Objective  To explore the evidence for Traditional Chinese Medicine (TCM) in the treatment of premature ovarian insufficiency (POI) based on evidence map and re-evaluation of systematic reviews.

Methods  CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library and Web of Science database were electronically searched to collect systematic reviews (SR)/Meta-analysis on the treatment of POI with TCM from the inception to March 31, 2025. The reporting quality, methodological quality, and evidence quality of the included studies were evaluated using the PRISMA 2020 Statement, AMSTAR 2 Checklist, and GRADE system, respectively. The interventions, number of studies, and evidence grades were comprehensively displayed using evidence map.

Results  A total of 15 SR/Meta-analysis were included, comprising 9 Chinese articles and 6 English articles. The PRISMA 2020 checklist evaluation revealed that 8 articles had certain deficiencies in reporting, while 7 articles demonstrated relatively complete reporting. Based on the AMSTAR 2 checklist, 5 articles were rated as high-level and 10 as very low-level. A total of 10 primary outcome indicators were involved, reported 133 times. When classified using the GRADE system, there were 20 pieces of moderate-quality evidence, 58 pieces of low-quality evidence, and 55 pieces of very low-quality evidence. The evidence map showed that TCM alone or in combination with hormone therapy could effectively treat POI, reduce follicle-stimulating hormone and luteinizing hormone levels, increase estradiol levels, and improve clinical manifestations and TCM syndrome manifestations.

Conclusion  TCM has certain advantages in the treatment of POI, enhancing the overall treatment effect, alleviating clinical symptoms of low estrogen, and regulating sex hormone levels to some extent. However, there are deficiencies in methodological quality and reporting quality, and the level of evidence is not high. Therefore, the findings should be used with caution in clinical practice.

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