Panay, Nick
Consultant Gynaecologist: Queen Charlotte’s & Chelsea Hospital
Professor of Practice: Imperial College London
The presentation will use as its basis the European Society of Human Reproduction and Embryology 2015 POI guidelines which are currently being updated and the International Menopause Society (IMS) 2020 White paper on POI. A summary of key POI guidelines from the IMS White Paper is shown below.
Demographics / etiology / pathophysiology of POI
- Terminology and diagnostic criteria should be standardised to avoid confusion about diagnosis.
- Full understanding of etiology / pathophysiology will facilitate efficient diagnosis and management e.g., global registry / biobank.
- Global, ethnic and cultural variations in prevalence, presentation require clarification.
Diagnosis of POI
- Personal e.g., menstrual health and family history are very important in making the diagnosis.
- The diagnosis should not be made on the basis of only one FSH level.
- AMH testing is only required if there is diagnostic uncertainty.
- A baseline DEXA scan should be offered to all women diagnosed with POI.
Management of POI
- Management of women with POI should ideally be multidisciplinary and include patient advocacy groups.
- Lifestyle, diet exercise should be optimised.
- Hormone replacement at least until average age of menopause should be first line treatment unless contraindicated or if rejected by the woman after careful counselling.
- There are very few data for the benefits and risks of CAMS and non-hormonal bone sparing agents in POI.
- Replacement can be with the COC initially if contraception is required or because of personal preference, but in the long-term HT is recommended to optimise bone and metabolic health.
Key Research priorities in POI
- Global POI registry collaboration / expansion / biobanking. e.g. https//: poiregistry.net
- Further determination of etiology of POI, especially genetic.
- Discovery of reliable biomarkers for predicting POI.
- Impact of hormonal interventions e.g. HT v COC, types of HT / COC on
- Quality of Life
- Psychological/psychosexual aspects
- Bone, cardiovascular and cognitive health.
- Role of androgen supplementation for QOL, cardiovascular, bone, cognitive health and fertility.
- Differential impact and management of iatrogenic and spontaneous POI.
- POI as part of an aging syndrome v aging following POI due to hormone deficiency.
- Confirmation of efficacy and safety of fertility enhancing techniques.
- Further clarification of role and division potential of human oogonial stem cells.