Premature ovarian failure

Key Findings

• Across 38 studies, abnormal menstruation was associated with POI (OR 2.707, 95% CI 1.705-4.299), while family history (OR 4.338) and pelvic surgery (OR 4.836) were also associated with higher risk.
• Hair dyeing (OR 4.725), chemical exposure (OR 3.314), smoking (OR 2.748), sleep deprivation (OR 3.340), and adverse mood or stress measures were associated with increased risk.
• Physical exercise and vegetable intake were associated with reduced POI risk (odds ratios 0.270 and 0.434, respectively), and sensitivity analyses supported the robustness of the findings.

Key Findings

• The expert statement defines POI as spontaneous oligo-amenorrhea for at least four months with FSH at least 25 IU/L before age 40, a threshold intended to improve diagnostic consistency.
• It recommends hormone replacement therapy as the treatment of choice regardless of neurovegetative symptoms to reduce the long-term consequences of early ovarian hormone loss.
• The statement identifies cardiovascular, musculoskeletal, and brain health as affected by early ovarian hormone loss and recommends hormone replacement to reduce these long-term risks.

Key Findings

• Iatrogenic factors account for approximately half of identifiable POI cases, and prevalence increased to as high as 82.2% among female cancer survivors younger than 24 years.
• The guideline reports global POI prevalence ranging up to 3.7% and increasing above 10% in some countries or regions.
• The expert group produced 26 recommendations addressing 19 clinical questions to improve early diagnosis, treatment, and management of iatrogenic POI.

Key Findings

• The pooled prevalence of POI among women with SLE treated with cyclophosphamide was 15% (95% confidence interval 7%-26%), with substantial heterogeneity.
• POI prevalence was reduced from 29% in studies published before 2005 to 9% in later studies, coinciding with adoption of Euro-Lupus low-dose protocols.
• Younger age at cyclophosphamide exposure predicted increased POI prevalence, while cumulative dose was not independently associated in meta-regression.

Key Findings

• Among 194 premenopausal women with HER2-positive early breast cancer, median AMH was reduced from 8.44 pmol/L at baseline to below 0.07 pmol/L at the end of therapy, with partial recovery to 0.14 pmol/L at 36 months.
• Baseline AMH predicted ovarian function loss with an AUC of 0.784; adding age improved the AUC to 0.800.
• Combining baseline and end-of-therapy AMH increased the AUC to 0.808, or 0.820 with age, while adding baseline FSH and estradiol did not improve prediction.