ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 65 P375 | DOI: 10.1530/endoabs.65.P375

Audit of premature ovarian insufficiency management at University Hospitals Leicester NHS Trust

Muhammad Waseem Aslam1, Nikki Kieffer1, Emma Bremner1, Ragini Bhake1, Miles Levy1,2, Neelam Potdar1, Tarek Gelbaya1, Yadava Jeve1 & Narendra L Reddy1,2

1University Hospitals of Leicester, Leiceter, UK; 2University of Leicester, Leiceter, UK

Background: Premature Ovarian Insufficiency (POI) is characterised by oligo-/amenorrhoea with elevated gonadotropins and low oestradiol before the age of 40 years.

Objective: To evaluate management of non-Turner POI patients in line with European Society of Human Reproduction and Embryology (ESHRE) guidance (1)

Methods: Retrospective evaluation of electronic and paper case records.

Results: Over 23-year period (1995 to 2018), n=53 were included in audit; 75 cases reviewed, 22 excluded due to incomplete data and erroneous coding. Mean age at diagnosis- 33 years; mean BMI 25.5 (17–39.4 kg/m2). Mean duration of oligo/ -amenorrhoea 13 months. Aetiology of POI: Autoimmune-16, total body irradiation/chemotherapy-4, HIV-3, thalassaemia-3, oophorectomy-2, Idiopathic POI-25. Ovarian antibodies were negative (n=19 assessed); adrenal autoantibodies negative (n=3 assessed); 35/51 (66%) not assessed for cortisol reserve at diagnosis; 7 patients had osteopenia/osteoporosis.

ESHRE guidanceCompliance
Biochemical diagnosis 2 FSH levels of >25 iu/l 4 weeks apart53/53 (100%)
Genetic testing/Karyotyping11/25 (44%)
Autoimmune endocrine screening26/53 (49%)
Cardiovascular risk screeningNone recorded apart from hypertension- therefore 0%
Bone health assessment47/53 (88%)
Fertility services referral is appropriateJoint Gynae-Endo clinic (100%)
Hormone Replacement therapy (HRT)53/53 (100%)
Patient education leaflets, website etc.0% recorded in notes

Discussion: There was considerable delay in patients seeking medical attention from the onset of symptoms: 13 months compared to ESHRE guidance of 4 months. We were compliant in measures such as HRT, bone health assessment but suboptimal in genetic testing, autoimmune screening, cardiovascular (CV) risk monitoring and patient information dissemination; following interventions are proposed:

1. Annual metabolic profile & advice regarding CV risk reduction.

2. Clinical assessment of autoimmune conditions.

3. Referral to clinical genetics for evaluation.

4. POI patient information dissemination.

5. Explore ways of improving public health awareness of POI with help of primary care colleagues.

Reference: 1. ESHRE POI guidelines, December 2015.

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