study question: What is the optimal management of women with premature ovarian insufficiency (POI) based on the best available
evidence in the literature?
summary answer: The guideline development group (GDG) formulated 99 recommendations answering 31 key questions on the
diagnosis and treatment of women with POI.
what is known already: NA.
study design, size, duration: This guideline was produced by a multidisciplinary group of experts in the field using the methodology
of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included
papers up to September 2014 and consensus within the guideline group on all recommendations. The GDG included a patient representative
to ensure input from women with POI. After finalization of the draft, the European Society for Human Reproduction and Embryology
(ESHRE) members and professional organizations were asked to review the guideline.
participants/materials, setting, methods: NA.
main results and the role of chance: The guideline provides 17 recommendations on diagnosis and assessment of POI and 46
recommendations on the different sequelae of POI and their consequences for monitoring and treatment. Furthermore, 24 recommendations
were formulated on hormone replacement therapy in women with POI, and two on alternative and complementary treatment. A chapter on
puberty induction resulted in five recommendations.
limitations, reasons for caution: The main limitation of the guideline is that, due to the lack of data, many of the recommendations
are based on expert opinion or indirect evidence from studies on post-menopausal women or women with Turner Syndrome.
wider implications of the findings: Despite the limitations, the guideline group is confident that this document will be able to
guide health care professionals in providing the best practice for managing women with POI given current evidence. Furthermore, the guideline
grouphas formulated research recommendations on the gaps in knowledge identified in the literature searches, in an attempt to stimulate research
on the key issues in POI.

/pdf/eshre-guideline-management-of-women-with-premature-ovarian-bcb43jg2c1.pdf

ESHRE Guideline: management of women with premature ovarian insufficiency

Ten years after the first results from the Women's Health Initiative (WHI) trial were published, it seems that the atmosphere around the issue of menopausal hormone therapy (MHT) is increasingly ev

https://www.spog.org.pe/web/phocadownloadpap/ADULTEZTARDIA.pdf

Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health.

Objective: To update practice guidelines for the therapeutic use of androgens in women. Participants: A Task Force appointed by the Endocrine Society, American Congress of Obestricians and Gynecologists (ACOG), American Society for Reproductive Medicine (ASRM), European Society of Endocrinology (ESE), and International Menopause Society (IMS) consisting of six experts, a methodologist, and a medical writer. Evidence: The Task Force commissioned two systematic reviews of published data and considered several other existing meta-analyses and trials. The GRADE methodology was used; the strength of a recommendation is indicated by a number “1” (strong recommendation, we recommend) or “2” (weak recommendation, we suggest). Consensus Process: Multiple e-mail communications and conference calls determined consensus. Committees of the Endocrine Society, ASRM, ACOG, ESE, and IMS reviewed and commented on the drafts of the guidelines. Conclusions: We continue to recommend against making a diagnosis of androgen defi...

/pdf/androgen-therapy-in-women-a-reappraisal-an-endocrine-society-3s2scw6ws0.pdf

Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline

The past decade has seen marked fluctuations in opinions concerning the merits and risks of postmenopausal hormone replacement therapy (HRT). In July 2002, menopause management faced a major turnin...

/pdf/updated-ims-recommendations-on-postmenopausal-hormone-18np4n42zn.pdf

Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health.

Introduction Hypoactive Sexual Desire Disorder (HSDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DSM-IV-TR) as persistent deficient sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. In the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5), HSDD has been subsumed by Female Sexual Interest/Arousal Disorder. However, decades of research based on DSM-IV-TR HSDD criteria form the foundation of our understanding of the essential symptom of distressing low sexual desire, its epidemiology, clinical management, and treatment. Aim This publication reviews the state of knowledge about HSDD. Methods A literature search was performed using terms HSDD and female sexual dysfunction (FSD). Main Outcome Measures Physicians acknowledge that FSD is common and distressing; however, they infrequently address it, citing low confidence, time constraints, and lack of treatment as barriers. Results HSDD is present in 8.9% of women ages 18 to 44, 12.3% ages 45 to 64, and 7.4% over 65. Although low sexual desire increases with age, distress decreases; so prevalence of HSDD remains relatively constant across age. HSDD is associated with lower health-related quality of life; lower general happiness and satisfaction with partners; and more frequent negative emotional states. HSDD is underdetected and undertreated. Less than half of patients with sexual problems seek help from or initiate discussions with physicians. Patients are inhibited by fear of embarrassing physicians and believe that physicians should initiate discussions. The Decreased Sexual Desire Screener, a tool for detecting and diagnosing HSDD, is validated for use in general practice. Conclusion Women can benefit from intervention in primary care, behavioral health and sexual medicine settings. Psychotherapeutic and pharmacological interventions aim to enhance sexual excitatory process and decrease inhibitory processes. Flibanserin, the first centrally acting daily medication for HSDD, was recently approved in the US for premenopausal women.

Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment.

Objective To evaluate the efficacy and safety of a transdermal testosterone patch (TTP, 300 mg/day) in naturally menopausal women with hypoactive sexual desire disorder (HSDD). Methods A total of 272 naturally menopausal women, predominantly not using hormone therapy, were randomized in this 6-month, placebo-controlled, double-blind, multicenter study to receive twice weekly either TTP or an identical placebo. Efficacy endpoints measured were the 4-week frequency of satisfying sexual episodes (SSE) using the Sexual Activity Log, the sexual desire domain of the Profile of Female Sexual Function and distress by the Personal Distress Scale. Safety was assessed by adverse events, laboratory parameters and hormone levels. Results The TTP group demonstrated significant improvements in SSE (p ¼ 0.0089) as well as in sexual desire (p ¼ 0.0007) and reduced personal distress (p ¼ 0.0024) versus placebo at 6 months (intent-to-treat analysis, n ¼ 247). The results were significant for all three endpoints in the subgroup (n ¼ 199) not using hormone therapy. Similar numbers of women treated with placebo and TTP discontinued (n ¼ 39, 27.5% vs. n ¼ 26, 20%), reported adverse events (including application site reactions) (n ¼ 101, 71.1% vs. n ¼ 81, 62.3%) and withdrew due to adverse events (n ¼ 20, 14.1% vs. n ¼ 9, 6.9%). No clinically relevant changes were noted in laboratory parameters. Serum free and total testosterone levels increased from baseline in the TTP group (geometric means 5.65 pg/ml and 67.8 ng/dl, respectively, at week 24) within the physiological range; no changes were seen in estradiol and sex hormone binding globulin levels. Conclusions TTP was effective in treating HSDD and improving sexual function in this study of naturally menopausal women with and without concurrent hormone therapy.

F. Al-Azzawi

Papers

Testosterone treatment of HSDD in naturally menopausal women: the ADORE study.