Premature ovarian insufficiency: addressing the most controversial issues

It was a true honor to be invited as President to deliver the Pieter Van Keep oration at the 2024 International Menopause Society (IMS) Congress in Melbourne, Australia. There was never any doubt that the topic of my lecture would be premature ovarian insufficiency (POI). POI is a condition which has been neglected for far too long given its greater global prevalence than originally estimated and its implications to the sufferers, both in terms of quality of life and long-term well-being. The hope is that we are now entering a new era of awareness given the recent update of the European Society of Human Reproduction (ESHRE) POI guideline, achieved through a partnership of the ESHRE, American Society for Reproductive Medicine (ASRM), Centre for Research Excellence in Women's Health in Reproductive Life (CRE WHiRL) at Monash University and IMS with support from numerous global stakeholder organizations. Whilst as a minimum the update of the guideline is expected to improve clinical management of this condition, the process has also identified key areas of much-needed research, where currently only practical guidance can be given due to the lack of data. The aim of my Pieter Van Keep lecture, and therefore this article, was not to replicate the extensive work already conducted to systematically review the literature for the guideline. The aim was to provide a state-of-the-art commentary highlighting the key controversial topics regarding this distressing condition, and how these are being addressed, or should be addressed in the future, for the sake of sufferers and their families.