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Committee Opinion No. 698 Summary: Hormone Therapy in Primary Ovarian Insufficiency

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doi: 10.1097/AOG.0000000000002040
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Abstract

Recommendations and Conclusions

The American College of Obstetricians and Gynecologists (the College) makes the following recommendations and conclusions:

  • Primary ovarian insufficiency is a pathologic condition that should not be considered a hastening of natural menopause.
  • Although women with primary ovarian insufficiency share common health risks with naturally menopausal women, the approach to health maintenance in these women is distinct.
  • 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.
  • In contrast to the treatment of postmenopausal osteopenia or osteoporosis, which focuses on bisphosphonates as first-line therapy, low bone mass in women with primary ovarian insufficiency is managed most appropriately with HT.
  • 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 ovu-lation and pregnancy more reliably than HT; despite only modest odds of spontaneous preg-nancy in women with primary ovarian insuf-ficiency, this is a critical consideration for those who deem pregnancy prevention a priority.
  • For a woman who prefers noncontraceptive estrogen replacement and wants highly effective contraception, insertion of a levonorgestrel intrauterine device is preferable to oral progestin therapy.
  • Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 50–51 years).

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.