What is the Best Management Strategy for a 20-year-old Woman With Premature Ovarian Failure?

Melanie C. Davies; Beth Cartwright

Disclosures

Clin Endocrinol. 2012;77(2):182-186. 

In This Article

Long-term Follow-up

Monitoring

The oestrogen dose should be titrated with symptom control and bone density. There is no value in monitoring FSH levels, which may not normalize. Serum oestradiol is not helpful in clinical practice (except for monitoring HRT implants) and does not measure ethinyloestradiol (in OCPs) or oestrone (the predominant oestrogen in some HRTs). BMD should be assessed every 3–5 years by DXA once treatment is established. If treatment is initially declined, it may be prudent to assess BMD after 1 year as a rapid loss in BMD may influence treatment decisions. All women should be seen for an annual review by a clinician.

Duration of Hormone Replacement Therapy

Oestrogen replacement is recommended until the age of natural menopause (51 years).[33] The required dose should decrease with time. It is presumed that long-term use of HRT in physiological doses in this population does not increase the risk of breast cancer or cause other problems, but long-term outcome data are needed to confirm this.

Service Provision

Premature ovarian failure is a sufficiently common condition to warrant dedicated services. This can improve care and facilitate links to clinical psychology and assisted reproduction, and also offers the opportunity to audit long-term outcomes. Guidelines for diagnosis and management of the condition should be developed.

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