When should I refer a patient with suspected Premature Ovarian Insufficiency to a specialist for further evaluation and management?

Refer a patient with suspected premature ovarian insufficiency (POI) to a specialist when:

• There is uncertainty about the diagnosis of POI after initial assessment, including if the diagnosis is not clear based on clinical history and follicle stimulating hormone (FSH) levels on two blood samples taken 4 to 6 weeks apart.
• The patient is likely to experience menopause as a result of medical or surgical treatment (e.g., cancer treatment or gynaecological surgery).
• Specialist investigations are needed, such as anti-Müllerian hormone (AMH) testing, genetic/chromosomal analysis, or autoantibody testing to assess for underlying causes.
• There are persistent symptoms requiring management advice, including hormone replacement therapy (HRT) options or contraindications to treatment.
• Psychological support or specialist advice is needed, for example, for altered sexual function or distress related to early menopause.

Referral should be to a specialist with expertise in menopause or reproductive medicine for comprehensive evaluation and management.