Hormone therapy (HT) in women with premature ovarian insufficiency or early menopause: Time to think of a new paradigm for healthy aging. A joint FIGO and IMS position paper

Premature ovarian insufficiency (POI) and early menopause (EM) affect millions of women worldwide. Compared with normal menopause, they confer a longer duration of estrogen deficiency and are associated not only with a shorter lifespan, but with a reduced healthspan, owing to an increased risk of cardiovascular, skeletal, cognitive and psychological morbidity, and sexual health concerns. Therefore, interventions in POI/EM represent some of the most actionable opportunities to reduce long-term disability and promote healthy longevity. However, current approaches to hormone therapy (HT) in POI/EM remain fragmented, delayed, and overly influenced by paradigms derived from older postmenopausal populations. We propose a shift toward a life-course model of care. POI and EM should no longer be managed as variants of menopause at normal age but recognized as chronic endocrine conditions and sentinel events for accelerated aging in women. HT should be reframed as a hormonal replacement aimed at preventing long-term disability. Timely initiation, adequate dosing, and long-term continuation of HT should be considered foundational to POI/EM care, alongside integrated preventive strategies. FIGO and IMS, therefore, call for a globally coordinated effort to strengthen awareness, professional education, and research on POI/EM, and to ensure equitable access to multidisciplinary care, with the goal of improving women's health and supporting the long-term sustainability of healthcare systems.