Early Menopause: A Simpler Diagnostic and Personalized Treatment
Premature ovarian insufficiency (POI), affecting roughly 4% of women worldwide, occurs when the ovaries stop functioning normally before age 40. This condition causes infertility and various complications, including psychological distress, osteoporosis, and cardiovascular risks.
A more complete understanding and management of POI are crucial for women’s well-being. Reputable gynecological organizations and women with POI have come together to update the guidelines initially established by the European Society of Human Reproduction and Embryology (ESHRE) in 2015.
Quicker Diagnosis
The 2024 POI guidelines, developed by ESHRE alongside the International Menopause Society, the American Society for Reproductive Medicine, and the Center for Research Excellence in Women’s Health in Reproductive Life, encompass 145 recommendations addressing symptoms, diagnosis, causes, complications, and treatment. These guidelines emphasize new details regarding the genetic causes of POI, its impact on muscle health, the use of anti-Mullerian hormone, non-hormonal therapies, lifestyle interventions, and complementary therapies.
A key change in the update, published in the medical journal Climacteric, involves the diagnostic criteria for POI, also known as early menopause. While four consecutive months without menstruation before age 40 still serve as the primary indicator, a single high FSH level (above 40 UI/l) can now be used to establish the diagnosis, eliminating the need for two measurements. Re-testing FSH levels is only necessary if the diagnosis remains unclear.
The new guidelines also incorporate recommendations from women living with POI regarding sensitive communication and shared decision-making around diagnosis.
"The new guideline allows for a faster diagnosis of POI, delivered sensitively and involving shared decision-making between the healthcare professional and the woman with POI," states Professor Amanda Vincent, co-chair of the guideline progress group. She stresses the importance of incorporating the patient’s overall well-being into the evaluation, including sexual health, fertility needs, psychological health, cardiovascular and osteoporosis risks, and co-existing conditions.
Personalized Hormone Therapy
Regarding treatment, the 2024 guidelines emphasize the importance of personalized hormone therapy as the first line of treatment, unless contraindicated.
Treatment shoudl be initiated promptly and continued untill the average age of menopause,generally between 48 and 51 years old. This long-term approach helps manage symptoms and mitigate risks associated with POI, such as osteoporosis and cardiovascular disease.
Professor Vincent emphasizes that these updated guidelines provide healthcare professionals with valuable insights and best practices for managing POI, grounded in the latest scientific evidence.
How can personalized hormone therapy benefit women diagnosed with early menopause or POI?
Early Menopause: A Simpler Diagnostic and Personalized Treatment
Time.news editor (TNE): Thank you for joining us today, Professor Amanda Vincent, to discuss the updated guidelines on premature ovarian insufficiency (POI) and their implications for women’s health. To start, could you explain what POI is and how it affects women?
Professor Amanda Vincent (PAV): Thank you for having me. Premature ovarian insufficiency, or POI, affects about 4% of women worldwide. It occurs when the ovaries cease functioning normally before the age of 40. this condition can lead to infertility and several complications, including psychological distress, osteoporosis, and increased cardiovascular risks. Understanding and managing POI effectively is crucial for the overall well-being of these women.
TNE: The new guidelines from 2024 seem to encourage a quicker diagnosis. Can you elaborate on what has changed in the diagnostic criteria for POI?
PAV: Certainly! The updated guidelines, created in collaboration with esteemed gynecological organizations, now allow for a more streamlined diagnosis. While the primary indicator remains four consecutive months without menstruation before age 40, a single high FSH level—above 40 UI/l—can be sufficient for establishing the diagnosis. This change reduces the need for multiple measurements and allows healthcare professionals to diagnose POI more efficiently, enhancing timely intervention for the patients.
TNE: That sounds like a meaningful improvement. How do the new guidelines ensure a sensitive approach to interaction with women diagnosed with POI?
PAV: the updated guidelines emphasize sensitive communication and shared decision-making between healthcare professionals and women with POI. We have incorporated perspectives from women living with this condition to ensure that their experiences inform our recommendations. This approach allows women to feel heard and respected, facilitating a more supportive habitat during the diagnostic process.
TNE: What options for treatment are recommended under the new guidelines, especially in terms of hormone therapy?
PAV: The 2024 guidelines stress the importance of personalized hormone therapy as the first line of treatment for women with POI, barring any contraindications. We recommend initiating treatment as soon as possible and continuing it until the average age of menopause, which typically falls between 48 and 51 years. This long-term strategy not only helps manage symptoms effectively but also mitigates risks associated with POI, such as osteoporosis and cardiovascular diseases.
TNE: It seems that the personalized approach to hormone therapy could greatly benefit patients. How can healthcare providers utilize these updated guidelines to improve patient outcomes?
PAV: the guidelines offer healthcare professionals actionable insights and best practices for managing POI based on the latest scientific evidence. By understanding the importance of a holistic evaluation, which includes assessing sexual health, fertility needs, psychological health, and underlying conditions, providers can tailor treatment plans that align with the specific needs of each patient. This individualized care approach contributes to better health outcomes and improves the quality of life for women with POI.
TNE: As we conclude, what practical advice would you give to women who suspect they might potentially be experiencing symptoms of POI?
PAV: I encourage women to seek medical advice if they experiance symptoms such as irregular periods, hot flashes, or other menopause-related signs before the age of 40. Open communication with healthcare providers is vital to ensure appropriate diagnosis and management. staying informed about one’s health and advocating for personalized care can substantially enhance long-term well-being.
TNE: Thank you, Professor Vincent, for providing such valuable insights into the 2024 POI guidelines and their implications for women’s health. we appreciate your time.
PAV: Thank you for having me. It’s essential to keep these conversations going, and I’m glad to help share this critical information.