Introduction
Premature ovarian insufficiency (POI) is a clinically significant endocrine disorder characterized by loss of ovarian function before the age of 40, affecting approximately 1% of women worldwide. This condition leads to infertility, hypoestrogenism, and increased risks of osteoporosis and cardiovascular disease, imposing a substantial burden on women’s health. Despite advances in assisted reproductive technologies and endocrinology, the etiologies underlying POI remain heterogeneous and often elusive, highlighting an urgent need to better understand the mechanisms driving ovarian failure and to guide novel therapeutic strategies.
In recent decades, the number of scientific publications targeted at POI has grown markedly due to technological advancements in genomics, immunology, and reproductive biology as well as intensified interdisciplinary collaborations. However, the rapidly expanding and complex scientific literature poses challenges in synthesizing knowledge and identifying key paradigms and emerging trends.
Study Design and Methods
To systematically assess the research landscape of POI, Cheng et al. conducted a bibliometric analysis selecting the 100 most-cited articles from the Web of Science (WOS) SCI-Expanded database, covering publications between 1999 and 2024. They employed a combination of bibliometric tools—VOS viewer, CiteSpace, and Scimago Graphica—to construct knowledge graphs delineating co-authorship networks, thematic clusters, and citation metrics.
Data extraction was standardized using Microsoft Excel to catalog publication sources, author affiliations, country of origin, citation counts, keywords, and research categories, facilitating qualitative and quantitative analysis of research priorities and trends. This approach provided a comprehensive overview of influential contributions guiding the field.
Key Findings
Publication Landscape and Contributors: The analysis identified that 53 academic journals from 34 countries published the top 100 most-cited POI articles, reflecting global research efforts. The Journal of Clinical Endocrinology & Metabolism led in the sheer number of publications, whereas The Lancet demonstrated the highest average citations per article, indicating influential clinical investigations or reviews.
Geographically, the United States maintained preeminence in research output, with China and France as significant contributors. Leading institutions included Erasmus MC (Netherlands), Shanghai Jiao Tong University, and Shandong University (China), each with a robust portfolio of influential publications, underscoring international academic leadership in this domain.
Research Categories and Thematic Focus: The major categories encompassed obstetrics and gynecology, endocrinology and metabolism, and reproductive biology, reflecting the multidisciplinary nature of POI research.
Keyword and Cluster Analysis: Prominent keywords extracted frequently were “failure,” “women,” “anti-Müllerian hormone” (AMH), “natural menopause,” and “age.” AMH, a biomarker for ovarian reserve, stands out as both a diagnostic and prognostic marker for POI, underscoring its clinical importance.
Cluster analysis revealed burgeoning interest in areas such as hereditary genetics, cardiovascular diseases, and cellular immunogenetics. This suggests evolving scientific efforts not only to decipher genetic predispositions but also to understand systemic consequences of POI, including cardiovascular pathology and immune-mediated mechanisms.
Expert Commentary and Interpretation
The bibliometric results align well with contemporary clinical observations: POI is no longer viewed solely as an isolated gynecological condition but as a systemic disorder with complex genetic, metabolic, and immunological underpinnings. The prominence of genetic and molecular biology research reflects advances in next-generation sequencing and genome-wide association studies helping elucidate pathogenic variants linked to follicular depletion.
The correlation of POI with cardiovascular diseases based on keyword mapping is clinically relevant given the estrogen deficiency-related endothelial dysfunction and atherogenesis seen in early ovarian failure. Furthermore, immunogenetics involvement indicates potential autoimmune pathologies contributing to POI development or progression.
Despite the insightful findings, bibliometric analyses provide a macroscopic snapshot and may be influenced by citation bias favoring older or landmark studies. Emerging fields such as epigenetics, novel biomarkers, and therapeutic interventions will require ongoing surveillance.
Conclusions and Future Directions
This bibliometric study offers a valuable overview of the research frontiers in POI, highlighting key journals, countries, institutions, and thematic trends. Importantly, it identifies genetic and molecular biology pathways, cardiovascular implications, and immunological aspects as prominent future research vectors.
Ongoing multidisciplinary efforts integrating clinical, genetic, and immunological data are essential to unravel POI pathophysiology fully and to develop personalized diagnostics and treatments. Enhanced collaboration across international centers, leveraging big data and bioinformatics, will be paramount to accelerate translational advances for women affected by this debilitating condition.
In clinical practice, heightened awareness of the systemic risks associated with POI must inform comprehensive management strategies encompassing cardiovascular risk reduction and bone health optimization alongside fertility preservation.
References
Cheng C, Liu S, Yu Z, Zhu K, Liu R, Li X, Zhang J. Frontiers of premature ovarian insufficiency research: an analysis from the top 100 most influential articles in the field. Gynecol Endocrinol. 2025 Dec;41(1):2470986. doi: 10.1080/09513590.2025.2470986. Epub 2025 Feb 28. PMID: 40019489.
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Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertil Steril. 2016 Aug;106(3):1588-1599. doi:10.1016/j.fertnstert.2016.07.005.
Webber L, Davies M, Anderson R, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016 May;31(5):926-37. doi:10.1093/humrep/dew027.
