Here we present the recommendations for premature ovarian insufficiency surveillance for female childhood, adolescent and young adult cancer survivors.

General recommendation

General recommendation

Who needs premature ovarian insufficiency surveillance?

who needs


What surveillance modality should be used for pre- and peri-pubertal survivors?

 what modality pre and peri

What surveillance modality should be used for post-pubertal survivors?

 what modality post

When should pre- and peri-pubertal survivors be referred?

 Referred pre and peri

When should post-pubertal survivors be referred?

Referred post

What should be done when abnormalities are identified in pre-, peri- and post-pubertal survivors?

what done abnormalities

What should be done when potential for future fertility is questioned?

what done future fertility





Definition POI: a clinical condition developing in any adult female before 40 years of age, characterized by: (1) absence of menses for at least 4 months, and (2) two elevated serum follicle-stimulating hormone (FSH) levels in the menopausal range (based on the maximum threshold of the laboratory assay used)
Treatments with evidence for causing premature ovarian insufficiency include alkylating agents in general (level A evidence), cyclophosphamide, procarbazine (level C evidence), and radiotherapy potentially exposing the ovaries (level A evidence)
At least annually, with increasing frequency as clinically indicated based on growth and pubertal progression.
At least for girls of 11 years of age and older, and for girls with primary amenorrhoea (age 16).
# If amenorrhoea, measure FSH and oestradiol randomly; if oligomenorrhoea, measure during early follicular phase (day 2-5).
§ This assessment should be performed after ending oral contraceptive pill/sex steroid replacement therapy use, ideally after four months without oral contraceptive pills (based on: amenorrhoea=no menstrual cycle for at least four months).
The absence of initiation of puberty (Tanner stage 2 breast development) in girls 13 years or older or failure to progress in pubertal stage for ≥12 months.

Green = strong recommendations to do; Orange = weak recommendation to do; Red = recommendation not to do.

See Journal of Clinical Oncology for the publication.