Global Experts Redefine Care for Women Diagnosed With Premature Ovarian Insufficiency

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Healthcare professionals have developed new guidelines for treating women with premature ovarian insufficiency syndrome (POI), thanks to an international collaboration between the Centre for Research Excellence in Women’s Health in Reproductive Life (CRE-WHiRL) at Monash University in Australia, the European Society of Human Reproduction and Embryology (ESHRE), the International Menopause Society and the American Society for Reproductive Medicine. The new guidelines, which include 145 recommendations for treatment and diagnosis of POI, were published in Climacteric this week. Guidelines were last update in 2015.

POI is diagnosed when the ovaries stop functioning normally before the age of 40. This usually manifests as irregular menstrual periods and imbalanced reproductive hormones known as gonadotrophins and low estrogen which can lead to infertility. The drop in estrogen levels also leaves bones more susceptible to osteoporosis and increases the risk of cardiovascular disease.

POI currently affects about 4% of women worldwide, according to the report. Previous estimates in 2016 placed POI frequency at around 1% worldwide.

Guideline points were developed through a combination of focus groups that included women with POI and clinical research.

A key change in the new guidelines regards the POI diagnostic process, according to Amanda Vincent, Ph.D., co-chair of the guideline development group and associate adjunct professor at Monash University. To be diagnosed, women now only need one test – rather than two - showing an elevated follicle stimulating hormone level, in combination with irregular menstrual period for at least four months. The follicle stimulating hormone stimulates the egg growth in the ovaries and causes estrogen levels to rise. If levels get too high, it’s an indication that the body is working harder than normal to produce an egg.

“The new guidelines mean faster diagnosis of POI, conveyed in a sensitive manner and involving shared decision making between the healthcare professional and the woman experiencing POI,” Vincent said in a news release. “It must also include asking a patient about her sexual wellbeing, fertility needs, psychological health, cardiovascular and osteoporosis risks, and co-morbidities.”

Other recommendations include:

• “The guideline group recommends that women with POI should have a regular clinical review, addressing individualized risk factors and adherence to therapy.”
• “The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including healthy diet, physical activity, avoiding smoking and maintaining normal body weight) to aid muscle health.”
• “The guideline group recommends that healthcare professionals convey the diagnosis of POI in a compassionate and sensitive manner, provide personalized evidence-based information about the condition and ensure time for the women to ask questions.”