Premature ovarian insufficiency – hormone replacement therapy and management of long-term consequences

Paulina Machura, Monika Grymowicz, Ewa Rudnicka, Wojciech Pięta, Anna Calik-Ksepka, Jolanta Skórska, Roman Smolarczyk
In: Menopausal Review · 2018 · vol. 17(3) , pp. 135–138 · doi:10.5114/pm.2018.78559 · PMID:30357030 · W2897542367
review OA: gold CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Premature ovarian insufficiency management involves hormone replacement therapy to mitigate risks of cardiovascular disease, osteoporosis, and genitourinary syndrome, with treatment continuing until natural menopause and tailored to patient preference.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This review discusses premature ovarian insufficiency (POI), defined as ovarian dysfunction before age 40 with oligo/amenorrhea and elevated FSH, and reviews hormone replacement therapy (HRT) approaches to manage both symptoms of hypoestrogenism and long-term risks such as cardiovascular disease, lipid disorders, osteoporosis, urogenital symptoms, and psychological or cognitive dysfunction. It outlines goals of HRT to restore age-appropriate estrogen levels, recommends starting at diagnosis and continuing until the average age of natural menopause, and summarizes options including transdermal 17β-estradiol with progestogen addition for endometrial protection in women with an intact uterus, while noting that compliance is low and that POI patients are under-researched regarding safety. The paper highlights evidence that stopping HRT can lead to reductions in bone mineral density and increased osteopenia/osteoporosis, and it describes proposed benefits of transdermal routes over combined oral contraceptives in relation to lipids, inflammation, blood pressure, and bone markers. The authors explicitly note that findings from studies in postmenopausal women cannot be directly generalized to younger POI patients, limiting certainty about safety. This paper is centrally about endometriosis and/or adenomyosis — it is not focused on these conditions; it was included in the endometriosis/adenomyosis corpus via keyword match in the upstream search index.

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Abstract

Premature ovarian insufficiency (POI) correlates with increased risk of cardiovascular diseases, osteoporosis, genitourinary syndrome, and other symptoms of prolonged oestrogen deprivation. Properly selected therapy improves the quality of women's lives and reduces the risk of mortality. There is a wide spectrum of available oestrogen and progestogen formulations restoring proper levels of serum sex steroid hormones. The treatment should be implemented at recognition of the POI and continued to at least the age of natural menopause. Transdermal oestradiol and oral or vaginal progesterone administration provide the most physiological sex steroid replacement therapy. Patients' views and individual preference according the route, dose, and regimen of hormonal treatment have to be taken into consideration in order to achieve high compliance rates. Women with POI should be managed by a multidisciplinary team, such as a gynaecologist, endocrinologist, dietitian, and psychologist.

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