The British Menopause Society and Women's Health Concern recommendations on the management of women with premature ovarian insufficiency.

This guidance document by the British Menopause Society provides recommendations on the assessment and management of women with premature ovarian insufficiency (POI). The consequences of POI are related to the decline in ovarian function and estrogen deficiency associated with the condition. These can be short-term menopausal symptoms and long-term effects on bone and cardiovascular health, cognition as well as the fertility consequences associated with POI. Sex steroid hormone replacement (both hormone replacement therapy containing physiological estrogens (HRT) and preparations containing synthetic ethinyl estradiol such as the combined oral contraceptive pill) provides a beneficial role both in the context of symptom control, as well as minimising the long-term adverse health effects associated with the condition. The benefits of hormone replacement and its role in this context are discussed in detail in the relevant sections in the document. The risks of hormone replacement including the risk of breast cancer quoted in the Women’s Health Initiative study (WHI) and other studies on naturally menopausal women over the age of 50, do not apply to women with POI. These findings should not therefore be extrapolated to this group of women and this is addressed in the relevant sections in these recommendations. The key message from this guidance is that women with POI represent a different cohort to women who have natural menopause beyond the age of 50. Hormone replacement has a beneficial role in maintaining bone and cardiovascular health as well as cognitive function in women with POI in addition to symptom control. HRT and the combined contraceptive pill containing ethinyl estradiol would both be suitable options for hormone replacement, although HRT may be more beneficial in improving bone health and cardiovascular markers compared to the combined oral contraceptive pill. Hormone replacement should aim to achieve physiological levels of estrogen and is generally recommended at least until the natural age of the menopause.