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Hormone Therapy in Primary Ovarian Insufficiency

Obstet Gynecol; ePub 2017 May; Butts, et al

Systemic hormone therapy is an effective approach to treat women with primary ovarian insufficiency, according to recommendations from the American College of Obstetricians and Gynecologists. This committee opinion from the ACOG Committee on Gynecologic Practice recommends hormone therapy in women with primary ovarian insufficiency as an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks. Other recommendations and conclusions include:

  • In women with primary ovarian insufficiency, systemic hormone therapy (HT) is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks if there are no contraindications to treatment.
  • Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency.
  • Women with primary ovarian insufficiency may experience hot flushes, night sweats, vaginal dryness, dyspareunia, and disordered sleep; some symptoms may develop before cycle irregularity. These symptoms routinely respond well to HT as indicated.
  • As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. However, serum estradiol level testing is not recommended to monitor the effects of treatment.
  • Combined hormonal contraceptives prevent ovulation and pregnancy more reliably than HT; despite only modest odds of spontaneous pregnancy in women with primary ovarian insufficiency, this is a critical consideration for those who deem pregnancy prevention a priority.

Citation:

Hormone therapy in primary ovarian insufficiency. Committee Opinion No. 698. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e134–41.