Use of hormone therapy in patients with premature ovarian insufficiency in tertiary hospitals in Saudi Arabia

OBJECTIVE: To examine diagnostic and treatment patterns of premature ovarian insufficiency (POI) in tertiary care settings in Saudi Arabia, with a focus on hormone therapy (HT) use. METHODS: A retrospective chart review was conducted at three hospitals from February 2002 to May 2024. POI was defined as follicle-stimulating hormone (FSH) > 25 IU/L. Patients aged 40 years or below, who underwent FSH testing on the basis of classic symptoms, were identified. Inclusion criteria were limited to women 40 years or below who had undergone FSH testing with a FSH concentration level of >25 IU/L; exclusion criteria included incomplete demographic or clinical data and duplicate test records. Among 255,204 eligible patients, 22,420 underwent FSH testing, of whom 1,132 met POI criteria. We performed a sample size calculation based on a pilot dataset (prevalence of HT use = 35.7%). Based on this, 205 notes were analyzed using descriptive statistics and comparative analysis. RESULTS: POI prevalence among tested women was 5.05% (95% CI: 4.77-5.34). Only 35.6% of women with POI received HT. Uptake was highest in genetically confirmed cases (62.1%) and lowest in cases with XY chromosomal abnormalities (8.3%) or iatrogenic causes (0%). Amenorrhea (42.4%) was the most common presenting symptom and significantly associated with HT use ( P = 0.001). HT uptake remained low despite diagnoses of osteopenia (6.8%) and osteoporosis (4.9%). CONCLUSIONS: HT is underutilized among women with POI in Saudi Arabia. Variability in prescription reflects systemic barriers, lack of national guidance, and insufficient physician training. Standardized protocols and structured follow-ups are urgently required to improve long-term health outcomes.