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 (1739.4 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.
|Biochemical diagnosis 2 FSH levels of >25 iu/l 4 weeks apart||53/53 (100%)|
|Genetic testing/Karyotyping||11/25 (44%)|
|Autoimmune endocrine screening||26/53 (49%)|
|Cardiovascular risk screening||None recorded apart from hypertension- therefore 0%|
|Bone health assessment||47/53 (88%)|
|Fertility services referral is appropriate||Joint 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.