Quality standard

Quality statement 2: Diagnosing premature ovarian insufficiency

Quality statement 2: Diagnosing premature ovarian insufficiency

Quality statement

Women, trans men and non-binary people registered female at birth under 40 presenting with menopause-associated symptoms have their levels of follicle-stimulating hormone (FSH) measured.

Rationale

An early diagnosis of premature ovarian insufficiency can help ensure treatment and access to specialised services sooner. This is particularly important because this population have higher morbidity and mortality during menopause than those over 45. Although in women, trans men and non-binary people registered female at birth under 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. People with untreated premature ovarian insufficiency (particularly surgical menopause) are at increased risk of developing osteoporosis and cardiovascular disease.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of women, trans men and non-binary people registered female at birth under 40 presenting with menopause-associated symptoms who have their FSH levels measured.

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

Denominator – the number of women, trans men and non-binary people registered female at birth under 40 presenting with menopause-associated symptoms.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Average time to diagnosis of premature ovarian insufficiency from first presenting with menopause-associated symptoms for women, trans men and non-binary people registered female at birth under 40.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

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, trans men and non-binary people registered female at birth under 40 presenting with menopause-associated 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, trans men and non-binary people registered female at birth under 40 who present with menopause-associated symptoms.

Commissioners ensure that they commission services in which women, trans men and non-binary people registered female at birth under 40 presenting with menopause-associated symptoms have their FSH levels measured.

Women, trans men and non-binary people registered female at birth under 40 who visit their GP or practice nurse with common symptoms associated with 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: identification and management. NICE guideline NG23 (2015, updated 2024), recommendation 1.7.2

Definitions of terms used in this quality statement

Premature ovarian insufficiency

Menopause occurring before the age of 40, 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, full guideline glossary]

Menopause-associated symptoms

Menopause-associated symptoms include the following:

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

  • vasomotor symptoms (hot flushes and night sweats)

  • effects on mood (for example, depressive symptoms)

  • genitourinary symptoms (for example, vaginal dryness)

  • musculoskeletal symptoms (for example, joint and muscle pain)

  • sexual difficulties (for example, low sexual desire).

[Adapted from NICE's guideline on menopause, context section and recommendations 1.2.2 and 1.3.1]

Measuring FSH

Two blood samples taken 4 to 6 weeks apart. [NICE's guideline on menopause, recommendation 1.7.2]