Hormone Replacement Therapy for Women with Premature Ovarian Insufficiency: A Comprehensive Review
January 2017
in “
Human Reproduction Open
”
hormone replacement therapy HRT premature ovarian insufficiency POI estradiol progestogen transdermal estrogen oral cyclical micronized natural progesterone endometrial protection androgen replacement therapy hypoandrogenic Turner syndrome BRCA gene mutation endometriosis hormone therapy estrogen therapy progesterone therapy testosterone therapy
TLDR The review recommends hormone replacement therapy for women with premature ovarian insufficiency to manage symptoms and protect health, with specific approaches for different groups.
The 2017 review recommended hormone replacement therapy (HRT) for women with premature ovarian insufficiency (POI) to manage symptoms, protect bone health, and potentially reduce cardiovascular disease risk. It emphasized the importance of early initiation and continuation of HRT until the average age of natural menopause. The review suggested using estradiol over other forms of estrogen and highlighted the necessity of progestogen unless the uterus is absent. Transdermal estrogen was favored for potentially lower cardiovascular and breast cancer risks, and oral cyclical micronized natural progesterone was considered for endometrial protection and possibly lower cardiovascular and breast cancer risks. The review called for regular follow-up instead of routine tests for monitoring HRT and recommended additional cancer screenings. It also addressed the specific HRT needs for women with Turner syndrome, breast cancer survivors, BRCA gene mutation carriers, and those with endometriosis, suggesting tailored approaches for each group. Androgen replacement therapy was considered for hypoandrogenic women with POI, but with a note on the lack of long-term safety data. Overall, the review concluded that HRT is essential for women with POI and that the controversies surrounding HRT in postmenopausal women are not applicable to this group.
