From the Guidelines
The treatment for primary ovarian insufficiency (POI) primarily involves hormone replacement therapy (HRT) until the natural age of menopause (around 51 years). The standard regimen consists of estrogen therapy, typically 17β-estradiol at 1-2 mg daily orally or 0.05-0.1 mg transdermal patch, combined with cyclic progesterone (such as micronized progesterone 200 mg daily for 12-14 days each month) for women with an intact uterus to prevent endometrial hyperplasia 1. For younger women with POI, higher estrogen doses may be needed compared to those used for postmenopausal women.
Key Considerations
- Calcium supplementation (1200-1500 mg daily) and vitamin D (800-1000 IU daily) are also recommended to maintain bone health 1.
- Regular physical activity and a healthy diet further support bone density.
- Psychological support is essential as POI can cause significant emotional distress.
- For women desiring pregnancy, options include egg donation, embryo donation, or adoption, as spontaneous conception is rare (1-5% chance).
Hormone Replacement Therapy
HRT is crucial not only for symptom management but also for preventing long-term health consequences like osteoporosis and cardiovascular disease associated with premature estrogen deficiency 1. The choice of progestin should be based on the individual patient's needs and co-morbidities, with medroxyprogesterone acetate (MPA) and natural micronized progesterone (MP) being viable options 1.
Administration Regimens
When prescribing HRT, clinicians should choose between a sequential and continuous regimen of administration, with the latter preventing withdrawal bleeding 1. The dose of progestogen is based on the concurrent dose of estrogen administered.
Patient-Specific Factors
The favorite route of administration, desire of avoiding periodical withdrawal bleeding, and the hormonal treatment undertaken for pubertal induction are some of the additional criteria that clinicians should take into account when choosing among the available formulations 1.
From the FDA Drug Label
Treatment of hypoestrogenism due to hypogonadism, castration or primary ovarian failure. The answer to the question is:
- Conjugated estrogens (PO) can be used for the treatment of primary ovarian insufficiency, as it is indicated for the treatment of hypoestrogenism due to primary ovarian failure 2.
- This is a direct indication from the FDA drug label.
From the Research
Treatment Options for Primary Ovarian Insufficiency
- Hormone therapy (HT) is an effective approach to treat symptoms of hypoestrogenism and mitigate long-term health risks in women with primary ovarian insufficiency, as stated in 3 and 4.
- Systemic hormone therapy is recommended to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy, and to improve quality of life, as mentioned in 3.
- Combined hormonal contraceptives can prevent ovulation and pregnancy, and may be considered for women with primary ovarian insufficiency who desire pregnancy prevention, as noted in 3.
Hormone Replacement Therapy
- Hormone replacement therapy (HRT) is paramount to increasing quality of life for women with primary ovarian insufficiency and ameliorating associated health risks, as discussed in 4.
- HRT formulations that most closely mimic normal ovarian hormone production are recommended, and treatment should continue until the normal age of natural menopause, around 50 years, as stated in 4 and 5.
- Transdermal oestradiol and oral or vaginal progesterone administration provide the most physiological sex steroid replacement therapy, as mentioned in 5.
Benefits and Risks of Hormone Therapy
- Hormone therapy is associated with a reduction in the prevalence of hot flushes and improvement in quality of life scores, as found in 6.
- Hormone therapy can preserve bone mineral density and avoid uterine atrophy in women with primary ovarian insufficiency, as reported in 6.
- However, evidence supporting bone and cardiovascular benefits of HT in women with primary ovarian insufficiency is limited by high risk of bias and heterogeneity of trials, as noted in 7.
Management of Primary Ovarian Insufficiency
- Women with primary ovarian insufficiency should be managed by a multidisciplinary team, including a gynaecologist, endocrinologist, dietitian, and psychologist, as recommended in 5.
- Patients' views and individual preference regarding the route, dose, and regimen of hormonal treatment should be taken into consideration to achieve high compliance rates, as stated in 5.