What supplements are recommended for premature ovarian reserve?

Supplements for Premature Ovarian Reserve

Sex hormone replacement therapy is the primary recommended treatment for premature ovarian insufficiency (POI), with no specific supplements having strong evidence to improve ovarian reserve. 1

Hormone Replacement Options

First-line therapy

• Transdermal 17β-estradiol: 50-100 μg/24 hours via patches (changed twice weekly or weekly)
  • Combined with cyclic progestin (for women with intact uterus)
  • Preferred over oral estrogen due to better cardiovascular and thrombotic risk profile 1

Progestin options (in order of preference)

1. Natural micronized progesterone: 200 mg orally or vaginally for 12-14 days per month
   • Better cardiovascular profile and neutral effect on blood pressure 1
2. Dydrogesterone: 10 mg for 12-14 days per month
3. Medroxyprogesterone acetate: 10 mg for 12-14 days per month

Bone Health Support

Women with POI have significantly higher risk of osteoporosis and fractures. The following are recommended:

• Calcium supplementation: 1000-1200 mg daily 1
• Vitamin D supplementation: 800-1000 IU daily 1, 2
• Weight-bearing exercise: Regular physical activity to maintain bone density 1
• Bone mineral density (BMD) measurement: At initial diagnosis of POI and follow-up within 5 years if abnormal 1

Cardiovascular Health

Women with POI have increased cardiovascular risk that should be addressed:

• Regular cardiovascular risk assessment: At least annual monitoring of blood pressure, weight, and smoking status 1
• Lipid profile monitoring: Especially important in women with Turner Syndrome 1
• Lifestyle modifications: Smoking cessation, regular exercise, maintaining healthy weight 1

Sexual Function Support

For women experiencing sexual dysfunction despite adequate estrogen replacement:

• Local estrogen: May be required to treat dyspareunia 1
• Testosterone supplementation: May be considered for decreased libido, though long-term safety and efficacy are unknown 1

Monitoring Recommendations

• Annual assessment: Blood pressure, weight, and smoking status
• Bone mineral density: At diagnosis and within 5 years if osteoporosis is diagnosed
• Hormone levels: As clinically indicated to assess adequacy of replacement
• Referral to specialists: Gynecology, endocrinology, and/or reproductive endocrinology consultation is recommended for women diagnosed with POI 1

Important Considerations

• HRT should be continued at least until the average age of natural menopause (45-55 years) 1
• No strong evidence supports specific herbal or nutritional supplements for improving ovarian reserve
• Traditional Chinese Medicine approaches have been studied but lack robust clinical evidence 3
• Women with POI should be monitored for associated autoimmune disorders including hypothyroidism, adrenal insufficiency, and diabetes mellitus 4

Fertility Considerations

• Women with POI should be referred for gynecology, endocrinology, and/or reproductive endocrinology consultation if they desire assessment of potential future fertility 1
• Anti-Müllerian hormone (AMH) can be used as an indirect marker of ovarian reserve in women age ≥25 years 1, 2
• Spontaneous pregnancies occur in 5-10% of women with POI 4

HRT remains the cornerstone of management for POI, with the primary goals of alleviating symptoms and preventing long-term health consequences related to estrogen deficiency.