Committee Opinion No. 698: Hormone Therapy in Primary Ovarian Insufficiency

Abstract

Primary ovarian insufficiency describes a spectrum of declining ovarian function and reduced fecundity due to a premature decrease in initial follicle number, an increase in follicle destruction, or poor follicular response to gonadotropins. The sequelae of primary ovarian insufficiency include vasomotor symptoms, urogenital atrophy, osteoporosis and fracture, cardiovascular disease, and increased all-cause mortality. In women with primary ovarian insufficiency, systemic hormone therapy (HT) is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks if there are no contraindications to treatment. Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency. Although exogenous estrogen replacement is recommended for women with primary ovarian insufficiency, data comparing various hormonal regimens for disease prevention, symptom amelioration, and safety are lacking in this population. As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. Combined hormonal contraceptives prevent ovulation and pregnancy more reliably than HT; despite only modest odds of spontaneous pregnancy in women with primary ovarian insufficiency, this is a critical consideration for those who deem pregnancy prevention a priority. Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 50-51 years). Finally, considering the challenges that adolescents and young women may face in coping with the physical, reproductive, and social effects of primary ovarian insufficiency, comprehensive longitudinal management of this condition is essential.

Hormone autocrination by vascularized hydrogel delivery of ovary spheroids to rescue ovarian dysfunctions

“…Menopause limits normal physiological activities due to a loss of ovarian function ( 4 ). For example, primary ovarian insufficiency hinders fertility functions in menopausal women (<40 years old) because of a decrease in the number of follicles at a premature stage ( 5 , 6 ). These menopausal situations are often accompanied by vasomotor symptoms, urogenital atrophy, osteoporosis and fracture, cardiovascular disease, and an increased all-cause mortality.…”

Impact of Hormonal Replacement Therapy on Bone Mineral Density in Premature Ovarian Insufficiency Patients

“…Current standards of practice dictate that the dose of exogenous estradiol should achieve replacement levels comparable to natural serum estrogen. Currently recommended formulations for patients with POI include daily doses of: 1-2 mg micronized oral E2; 100 µg transdermal E2; or 0.625-1.25 mg oral conjugated EE [1,30].…”

Bone health and evaluation of bone mineral density in patients with premature ovarian insufficiency

“…1 ). Doses of oestradiol should be appropriate for achieving good control of symptoms and protection against side health consequences; nevertheless, assessment of oestradiol concentration should not be conducted [ 21 ]. Patients suffering from POI without properly developed secondary sex characteristics and presenting primary amenorrhoea should be prescribed increasing doses of oestrogen replacement therapy due to gradual maturation induction.…”

“…Combined hormonal contraceptives can be prescribed to patients particularly seeking ovulation preservation, despite the fact that in POI patients ovulation is rare [ 21 ]. Insertion of an intrauterine device with levonorgestrel due to protection of endometrial hyperplasia and against pregnancy with additional administration of non-contraceptive oestrogens is noteworthy.…”