The Center for Research Excellence in Women’s Health in Reproductive Life (CRE-WHiRL) at Monash University, in collaboration with international women’s health organizations and a team of experts—including women with lived experience—has released updated guidelines for the diagnosis and management of Premature Ovarian Insufficiency (POI). These guidelines, published simultaneously in three major journals, including Climacteric, represent a significant step forward in addressing the challenges faced by women with POI.
POI, defined as the loss of ovarian function before the age of 40, occurs far earlier than the typical age of menopause, which globally averages between 48 and 51 years. This condition affects approximately 4% of women worldwide and is linked to infertility, psychological distress, and an increased risk of osteoporosis, cardiovascular disease, cognitive decline, and premature mortality.
Although hormone therapy has been shown to alleviate some of these health risks, POI remains underdiagnosed, and its management is often inconsistent across different regions. Many women experience delays in diagnosis, variations in the quality of care, and overall dissatisfaction with their treatment.
The new 2024 update to the POI Guidelines of the European Society of Human Reproduction and Embryology (ESHRE) marks the first time that these guidelines were developed through an international partnership. The collaboration includes ESHRE, the International Menopause Society, the American Society for Reproductive Medicine, and the CRE-WHiRL team at Monash University. The updated guidelines provide 145 evidence-based recommendations, covering everything from symptom recognition and diagnosis to treatment options, and are informed by an international survey of both women with POI and healthcare providers.
Key updates to the guidelines include new insights into the genetic causes of POI and its impact on muscle health, the use of anti-Müllerian hormone (AMH) in diagnostics, and a broader range of treatment options. The guidelines also offer advice on non-hormonal therapies, lifestyle interventions, and complementary approaches.
One of the most significant changes in the 2024 guidelines is the simplified diagnostic criteria for POI. According to Associate Professor Amanda Vincent, Co-Chair of the guideline development group, a single elevated follicle-stimulating hormone (FSH) level combined with at least four months of irregular or absent menstrual periods is now sufficient for a diagnosis. This change aims to speed up the diagnosis process, ensuring that women receive appropriate care more promptly. FSH testing should only be repeated if the diagnosis remains uncertain.
The updated guidelines also stress the importance of a holistic clinical evaluation. Healthcare providers are encouraged to assess not only the symptoms of POI but also a woman’s sexual health, fertility desires, psychological well-being, and risks for cardiovascular disease and osteoporosis.
“Personalized hormone therapy remains a cornerstone of treatment for symptom relief and chronic disease prevention, unless contraindicated,” said Associate Professor Vincent. “The guidelines provide clear, evidence-based recommendations for healthcare professionals to offer the best possible care to women with POI.”
Accompanying the updated guidelines are new co-designed resources aimed at both patients and healthcare providers. These include the Ask Early Menopause app, which has over 9,000 users worldwide, offering women evidence-based tools for managing early menopause. The app includes a personalized dashboard, resources, and a discussion forum to support women through their journey.
In sum, the 2024 POI guidelines aim to standardize and improve the care of women affected by this condition, ensuring faster, more accurate diagnoses and more effective, personalized treatments for POI-related health risks.
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