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Primary ovarian insufficiency

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 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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Guidelines

1.Screening and diagnosis

Definition: as per ACOG 2017 guidelines, recognize that POI is a pathologic condition and not a hastening of natural menopause.
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  • Diagnostic criteria

  • Indications for testing (symptomatic patients)

  • Indications for testing (family relatives)

2.Classification and risk stratification

Health risks: as per ACOG 2017 guidelines, ensure a distinct approach to health maintenance in patients with POI from that used in natural menopause, although these two conditions share common health risks.
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3.Diagnostic investigations

Medical history: elicit symptoms of estrogen deficiency in patients presenting with oligomenorrhea or amenorrhea.
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  • Karyotyping

  • Genetic testing

  • Screening for adrenocortical antibodies

  • Screening for thyroid antibodies

  • Screening for diabetes

  • Screening for infection

  • Cardiovascular evaluation

  • Bone mineral density testing

4.Medical management

Hormone therapy: 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

5.Patient education

Pre-pregnancy counseling
Assess BP, renal function, and thyroid function before pregnancy in patients with premature ovarian insufficiency.
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Reassure patients that spontaneous pregnancies after idiopathic premature ovarian insufficiency or most forms of chemotherapy do not show any higher obstetric or neonatal risk than in the general population.
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