Complementary therapies for women with premature ovarian insufficiency: a systematic literature review to inform the 2024 update of the ESHRE/ASRM/IMS/CRE-WHiRL guidelines on premature ovarian insufficiency

Objective: Premature ovarian insufficiency (POI) is associated with reduced quality of life and increased health risks. While hormone therapy (HT) is standard treatment, some women seek other options to treat its sequelae. This review explores the role of complementary therapies for POI. Method: A systematic search of four databases up to January 2024 identified randomized controlled trials, systematic reviews, meta-analyses and umbrella reviews that examined the use of complementary therapies by women with POI. Outcomes included menopausal symptoms, gonadotropins, antral follicle count, ovarian volume and quality of life. Study quality was evaluated using Cochrane Risk of Bias and A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Results: The search identified 1869 citations, with nine studies meeting the inclusion criteria. Findings suggest that Chinese herbal medicine and acupuncture may alleviate menopausal symptoms and regulate gonadotropins in women with POI, although evidence is very limited. There is insufficient evidence for other complementary therapies for POI. Conclusion: While Chinese herbal medicine may improve menopausal symptoms, there is insufficient evidence specific to POI. There is a clear need for additional and rigorous research on the efficacy and safety of complementary therapies for POI. Evidence does not support complementary medicines as replacements for HT.