THE premature ovarian failurethe cessation of ovarian function before the age of 40, has been increasing dramatically in recent years.

It has been proven that, in addition to chromosomal abnormalities, syndromes and iatrogenic menopause, in recent years climate change affects ovarian function and causes premature ovarian failure, emphasizes in APE-MPE the Sophia Kalantaridou, professor of Obstetrics and Gynecology at the University of Athens, who participated in the drafting of the new guidelines for premature ovarian failure.

The incidence of non-iatrogenic premature ovarian failure is 3.5%. In the context of its 40th Congress European Company (European Society of Human Reproduction and Embryology, ESHRE), which took place in Amsterdam on July 7-10, 2024, the new guidelines for the diagnosis and treatment of premature ovarian failure were presented.

The guidelines were written by a group of scientists with extensive research experience in premature ovarian failure (American Society for Reproductive Medicine, World Menopause Society, Center of Research Excellence for Reproductive Women’s Health).

Guidelines

Women with risk factors for premature ovarian failure, for example with relatives who have premature ovarian failure, should be informed on the one hand about the ways of early diagnosis, by determining the Antimullerian hormone (AMH) and FSH and on the other hand about possible smoking cessation and fertility preservation.

Premature ovarian failure is now diagnosed in older women < 40 ετών, με διαταραχές περιόδου για τουλάχιστον 4 μήνες και επίπεδα FSH >25 IU/L. FSH should be repeated after 4 weeks, in case the first value is not diagnostic. In this case, the AMH should also be measured.

All women with premature ovarian failure should have chromosomal testing and testing for fragile X premutations.

Also, genetic counseling and possibly further genetic testing with more specialized tests (next generation sequencing, NGS) should be done.

Women with premature ovarian failure of unknown etiology should be screened for autoimmune premature ovarian failure by determination of 21OH-Abs antibodies.

Genetic counseling should be given to women with fragile X pre-mutations, as well as their relatives.

Special attention should be paid to the sisters and daughters of women with premature ovarian failure, as they are at increased risk of developing premature ovarian failure themselves.

Hormone replacement therapy should be administered until the age of normal menopause, at age 50.

Women who do not take hormone replacement therapy are at risk for reduced life expectancy, mainly due to morbidity and mortality from cardiovascular disease. For this reason, cardiovascular disease prevention measures are recommended, such as avoiding smoking, proper nutrition, exercise and maintaining a normal body weight.

Women with premature ovarian failure may have spontaneous ovarian function and pregnancies, after diagnosis, without any therapeutic intervention. Fertility is normal before the onset of the disease. There are no methods to improve automatic ovarian function. Pregnancies resulting from natural conception in women with premature ovarian failure do not present an increased obstetric or neonatal risk compared to the general population.

Pregnancies in women with Turner syndrome present a greatly increased obstetric risk and should have close cardiological monitoring. Egg donation is the treatment of choice for fertility in women with premature ovarian failure. Follow-up of these women should be close until the age of normal menopause. After age 50, follow-up should follow normal menopause guidelines.