Quality statement 2: Diagnosing premature ovarian insufficiency

Quality statement

Women under 40 years presenting with menopausal symptoms have their levels of follicle-stimulating hormone (FSH) measured.

Rationale

An early diagnosis of premature ovarian insufficiency can mean these women get treatment and access to specialised services sooner. This is particularly important because this group of women have higher morbidity and mortality during menopause than women over 45 years. Although in women under age 40 menstrual history is often the first indication of premature ovarian insufficiency, persistently elevated FSH levels are needed to confirm the diagnosis in this age group. Changes in menstrual history can also suggest other conditions, for example, pregnancy or polycystic ovarian syndrome, and these should also be considered when making a diagnosis. Women with untreated premature ovarian insufficiency (particularly surgical menopause) are at increased risk of developing osteoporosis and cardiovascular disease.

Quality measures

Structure

Evidence of local arrangements to ensure that women under 40 years presenting with menopausal symptoms have their FSH levels measured.

Data source: Local data collection.

Process

Proportion of women under 40 years presenting with menopausal symptoms who have their FSH levels measured.

Numerator – the number in the denominator who have their FSH levels measured.

Denominator – the number of women under 40 years presenting with menopausal symptoms.

Data source: Local data collection.

Outcome

a) Proportion of women with premature ovarian insufficiency who had a positive experience of the diagnostic process.

Data source: Local data collection.

b) Average time to diagnosis of premature ovarian insufficiency from first presenting with menopausal symptoms for women under 40 years.

Data source: Local data collection.

c) Incidence of premature ovarian insufficiency.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (primary and secondary care and community services) ensure that systems are in place for women under 40 presenting with menopausal symptoms to have their FSH levels measured.

Healthcare professionals (such as GPs, practice nurses and healthcare professionals with expertise in menopause) base a diagnosis of premature ovarian insufficiency on symptoms and elevated FSH levels in women under 40 who present with menopausal symptoms.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which women under 40 presenting with menopausal symptoms have their FSH levels measured.

Women under 40 who visit their GP or practice nurse with common symptoms of the menopause are offered blood tests for hormone levels to find out whether they have premature menopause (also known as premature ovarian insufficiency). The sooner a diagnosis is made, the sooner any treatment of symptoms can start.

Source guidance

Menopause (2015) NICE guideline NG23, recommendation 1.6.2

Definitions of terms used in this quality statement

Premature ovarian insufficiency

Menopause occurring before the age of 40 years, which is also known as premature ovarian failure or premature menopause. It can occur naturally or as a result of medical or surgical treatment.

[NICE's guideline on menopause, terms used in the guideline]

Menopausal symptoms

Symptoms include the following:

  • no or infrequent periods (taking into account whether the women has a uterus)

  • hot flushes

  • night sweats

  • mood changes

  • memory and concentration loss

  • vaginal dryness

  • lack of interest in sex

  • headaches

  • joint and muscle stiffness.

[Adapted from NICE's guideline on menopause, context section and recommendations 1.3.2 and 1.6.2]

Measuring FSH

Two blood samples taken 4 to 6 weeks apart.

[NICE's guideline on menopause, recommendation 1.6.2]