnancy management, and care among women with iatrogenic POI following cancer treatment. For bone health, the guidelines recommended dual X-ray absorptiometry (DXA) screening at diagnosis where available.
New sections discussed muscle health, noting associations between POI and reduced muscle mass and strength. The guidelines addressed complementary therapies while noting limited evidence for their efficacy compared with HT.
For puberty induction, the guidelines recommended starting estradiol at age 11 years with gradual dose increases over 2 to 3 years.
The 145 recommendations included 92 supported by research evidence and 53 based on clinical expertise. The development process involved stakeholder review, generating 374 comments during public consultation, with 61% leading to modifications.
The investigators included 30 recommendations for future research. The guidelines specified a review in 4 years, with an intermediate assessment after 2 years.
The combined prevalence of POI and early menopause (occurring between ages 40 to 44 years) reached 12.2% according to the guidelines.
A disclosure statement can be found in the guidelines.