From the Guidelines
The recommended treatment for ovarian insufficiency typically involves hormone replacement therapy (HRT) until the natural age of menopause (around 50-51 years). The standard regimen includes estrogen, such as 17-beta estradiol, combined with progesterone, such as micronized progesterone, for women with an intact uterus to prevent endometrial hyperplasia 1.
Key Considerations
- For younger women with primary ovarian insufficiency, higher doses of estrogen may be needed compared to those used for menopausal women.
- Calcium and vitamin D supplements are also recommended to maintain bone health.
- Regular monitoring of bone density is important.
- HRT helps prevent long-term health consequences like osteoporosis, cardiovascular disease, and cognitive issues while alleviating symptoms such as hot flashes, vaginal dryness, and sleep disturbances.
Treatment Options
- Estrogen replacement: 17-beta estradiol (1-2 mg daily orally, 0.05 mg transdermal patch, or 0.5 mg gel) 1.
- Progesterone replacement: micronized progesterone (200 mg daily for 12-14 days each month or 100 mg daily continuously) for women with an intact uterus to prevent endometrial hyperplasia 1.
- Calcium supplements: 1200-1500 mg daily.
- Vitamin D supplements: 800-1000 IU daily.
Fertility Options
- For women desiring pregnancy, egg donation with in vitro fertilization is typically the only effective option, as ovarian function cannot usually be restored 1.
Guideline Recommendations
- The European Society for Human Reproduction and Embryology (ESHRE) guideline on the management of women with premature ovarian insufficiency offers best practice advice on the care of women with POI, both primary and secondary 1.
From the FDA Drug Label
Treatment of hypoestrogenism due to hypogonadism, castration or primary ovarian failure. The recommended treatment for ovarian insufficiency is estrogen therapy, such as conjugated estrogens (PO), to treat hypoestrogenism due to primary ovarian failure 2.
- The treatment goals are to alleviate symptoms and prevent long-term complications associated with estrogen deficiency.
- The dosage and administration of estrogen therapy should be individualized and monitored periodically to determine if treatment is still necessary 2.
From the Research
Treatment for Ovarian Insufficiency
The recommended treatment for ovarian insufficiency involves hormone replacement therapy (HRT) to alleviate symptoms and prevent long-term consequences.
- HRT should be initiated at the time of diagnosis and continued until at least the age of natural menopause 3, 4.
- Transdermal oestradiol and oral or vaginal progesterone administration are considered the most physiological sex steroid replacement therapy 3.
- The treatment regimen should be individualized, taking into account the patient's preferences and medical history 3, 4.
- HRT has been shown to be effective in preserving bone mineral density, reducing hot flushes, and improving quality of life in women with premature ovarian insufficiency (POI) 5.
- Hormone therapy with oestrogen and progesterone or progestin, including contraceptives, is beneficial for women with POI, mitigating hypoestrogenic symptoms, preserving bone mineral density, and avoiding uterine atrophy 5.
Hormone Replacement Therapy Regimens
Different HRT regimens have been studied, including:
- Conjugated oral oestrogens versus transdermal 17ß-oestradiol 6
- Low versus high 17ß-oestradiol dose 6
- Oral versus vaginal administration of oestradiol and dydrogesterone 6
- However, the optimal effective HRT regimen to maximize reproductive potential for women with POI remains unclear 6.
Management of Long-Term Consequences
Women with POI should be managed by a multidisciplinary team, including a gynaecologist, endocrinologist, dietitian, and psychologist, to address the long-term consequences of ovarian insufficiency, such as: