From the Guidelines
Hormone replacement therapy (HRT) is the primary treatment for ovarian insufficiency, as it helps alleviate symptoms and prevent long-term complications such as osteoporosis and cardiovascular disease. The standard regimen consists of estrogen (such as estradiol 1-2 mg daily orally or 0.05 mg patch twice weekly) combined with progesterone (such as micronized progesterone 100-200 mg daily for 12-14 days each month or continuously) for women with an intact uterus, as recommended by the European Society of Human Reproduction and Embryology (ESHRE) guideline on the management of women with premature ovarian insufficiency 1.
Key Considerations
- The therapy should be continued until the average age of natural menopause (around 51 years) to prevent complications like osteoporosis, cardiovascular disease, and vasomotor symptoms.
- For younger women, higher estrogen doses may be needed to achieve symptom relief and bone protection, and the treatment should be carefully tailored according to the patient's individual needs and co-morbidities 1.
- Regular monitoring including bone density scans every 1-2 years is recommended.
- HRT works by replacing the hormones that would naturally be produced by functioning ovaries, addressing both immediate symptoms like hot flashes and long-term health risks.
- Calcium (1200-1500 mg daily) and vitamin D (800-1000 IU daily) supplements are also important adjunctive treatments.
- For women seeking pregnancy, egg donation with in vitro fertilization is typically required as ovarian insufficiency generally causes infertility.
Treatment Approach
- Transdermal 17βEstradiol-based hormonal replacement therapy should represent the first choice in terms of safety profile in patients with cancer-related late effects, unless contraception is regarded as a paramount 1.
- Combined oral contraceptives should be prescribed only in patients deeming contraception as a priority.
- 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 Research
Ovarian Insufficiency Treatment
The primary treatment for ovarian insufficiency is hormone replacement therapy (HRT). This treatment is effective in relieving symptoms such as hot flashes and vaginal dryness, as well as preventing bone loss and reducing the risk of cardiovascular disease 2, 3, 4, 5.
Benefits of HRT
The benefits of HRT for women with ovarian insufficiency include:
- Relief from vasomotor symptoms such as hot flashes and night sweats
- Prevention of bone loss and reduction of the risk of osteoporosis
- Improvement in genitourinary symptoms such as vaginal dryness
- Possible reduction in the risk of cardiovascular disease
- Improvement in quality of life 2, 3, 4, 5
Types of HRT
There are different types of HRT available, including:
- Estrogen-only therapy
- Combined estrogen and progestogen therapy
- Transdermal estrogen therapy
- Oral or vaginal progesterone administration The choice of HRT depends on the individual woman's needs and preferences, as well as her medical history and risk factors 3, 4, 5
Importance of Individualized Treatment
It is essential to individualize HRT treatment for each woman, taking into account her specific needs and preferences. This includes considering the route, dose, and regimen of hormonal treatment, as well as her contraceptive needs and medical history 4, 5
Management of Ovarian Insufficiency
Women with ovarian insufficiency should be managed by a multidisciplinary team, including a gynecologist, endocrinologist, dietitian, and psychologist. This team can provide comprehensive care and support to address the physical and emotional symptoms of ovarian insufficiency, as well as reduce the risk of long-term consequences such as cardiovascular disease and osteoporosis 4