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Primary ovarian insufficiency
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of primary ovarian insufficiency are prepared by our editorial team based on guidelines from the American Society for Reproductive Medicine (ASRM/ESHRE 2024), the American College of Obstetricians and Gynecologists (ACOG 2017), the European Society of Human Reproduction and Embryology (ESHRE 2016), and the Endocrine Society (ES 2015).
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Screening and diagnosis
Definition: as per ASRM/ESHRE 2024 guidelines, use the term ‘premature ovarian insufficiency' to describe this condition in research and clinical practice.
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Indications for testing (symptomatic patients)
Indications for testing (family relatives)
Diagnostic criteria
Classification and risk stratification
Health risks
As per ASRM/ESHRE 2024 guidelines:
Make efforts to reduce the risk of POI, in view of the long-term health consequences of POI, including the following modifiable factors:
gynecological surgical practice
lifestyle factors such as smoking
treatment regimens for malignant and chronic diseases
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Identify females with risk factors for POI and counsel regarding POI risk and fertility preservation.
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Diagnostic investigations
Medical history: as per ASRM/ESHRE 2024 guidelines, enquire about symptoms of estrogen deficiency in patients presenting with irregular menstrual cycles or amenorrhea.
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Cardiovascular evaluation
Screening for diabetes
Screening for infection
Bone mineral density testing
Hormone testing (FSH)
Hormone testing (estradiol)
Hormone testing (anti-Müllerian hormone)
Karyotyping
Genetic testing
Screening for adrenocortical antibodies
Screening for thyroid antibodies
Medical management
Hormone therapy: as per ACOG 2017 guidelines, initiate systemic hormone therapy, if not contraindicated, to treat hypoestrogenism symptoms and mitigate long-term health risks in patients with POI.
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Duration of treatment
Contraception
Fertility preservation
Evaluation for pregnancy
Management of pregnancy
Bone protection
Muscle protection
Nonpharmacologic interventions
Patient education
General counseling: as per ASRM/ESHRE 2024 guidelines, convey the diagnosis of POI in a compassionate and sensitive manner, provide personalized evidence-based information about the condition and ensure time for the patients to ask questions.
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Pre-pregnancy counseling