Menopause guideline appraisal and algorithm development for premature ovarian insufficiency

Yeganeh, Ladan; Boyle, Jacqueline; Wood, Anna; Teede, Helena; Vincent, Amanda

doi:10.1016/j.maturitas.2019.09.009

Cited by 21 publications

(36 citation statements)

References 44 publications

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“…Psychosexual and psychosocial symptoms in POI deserve more research in order to understand the complexity of factors involved in the burden of the condition and to establish a tailored treatment with hormonal and non-hormonal strategies in the long term 53,74 . Clinical judgment has to guide the choice of treatment with the aim of counteracting, whenever possible, androgen insufficiency 53 , either by prescribing transdermal estradiol at an adequate dosage 75 and/ or by using transdermal testosterone at the dosage typical of the physiological premenopausal range 76,77 .…”

Section: Optimizing Psychosexual and Psychosocial Healthmentioning

confidence: 99%

Premature ovarian insufficiency: an International Menopause Society White Paper

et al. 2020

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The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.

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Section: Optimizing Psychosexual and Psychosocial Healthmentioning

confidence: 99%

Premature ovarian insufficiency: an International Menopause Society White Paper

et al. 2020

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“…Women with POI, therefore, should be treated as patients with any endocrine deficiency, and physiological replacement of ovarian steroid hormones (estrogens and progestogens) is indicated up to the age of normal natural menopause 24,25 . Hormone replacement therapy (HRT) should be individualized according to age, patient characteristics and patient needs and preferences 7,[24][25][26][27] . Younger women may require a higher estrogens dose than those used in older women.…”

Section: Hormone Replacement Therapymentioning

confidence: 99%

“…Specifically, 17b- estradiol (E2) 2-4 mg or conjugated equine estrogens (CEE) 0.625-1.25 mg are the oral route options, the former being preferred in the UK and Europe, since it is 'body identical'. Transdermal 17b-E2 50-100 lg is another option, available in patches or gels 7,[24][25][26][27] . Topical vaginal estrogens may be used as an adjunct to systemic therapy, especially when vulvovaginal atrophy (VVA) is diagnosed, a condition often termed as genitourinary syndrome of menopause (GSM).…”

Section: Hormone Replacement Therapymentioning

confidence: 99%

“…In women with an intact uterus, a progestogen should be added to prevent endometrial hyperplasia. Natural progesterone 200 mg, dihydrogesterone 10-20 mg, oral norethisterone 1-5 mg or transdermal norethisterone 0.25 mg are recommended 7,[24][25][26][27] (Table 3). Oral progestogens are administered once or twice daily sequentially for 10-14 days per month, leading to regular monthly menstrual bleeding.…”

Section: Hormone Replacement Therapymentioning

confidence: 99%

“…A number of laboratory tests should also help to estimate the individual fracture and cardiovascular risk. Mammography and cervical cytology for cervical cancer screening should be performed as indicated for the general population of the same age in the woman's own country (Table 4) 7,[24][25][26][27] . The aim is to achieve effective hormone replacement with as few adverse effects as possible, as continuation of treatment may be required for many years.…”

Section: Hormone Replacement Therapymentioning

confidence: 99%

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Premature ovarian insufficiency: a toolkit for the primary care physician

et al. 2021

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Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: (1) the diagnostic approach to POI, (2) the investigation of the etiology of this condition, (3) the therapeutic strategy regarding both hormone replacement therapy and fertility, and (4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal of this article is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine. HIGHLIGHTS Premature ovarian insufficiency occurs in 1% of the female population of reproductive age, yet the diagnosis is often delayed, with severe physical and emotional consequences for the patient. Primary care physicians should be aware of the possibility of premature ovarian insufficiency in young women presenting with menstrual irregularity. Prompt initiation of hormone replacement therapy ensures quality of life and prevents osteoporosis and cardiovascular disease. Women seeking fertility should be referred to specialists to discuss assisted reproduction options.

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