Endocrine Abstracts

Introduction: Women with premature ovarian insufficiency (POI) may complain of various symptoms and consequently be seen by clinicians in a range of settings. Management is multifactorial and may vary depending on the awareness of practitioners within each specialty/subspecialty. In 2015, the European Society for Human Reproduction and Embryology (ESHRE) published guidelines on the management of POI. These state that women should have the following investigations: karyotype; screening for Fragile X pre-mutation, thyroid peroxidase (TPO) and 21-hydroxylase antibodies; and measurement of bone mineral density (BMD). Treatment should incorporate: lifestyle advice; oestrogen replacement; contraception; fertility; bone protection; and psychological support.

Aims: To assess compliance with ESHRE guidelines at Leeds Teaching Hospitals NHS Trust (LTHT) and determine whether this varies according to clinical setting of presentation.

Methods: A retrospective review of all females diagnosed with POI between 01/07/16 and 30/06/17 in one of the following clinics: paediatric endocrinology; general endocrinology; oncology; reproductive medicine; menopause; and general gynaecology. We assessed which investigations had been performed and what treatments had been discussed.

Results: We identified 103 women, who were evenly distributed between the different clinics. Overall, 40.6% had a karyotype. Screening for Fragile-X pre-mutation, TPO and 21-hydroxylase antibodies and BMD occurred in 7.4, 11.1, 13.6 and 35.9% respectively. There was significant variation in performance of a karyotype and TPO antibodies between the different settings. Overall, lifestyle advice was offered to 30.1%. Oestrogen replacement, contraception, fertility, bone protection and psychological support were discussed with 76.0, 38.4, 59.0, 75.0 and 25.2% respectively.There was significant variation for all apart from contraception.

Conclusion: Management of POI at the LTHT is not consistent with ESHRE guidelines and requires improvement. Furthermore, there is significant variation in practice amongst the different specialties/subspecialties. We suspect similar results may occur elsewhere. We have proposed remedial action and will reassess following implementation.