Primary Ovarian Insufficiency (POF, Premature Ovarian Failure, POI)

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What are the treatments for primary ovarian insufficiency?

Currently, there is no proven treatment to restore normal function to a woman's ovaries.1,2 But there are treatments for some of the symptoms of POI, as well as treatments and behaviors to reduce health risks and conditions associated with POI.

It is also important to note that between 5% and 10% of women with POI get pregnant without medical intervention after they are diagnosed with POI. Some research suggests that these women go into what is known as "spontaneous remission" of POI, meaning that the ovaries begin to function normally on their own. When the ovaries are working properly, fertility is restored and the women can get pregnant.

Hormone replacement therapy (HRT)

HRT is the most common treatment for women with POI. It gives the body the estrogen and other hormones that the ovaries are not making. HRT improves sexual health and decreases the risks for cardiovascular disease (including heart attacks, stroke, and high blood pressure) and osteoporosis.17

If a woman with POI begins HRT, she is expected to start having regular periods again. In addition, HRT is expected to reduce other symptoms, such as hot flashes and night sweats, and help maintain bone health.1,13,17,26 HRT will not prevent pregnancy, and evidence suggests it might improve pregnancy rates for women with POI by lowering high levels of luteinizing hormone - which stimulates ovulation - to normal in some women.19

HRT is usually a combination of an estrogen and a progestin. A progestin is a form of progesterone. Sometimes, the combination might also include testosterone, although this approach is controversial.11 HRT comes in several forms: pills, creams, gels, patches that stick onto the skin, an intrauterine device, or a vaginal ring.14 Estradiol is the natural form of human estrogen. The optimal method of providing estradiol to women with POI is by a skin patch or vaginal ring. These methods are linked with a lower risk of potentially fatal blood clots developing. Most women require a dose of 100 micrograms of estradiol per day. It is important to take a progestin along with estradiol to balance out the effect of estrogen on the lining of the womb. Women who do not take a progestin along with estradiol are at increased risk of developing endometrial cancer. The progestin with the best evidence available to support use in women with POI is 10 mg of medroxyprogesterone acetate by mouth per day for the first 12 calendar days of each month.

A health care provider may suggest that a woman with POI take HRT until she is about 50 years old, the age at which menopause usually begins.

After that time, she should talk with her health care provider about stopping the treatment because of risks associated with using this type of therapy in the years after the normal age of menopause.4

Is it safe for women with POI to take HRT?

In general, HRT treatment for women with POI is safe and is associated with only minimal side effects. Women with POI take HRT to replace hormones their bodies would normally be making if they didn't have POI.

The HRT taken by women with POI is different from the hormone therapies taken by women who are going through or have gone through natural menopause, which are often called menopausal or post-menopausal hormone therapy (PMHT).

A large, long-term study - called the Women's Health Initiative - examined the effects of a specific type of PMHT, taken for more than 5 years, by women ages 50 to 79 who had already gone through menopause. This study showed that PMHT was associated with an increased risk of stroke, blood clots, heart disease, heart attacks, and breast cancer in these women.20

These results do not apply to young women with POI who take HRT.4,14 The type and amount of HRT prescribed to women with POI is different from the PMHT taken by older women.4

A woman should talk to her health care provider if she has questions about HRT as a treatment for POI. Also, she should tell her health care provider about any side effects she experiences while taking HRT. There are many different types of HRT. Women should work with their health care providers to find out the best type of treatment.

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