Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause

Abstract

Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychological impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective hormone replacement therapy options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ~50 years. We address special populations of women with POI, including women with Turner Syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women.

Presentation, progression, and predictors of ovarian insufficiency in classic galactosemia

“…women with Turner Syndrome or Fragile X pre-mutation carriers) may apply. In those cases the recommendation (Sullivan et al 2016) is to continue HRT at least until the normal age of menopause (e.g. around 50) unless contraindicated, for example, by a personal or family history of breast cancer.…”

Assessment of ovarian function in adolescents and young adults after childhood cancer treatment—How accurate are young adult/parent proxy‐reported outcomes?

“…5 POI, also referred to as premature menopause, 5 is associated with significant morbidity, including infertility, sexual dysfunction, cardiovascular disease, decreased bone mineral density, and emotional distress. 6,7 Based on self-report surveys, the relative risk of POI is 3.5 times higher in childhood cancer survivors compared to that in their siblings. 4 Close monitoring of ovarian function in survivors who received gonadotoxic therapies is important because it allows healthcare providers the opportunity to offer fertility preservation counseling prior to the survivor's potential development of POI.…”

Association of hysterectomy with bipolar disorder risk: A population‐based cohort study

“…From a biological perspective, hysterectomy can cause premature ovarian failure, resulting in low estrogen after surgery (Sullivan, Sarrel & Nelson, 2016). Increasing evidence suggests that estrogen can modulate neurotransmitter systems and intracellular signaling pathways (e.g., brain-derived neurotrophic factor, oxidative stress, and inflammation pathways) that are known to respond to mood stabilization (Frey & Dias, 2014;Meinhard, Kessing, & Vinberg, 2014).…”