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

Women with primary ovarian insufficiency (POI) have ovarian hormone deficiency and associated increased morbidity. This review discusses hormone replacement therapy options to improve the quality of life for women with POI.

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Volume 106, Issue 7, Pages 1588-1599


Philip M. Sarrel, M.D., Shannon D. Sullivan, M.D., Ph.D., Lawrence M. Nelson, M.D.


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, psychologic impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy (HRT) 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 HRT 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.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Sean Perot
almost 5 years ago
Many thanks for an excellent review. I work in a resource-poor country in which transdermal estradiol is not available. Would daily conjugated estrogens with cyclical medroxyprogesterone be appropriate therapy for HRT with a 25 year old with Turners Syndrome?