From the Guidelines
For a primary ovarian insufficiency (POI) hormone workup, I recommend starting with follicle-stimulating hormone (FSH) and estradiol measurements on two separate occasions, 4-6 weeks apart, as suggested by the most recent guidelines 1.
Key Tests
The following tests are essential for a comprehensive workup:
- FSH and estradiol measurements
- Luteinizing hormone (LH)
- Prolactin
- Thyroid-stimulating hormone (TSH)
- Anti-Müllerian hormone (AMH)
- Karyotype analysis Consider testing for adrenal antibodies, 21-hydroxylase antibodies, and fragile X premutation if clinically indicated, as recommended by the ESHRE guideline 1.
Rationale
POI is characterized by ovarian follicle depletion or dysfunction before age 40, leading to elevated gonadotropins and low estrogen 1. The workup aims to rule out other conditions like hyperprolactinemia or thyroid disorders that can mimic POI symptoms, while also screening for associated autoimmune conditions and genetic factors that may influence management and family planning discussions.
Additional Considerations
A comprehensive metabolic panel and complete blood count are also useful in the initial assessment, as they provide valuable information on the patient's overall health and potential underlying causes of POI. By following this approach, clinicians can ensure a thorough and accurate diagnosis, ultimately improving patient outcomes and quality of life.
From the Research
POI Hormone Work Up
- The diagnosis of Premature Ovarian Insufficiency (POI) is often delayed, which can have severe physical and emotional consequences for the patient 2.
- Primary care physicians should be aware of the possibility of POI in young women presenting with menstrual irregularity and initiate hormone replacement therapy (HRT) promptly to ensure quality of life and prevent osteoporosis and cardiovascular disease 2, 3.
- HRT is strongly recommended for women with POI, mainly for vasomotor and genito-urinary symptom relief, as well as for bone protection and primary prevention of cardiovascular disease 4.
- The treatment should be implemented at recognition of POI and continued to at least the age of natural menopause, with consideration of patient preference for route and method of administration of each component of HRT 3, 4.
- Estrogen-progestogen therapy combined with dehydroepiandrosterone (DHEA) and melatonin may optimize fertility and lead to successful pregnancy in POI patients 5.
- Women with POI should be managed by a multidisciplinary team, including a gynecologist, endocrinologist, dietitian, and psychologist, to ensure comprehensive care and address individual needs 3.