Materiały źródłowe

• #1 Primary Ovarian Insufficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK589674/

  Primary ovarian insufficiency (POI) is a disease that affects women less than 40 years of age. […] POI affects mental health, fertility, cardiovascular health, and bone health. […] This article outlines the evaluation, diagnosis, treatment, and management of primary ovarian insufficiency. […] It is of great importance for POI to be recognized early within its disease process in order to prevent and reduce the morbidity and mortality associated with hypoestrogenemia and to increase the quality of life of the women affected. […] Treatment of POI is largely based on estrogen repletion to diminish vasomotor symptoms, maintain bone density, decrease fracture risk, decrease cardiovascular and autoimmune morbidity and mortality, protect cognitive function, and improve the overall well-being of the patients affected.

• #1 Hormone Therapy in Primary Ovarian Insufficiency | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/hormone-therapy-in-primary-ovarian-insufficiency

  Primary ovarian insufficiency is a pathologic condition that should not be considered a hastening of natural menopause. […] 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. […] As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. […] Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 5051 years).

• #1 Primary ovarian insufficiency – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/diagnosis-treatment/drc-20354688

  Most often, treatment for primary ovarian insufficiency focuses on the problems that arise from estrogen deficiency. Treatment might include: […] Estrogen therapy can help prevent osteoporosis. It also can relieve hot flashes and other symptoms of low estrogen. You’ll likely be prescribed estrogen with the hormone progesterone if you still have your uterus. Adding progesterone protects the lining of your uterus, called the endometrium, from changes that could lead to cancer. These changes may be caused by taking estrogen alone. […] Calcium and vitamin D supplements. Both nutrients are key for preventing osteoporosis. And you might not get enough of either in your diet or from sunlight. Your health care team might suggest an X-ray test that measures calcium and other minerals in bones before you start supplements. This is called a bone density test.

• #1 Primary Ovarian Insufficiency | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/p/primary-ovarian-insufficiency

  Primary ovarian insufficiency (POI), also known as primary ovarian failure or premature menopause, is a rare condition that affects teenagers and young females under the age of 40. […] POI affects a patients physical health, emotional health and well-being. […] The treatment of POI is a team approach. Primary care doctors, gynecologists, endocrinologists and social workers help to care for these patients. […] Estrogen replacement therapy is recommended. In patients with POI, the ovaries do not make enough estrogen. Estrogen replacement helps patients to go through puberty, start having periods, grow taller, and build stronger bones. […] Family planning is important. Patients with POI are less likely to get pregnant on their own, but there is still a small chance of pregnancy. Good birth control is important for patients who are in intimate relationships. We recommend talking with a doctor about this.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends shared decision making and support for continuity of care in managing POI. […] The guideline group recommends referral of women with POI to appropriate support groups and mental health care. […] The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including avoiding smoking, having a healthy diet and regular physical activity, and maintaining a healthy weight range) to reduce cardiovascular risk. […] The guideline group recommends that women with POI should have a regular clinical review, addressing individualised risk factors and adherence to therapy. […] The guideline group recommends that HCPs should offer vaginal estrogen therapy to improve genitourinary and sexual symptoms. […] The guideline group recommends that HCPs should be aware that a diagnosis of POI can have a significant impact on psychological wellbeing and quality of life.

• #1 Premature ovarian insufficiency – British Menopause Society

  https://thebms.org.uk/publications/consensus-statements/premature-ovarian-insufficiency/

  Sex steroid hormone replacement should be considered the preferred choice of treatment for the prevention and management of osteoporosis in women with POI. Bisphosphonates should not be first line treatment for the management of osteoporosis in women with POI and should only be considered after discussion with an osteoporosis specialist. […] Assessment of bone mineral density should be considered at the time of diagnosis of POI. The frequency of repeat bone density assessment should be guided by the woman’s risk for developing osteoporosis and consideration should be given to repeat bone mineral density assessment in women with osteoporosis within 2-3 years of the diagnosis. […] Women with POI can have intermittent ovarian activity and have a chance of natural conception estimated to be in the region of 5-10%. Assisted reproduction techniques using the woman’s own eggs are unlikely to be successful and oocyte donation remains the most effective intervention in this context.

• #1 Hormone Therapy in Primary Ovarian Insufficiency | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/hormone-therapy-in-primary-ovarian-insufficiency

  Considering the challenges that adolescents and young women may face in coping with the physical, reproductive, and social effects of primary ovarian insufficiency, comprehensive longitudinal management of this condition is essential. […] 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. […] The approach to HT for primary ovarian insufficiency is full replacement doses of hormone for long-term treatment.

• #1 Primary ovarian insufficiency // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/primary-ovarian-insufficiency

  Learning that you have primary ovarian insufficiency may be emotionally painful. But with proper treatment and self-care, you can expect to lead a healthy life. […] Keep your bones strong. Eat a calcium-rich diet. Do weight-bearing exercises such as walking and strength training exercises for your upper body. And don’t smoke. Ask your health care team if you need calcium and vitamin D supplements. […] If you’d hoped for future pregnancies, you might feel a deep sense of loss after you learn that you have primary ovarian insufficiency. This feeling can happen even if you’ve already given birth. See a counselor for therapy if you feel it would help you cope.

• #1 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  ABSTRACT: Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. […] Health care providers who make this clinical diagnosis should be mindful of the sensitive nature of this medical condition. Patients and their families should be counseled on the effect of the patients condition on future fertility, on the risk of comorbidities associated with primary ovarian insufficiency, and on the conditions potential for genetic inheritance. […] Psychologic counseling also should be offered because impaired self-esteem and emotional distress have been reported after diagnosis of primary ovarian insufficiency. Once primary ovarian insufficiency is diagnosed, patients should be evaluated at least annually. The goals of hormonal therapy extend beyond simply symptom relief to levels that support bone, cardiovascular, and sexual health.

• #1 Premature ovarian insufficiency: why is it not being diagnosed enough in primary care? | British Journal of General Practice

  https://bjgp.org/content/68/667/83

  Infertility is a major complication of POI, so referral to a fertility centre may be indicated and the best results for a live pregnancy are often as a result of egg donation. […] Treatment with hormone replacement therapy (HRT) should be started and continued until at least the average age of menopause (51 years). […] Women should be reassured that there is no increased risk of breast cancer in taking HRT at a young age as they are simply replacing hormones that their body should otherwise be producing. […] Some women with POI who need contraception do take the combined oral contraceptive pill [COC]; this will provide hormone replacement and contraception. […] Sexual dysfunction is very common in women with POI and needs to be asked about directly. […] The diagnosis of POI for a young woman can be devastating and supportive counselling can be very important and helpful. […] Making the diagnosis of POI early and offering appropriate treatment can therefore often reduce or prevent long-term sequelae from POI. Women should be reassured about the importance of hormone treatment.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  Personalised care, including psychological support, should be accessible to women with POI. […] The guideline group recommends that women with POI should be informed that POI without HT is associated with reduced life expectancy, largely due to cardiovascular disease. […] HT is recommended for women with POI until the usual age of menopause for primary prevention to reduce the risk of morbidity and mortality, whether there are estrogen deficiency symptoms or not. […] The guideline group recommends that HCPs advise women with POI that hormone replacement therapy (HRT) does not provide contraception, in order to assist them with their family planning. […] The guideline group recommends that women with POI should be informed that there are no interventions that have been reliably shown to increase ovarian activity and natural conception rates.

• #1 FXPOI Treatment Recommendations

  https://fragilex.org/professional-resources/treatment-recommendations/fragile-x-associated-primary-ovarian-insufficiency/

  HRT is recommended for women with POI for a variety of reasons. […] Women with POI who do not take HRT have a very high risk of developing osteoporosis. […] The American College of Obstetricians and Gynecologists and the North American Menopause Society recommend hormone replacement therapy for women with POI who do not have contraindications. […] Women with FXPOI should not assume infertility, and contraception is recommended for those not wanting to conceive a pregnancy. […] When a woman is diagnosed with FXPOI, a referral to a genetic counselor is indicated to discuss the risks of transmission of the Fragile X pre or full mutation to offspring and risk of Fragile X-related conditions in other family members. […] Some women may choose fertility treatment, such as in vitro fertilization (IVF), especially if looking to pursue preimplantation genetic testing (PGT).

• #1 To Patients with Premature Ovarian Failure

  https://rscbayarea.com/article/premature-ovarian-failure/

  Incorporating healthy lifestyle choices can significantly impact your overall well-being when living with POI. Regular exercise, a balanced diet, and adequate sleep can help alleviate some symptoms and improve your overall quality of life. Avoiding smoking, excessive alcohol consumption, and maintaining a healthy weight are also important for your long-term health. […] Educating yourself about the condition, seeking emotional support, and discussing treatment options with me are vital steps in managing this condition effectively.

• #1 Primary Ovarian Insufficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK589674/

  The objective of treatment is to ensure that women diagnosed with POI maintain a daily level of 100 pg/mL of estradiol, as do premenopausal women with normal ovarian function. […] In regards to assisted reproduction and fertility, there is no evidence that ovulation induction can be reliably achieved with gonadotropins or GnRH analogs. […] Furthermore, diagnosis of POI can incur devastating psychological effects not only for the patient but also for the patients significant other and family. […] It is imperative that the patient is followed closely in the clinic and given the resources necessary to establish care with a behavioral health specialist and therapist to facilitate discussion and coping with the emotional stressors associated with POI. […] The medical care of women with POI is a multi-specialty undertaking.

• #1 Premature ovarian insufficiency in general practice: Meeting the needs of women

  https://www.racgp.org.au/afp/2017/june/premature-ovarian-insufficiency-in-general-practic

  The diagnosis of POI can be extremely distressing for women. Several consultations may be required to provide emotional and psychological support regarding the diagnosis, and to address the multisystem approach needed for optimal care. […] Management of women with POI requires a multidisciplinary team approach to address the psychological impact of the diagnosis, initiate HRT (if not contraindicated) and/or contraceptive options, manage menopausal symptoms and long-term consequences, address the underlying cause of POI, and infertility treatment. […] Referral for psychological support should be considered, and women should be made aware of available support groups and educational resources. […] The IMS and ESHRE guidelines recommend that HRT be initiated early in all women diagnosed with POI (unless contraindicated) and continued until the natural age of menopause (approximately 51 years of age). […] Women should be reviewed frequently while the dose of HRT is titrated. Once a maintenance dose is established, consultations should occur at least annually to monitor for symptom control and to complete an annual complication screen.

• #1 From Victim to Survivor to Thriver: Helping Women with Primary Ovarian Insufficiency Integrate Recovery, Self-Management, and Wellness

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4350677/

  For women who get a diagnosis of POI, the journey from recovery, to self-management, to wellness presents a series of challenges, hurdles, and frustrations. Wellness can be found by moving from a place of fear and doubt to a place of hope and confidence. […] There is a need to develop an evidence-based integrated program to assist women with POI in navigating the transition to acceptance of the diagnosis, ongoing management of the condition, and ongoing maintenance of wellness in the presence of the disorder.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  Informed by those with lived experience of premature ovarian insufficiency (often shortened to POI), in addition to current evidence, this guideline aims to facilitate prompt diagnosis of POI, conveyed in a sensitive manner, and shared decision making for personalised best practice management. This will assist in effectively addressing recognised patient dissatisfaction, care variation, non-adherence with therapy, and resultant poorer outcomes in women with POI. […] This guideline on premature ovarian insufficiency (POI) offers best practice advice on the care of women with POI. […] The guideline group recommends that HCPs convey the diagnosis of POI in a compassionate and sensitive manner, provide personalised evidence-based information about the condition, and ensure time for the women to ask questions.

• #1 Primary Ovarian Insufficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK589674/

  Proper counseling for patients includes a discussion regarding how low estrogen levels can affect bone, cardiovascular, neurocognitive, and mental health. […] Patients with POI require close follow-up to ensure they are receiving the necessary hormonal replacement and are not having complications of such medications.

• #1 Ovarian Insufficiency Treatment & Management: Medical Care, Further Outpatient Care, Consultations

  https://emedicine.medscape.com/article/271046-treatment

  Medical treatment of patients with POI/POF should address the following aspects: ovarian hormone replacement, restoration of fertility, and psychological well-being of the patient. […] The diagnosis of POI/POF can be particularly traumatic for young women. […] Use of appropriate terminology is important (use of POI or insufficiency is preferred instead of premature menopause or early menopause). […] The ovary is not only a reproductive organ but is also a source of important hormones that help maintain strong bones. Adequate replacement of these missing hormones, a healthy lifestyle, and a diet rich in calcium are essential. […] POI/POF is not menopause. Spontaneous ovarian activity and pregnancies are possible. […] All women with POI/POF should receive cyclical HT with estrogens and progestins to relieve the symptoms of estrogen deficiency and to maintain bone density.

• #1 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  Optimal treatment of an adolescent in whom primary ovarian insufficiency is diagnosed requires special sensitivity to both the physical and emotional needs of young women receiving this diagnosis during a time of significant developmental changes. […] The goals of hormonal therapy extend beyond simply symptom relief to levels that support bone, cardiovascular (CV), and sexual health. […] Hormonal support involves daily therapy with the goal of maintenance of normal ovarian functioning levels of estradiol. […] Patients with primary ovarian insufficiency are estrogen deficient. […] Patients and their families should be counseled on the effect of the patients condition on future fertility. […] Psychologic counseling also should be offered because impaired self-esteem and emotional distress have been reported after diagnosis of primary ovarian insufficiency. […] Once primary ovarian insufficiency is diagnosed, patients should be evaluated at least annually.

• #1

  https://bpac.org.nz/2019/ovarian.aspx

  Primary ovarian insufficiency can be diagnosed in women aged 40 years with four to six months of amenorrhoea (after excluding other causes) and two FSH tests 40 IU/L, at least four weeks apart. […] Treatment options include menopausal hormone therapy or combined oral contraceptives. Treatment selection should be individualised to improve adherence, considering any relevant history, co-morbidities, need for contraception and patient preference. […] Hormone treatment should be continued at least until the age of natural menopause (approximately age 50 years). […] Patients should be reviewed annually, including an assessment of symptom control, cardiovascular risk and adherence to treatment; bone mineral density should be checked every two years. […] Hormone treatment, either with MHT or a COC, is recommended for women with primary ovarian insufficiency (unless there are contraindications) to alleviate symptoms, improve their quality of life, and reduce the long-term risks of oestrogen deficiency. […] Treatment should be continued until at least the age of natural menopause (approximately age 50 years). […] Women with primary ovarian insufficiency should be reviewed at least annually, including an assessment of symptom control, adherence to treatment and cardiovascular risk.

• #1 Primary Ovarian Insufficiency: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17963-primary-ovarian-insufficiency

  If you begin HRT, you’ll continue treatment up until the age when natural menopause typically begins (age 51 to 52). Discuss the benefits and risks of HRT with your provider to make sure it’s right for you. […] In addition to HRT, other treatments could include taking calcium and vitamin D to help lower your risk of osteoporosis. […] If you don’t wish to get pregnant, be sure to discuss birth control with your provider. […] Primary ovarian insufficiency isn’t reversible. Healthcare providers can treat symptoms, side effects and associated conditions, but they can’t cure it. […] Treatment for primary ovarian insufficiency helps relieve symptoms of the condition and lowers your risk of health conditions that POI may cause. […] Primary ovarian insufficiency is usually permanent. Most women with the condition take long-term hormone therapy to manage symptoms and reduce the risk of complications. […] Support groups and counseling are available. These supports can help you manage emotions and find ways to cope.

• #1 Watching Out for Primary Ovarian Insufficiency

  https://consultqd.clevelandclinic.org/watching-out-for-primary-ovarian-insufficiency

  Primary (or premature) ovarian insufficiency not only affects a womans fertility but puts her health at risk. Unfortunately, it often is undiagnosed, and impacts many women under age 40. […] In the medical community, there often isnt a high degree of suspicion for primary ovarian insufficiency, so it may go unrecognized, but its important to identify and treat it, says Dr. Batur. Early loss of estrogen before age 40 is associated with many negative outcomes, such as low bone mass, cardiovascular disease, sexual dysfunction and neurological conditions such as dementia and Parkinson’s disease. […] When patients are first diagnosed with cancer, theyre understandably facing information overload. But Dr. Batur notes its a good idea to have a conversation early on with female patients that treatment may impact their ovaries.

• #2 From Victim to Survivor to Thriver: Helping Women with Primary Ovarian Insufficiency Integrate Recovery, Self-Management, and Wellness

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4350677/

  Most women discover that they are infertile in a gradual manner after many failed attempts at conception. By contrast, most women with primary ovarian insufficiency (POI) uncover their infertility as part of an evaluation of other presenting complaints, frequently before attempts at conception have even been contemplated. […] POI is a serious and incurable chronic disease. The diagnosis is more than infertility and affects a woman’s physical and emotional well-being. Management of the condition must address both. […] There is a need for an evidenced-based integrated program to assist women with POI in navigating the transition to acceptance of the diagnosis, ongoing management of the condition, and ongoing maintenance of wellness in the presence of the disorder. […] The shock of the diagnosis can have a profound effect on patient satisfaction, treatment compliance, quality of life, and other health outcomes.

• #2

  https://journals.lww.com/greenjournal/fulltext/2017/05000/committee_opinion_no__698__hormone_therapy_in.48.aspx

  Primary ovarian insufficiency describes a spectrum of declining ovarian function and reduced fecundity due to a premature decrease in initial follicle number, an increase in follicle destruction, or poor follicular response to gonadotropins. […] 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. […] As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. […] Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 5051 years). […] Comprehensive longitudinal management of this condition is essential.

• #2 Amenorrhea: A Systematic Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0701/p39.html

  Patients with primary ovarian insufficiency can maintain unpredictable ovary function and may require hormone replacement therapy, contraception, or infertility services. […] Patients diagnosed with primary ovarian insufficiency should be offered testing for FMR1 gene premutation, which confers the risk of fragile X syndrome in children. […] Hormone replacement therapy (HRT) may reduce associated vasomotor symptoms, bone mineral density loss, and cardiovascular risk and should be continued until the age of natural menopause (50 to 51 years). […] A common post-pubertal regimen of HRT is 100 mcg of daily transdermal estradiol or 0.625 mg of daily oral conjugated estrogens, adding 200 mg of micronized oral progesterone daily for 12 days each month. […] Approximately 10% of females diagnosed with primary ovarian insufficiency retain fertility.

• #2 Primary ovarian insufficiency // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/primary-ovarian-insufficiency

  Treatment for primary ovarian insufficiency helps prevent these other health conditions. […] Most often, treatment for primary ovarian insufficiency focuses on the problems that arise from estrogen deficiency. Treatment might include: Estrogen therapy can help prevent osteoporosis. It also can relieve hot flashes and other symptoms of low estrogen. You’ll likely be prescribed estrogen with the hormone progesterone if you still have your uterus. Adding progesterone protects the lining of your uterus, called the endometrium, from changes that could lead to cancer. These changes may be caused by taking estrogen alone. […] Calcium and vitamin D supplements. Both nutrients are key for preventing osteoporosis. And you might not get enough of either in your diet or from sunlight. Your health care team might suggest an X-ray test that measures calcium and other minerals in bones before you start supplements. This is called a bone density test.

• #2 Premature Ovarian Insufficiency | Doctor

  https://patient.info/doctor/premature-ovarian-insufficiency-pro

  Women with POI should be managed by a professional with the experience to help manage all aspects of the physical and psychological aspects of the condition. Depending on local expertise, that professional may be in primary or secondary care. […] Women with POI may have complex physical and psychological needs and a multidisciplinary approach may be appropriate. […] Some women may need referral to a psychologist or psychiatrist. […] Any associated depression or anxiety needs to be addressed and managed appropriately. […] General lifestyle and dietary measures to reduce the risk of cardiovascular disease and osteoporosis should be undertaken. […] Women with POI should almost always be given sex steroid replacement until at least the average age of the menopause (51 years). This is not just for symptom control but also to maintain their long-term health.

• #2

  https://bpac.org.nz/2019/ovarian.aspx

  Primary ovarian insufficiency can be diagnosed in women aged 40 years with four to six months of amenorrhoea (after excluding other causes) and two FSH tests 40 IU/L, at least four weeks apart. […] Treatment options include menopausal hormone therapy or combined oral contraceptives. Treatment selection should be individualised to improve adherence, considering any relevant history, co-morbidities, need for contraception and patient preference. […] Hormone treatment should be continued at least until the age of natural menopause (approximately age 50 years). […] Patients should be reviewed annually, including an assessment of symptom control, cardiovascular risk and adherence to treatment; bone mineral density should be checked every two years. […] Hormone treatment, either with MHT or a COC, is recommended for women with primary ovarian insufficiency (unless there are contraindications) to alleviate symptoms, improve their quality of life, and reduce the long-term risks of oestrogen deficiency. […] Treatment should be continued until at least the age of natural menopause (approximately age 50 years). […] Women with primary ovarian insufficiency should be reviewed at least annually, including an assessment of symptom control, adherence to treatment and cardiovascular risk.

• #2 Premature ovarian insufficiency – British Menopause Society

  https://thebms.org.uk/publications/consensus-statements/premature-ovarian-insufficiency/

  Sex steroid hormone replacement should be considered the preferred choice of treatment for the prevention and management of osteoporosis in women with POI. Bisphosphonates should not be first line treatment for the management of osteoporosis in women with POI and should only be considered after discussion with an osteoporosis specialist. […] Assessment of bone mineral density should be considered at the time of diagnosis of POI. The frequency of repeat bone density assessment should be guided by the woman’s risk for developing osteoporosis and consideration should be given to repeat bone mineral density assessment in women with osteoporosis within 2-3 years of the diagnosis. […] Women with POI can have intermittent ovarian activity and have a chance of natural conception estimated to be in the region of 5-10%. Assisted reproduction techniques using the woman’s own eggs are unlikely to be successful and oocyte donation remains the most effective intervention in this context.

• #2 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  Women with POI should be informed that oocyte donation is an established option to achieve pregnancy after a diagnosis of POI. […] The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including weight-bearing exercise, healthy diet, avoiding smoking, and maintaining normal body weight) to optimise bone health. […] The guideline group recommends that HCPs consider screening for sarcopenia at POI diagnosis. […] The guideline group recommends that HCPs should be aware that POI is associated with abnormal bone microarchitecture and reduced bone mineral density. […] The guideline group recommends that HCPs do not routinely perform thyroid peroxidase (TPO) antibody screening as part of testing for autoimmune causes of POI due to the high prevalence of positive TPO antibodies in the general community. […] The guideline group recommends that HCPs should not routinely perform AMH testing to predict POI due to insufficient evidence of accuracy.

• #2 Primary ovarian insufficiency – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/diagnosis-treatment/drc-20354688

  Learning that you have primary ovarian insufficiency may be emotionally painful. But with proper treatment and self-care, you can expect to lead a healthy life. […] If you’d hoped for future pregnancies, you might feel a deep sense of loss after you learn that you have primary ovarian insufficiency. This feeling can happen even if you’ve already given birth. See a counselor for therapy if you feel it would help you cope. […] It can take a while to come to terms with having primary ovarian insufficiency. In the meantime, take good care of yourself. Eat well, exercise and get enough rest.

• #2 Primary ovarian insufficiency – Wikipedia

  https://en.wikipedia.org/wiki/Primary_ovarian_insufficiency

  Most authorities recommend that this hormone replacement continue until age 50 years, the normal age of menopause. […] In observational studies, hormone replacement therapy in women with primary ovarian insufficiency and other causes of early menopause was associated with a lower risk of cardiovascular disease, increased bone density, and a reduced mortality. […] The diagnosis is more than infertility and affects a woman’s physical and emotional well-being. […] It is important to connect women with POI to an appropriate collaborative care team because the condition has been clearly associated with suicide related to the stigma of infertility.

• #2 FXPOI Treatment Recommendations

  https://fragilex.org/professional-resources/treatment-recommendations/fragile-x-associated-primary-ovarian-insufficiency/

  HRT is recommended for women with POI for a variety of reasons. […] Women with POI who do not take HRT have a very high risk of developing osteoporosis. […] The American College of Obstetricians and Gynecologists and the North American Menopause Society recommend hormone replacement therapy for women with POI who do not have contraindications. […] Women with FXPOI should not assume infertility, and contraception is recommended for those not wanting to conceive a pregnancy. […] When a woman is diagnosed with FXPOI, a referral to a genetic counselor is indicated to discuss the risks of transmission of the Fragile X pre or full mutation to offspring and risk of Fragile X-related conditions in other family members. […] Some women may choose fertility treatment, such as in vitro fertilization (IVF), especially if looking to pursue preimplantation genetic testing (PGT).

• #2 Primary Ovarian Insufficiency: Teenagers in Menopause

  https://www.nationwidechildrens.org/family-resources-education/700childrens/2022/11/primary-ovarian-insufficiency

  For all teenagers who are or who are planning to be sexually active, but dont want to become pregnant in the next year, birth control is recommended. […] Even though having POI means the chances of becoming pregnant are very low, there is still a very small chance of an egg being released randomly leading to pregnancy. […] Balancing the desire for this small chance of spontaneous pregnancy with possible difficult life circumstances if that pregnancy were to occur is a very personal decision.

• #2

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=uf6200spec

  Primary ovarian insufficiency may develop after a hysterectomy or other pelvic surgery or from radiation or chemotherapy treatment for cancer. […] Treatment for primary ovarian insufficiency will help you manage your symptoms. But there is currently no treatment that will make the ovaries start to work properly again. Your doctor may prescribe hormone therapy or other medicines to help with hot flashes. […] Finding out you have primary ovarian insufficiency can be upsetting. You may want to get support through counselling. […] At this time, there is no way to prevent primary ovarian insufficiency. But you can take steps to protect your overall health. This condition can increase your risk of bone thinning and fractures (osteoporosis) and heart disease. A balanced and low-fat diet, regular exercise, and not smoking can help protect your bones and heart.

• #2 Primary ovarian insufficiency – Wikipedia

  https://en.wikipedia.org/wiki/Primary_ovarian_insufficiency

  Primary ovarian insufficiency (POI), also called premature ovarian insufficiency and premature ovarian failure, is the partial or total loss of reproductive and hormonal function of the ovaries before age 40 because of follicular dysfunction or early loss of eggs. […] Hormonal therapy with estrogen and progesterone is the first line treatment and is associated with improvement of symptoms and possibly improvement in other parameters such as bone density, mortality and cardiovascular risk. […] The general treatment is for symptoms, bone protection, and mental health. […] Treatment will vary depending on the symptoms. It can include hormone replacement therapy, fertility management, and psychosocial support, as well as annual screenings of thyroid and adrenal function. […] Women with POI can develop symptoms of estrogen deficiency, including vasomotor flushes and vaginal dryness that respond to physiologic replacement of hormones.

• #2 Hormone Therapy in Primary Ovarian Insufficiency | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/hormone-therapy-in-primary-ovarian-insufficiency

  Considering the challenges that adolescents and young women may face in coping with the physical, reproductive, and social effects of primary ovarian insufficiency, comprehensive longitudinal management of this condition is essential. […] 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. […] The approach to HT for primary ovarian insufficiency is full replacement doses of hormone for long-term treatment.

• #2 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  Optimal treatment of an adolescent in whom primary ovarian insufficiency is diagnosed requires special sensitivity to both the physical and emotional needs of young women receiving this diagnosis during a time of significant developmental changes. […] The goals of hormonal therapy extend beyond simply symptom relief to levels that support bone, cardiovascular (CV), and sexual health. […] Hormonal support involves daily therapy with the goal of maintenance of normal ovarian functioning levels of estradiol. […] Patients with primary ovarian insufficiency are estrogen deficient. […] Patients and their families should be counseled on the effect of the patients condition on future fertility. […] Psychologic counseling also should be offered because impaired self-esteem and emotional distress have been reported after diagnosis of primary ovarian insufficiency. […] Once primary ovarian insufficiency is diagnosed, patients should be evaluated at least annually.

• #2 Primary Ovarian Insufficiency: A new paradigm for care and research

  https://researchfeatures.com/primary-ovarian-insufficiency-new-paradigm-care-research/

  Primary ovarian insufficiency (POI) is linked with lower levels of 17-Beta-Estradiol and is associated with poorer health outcomes. […] A diagnosis of POI impacts emotional as well as physical health as it can result in unexpected infertility and may feel isolating for those newly diagnosed with the condition. Therefore, an integrated, long-term team approach to care is needed. […] This network has the potential to improve the evaluation and management of 17-Beta-Estradiol deficiency not only through collecting and reporting information, but also by linking to international research programmes to expand knowledge of hormonal health in women. […] Nelson reiterates that it is crucial to prioritise womens hormonal health and ensure that it is a central focus within womens overall healthcare and research. […] A central, digital hub can support patients, their families, and healthcare providers by providing a convenient, up-to-date, cost-effective and integrated solution for rare health conditions in women, such as POI.

• #2 How Common Is Primary Ovarian Insufficiency? Life Expectancy

  https://www.medicinenet.com/how_common_is_primary_ovarian_insufficiency/article.htm

  There is currently no proven treatment to restore normal ovarian function; however, several treatment options can reduce symptoms and other risk factors linked with primary ovarian insufficiency (POI). […] Five to ten percent of women with POI can successfully conceive without medical help. […] Women must seek complete hormone treatment for POI and receive individualized holistic care, yearly checkups, and assistance for acute concerns, as well as long-term health monitoring. […] Women with primary ovarian insufficiency (POI) have a two-year lower life expectancy than those without POI. […] The doctor should discuss with women the consequences of POI, including infertility, decreased bone mineral density, increased fracture risk later in life, poor effect on psychological well-being and quality of life, and potentially harmful effects on cognition.

• #2 To Patients with Premature Ovarian Failure

  https://rscbayarea.com/article/premature-ovarian-failure/

  Incorporating healthy lifestyle choices can significantly impact your overall well-being when living with POI. Regular exercise, a balanced diet, and adequate sleep can help alleviate some symptoms and improve your overall quality of life. Avoiding smoking, excessive alcohol consumption, and maintaining a healthy weight are also important for your long-term health. […] Educating yourself about the condition, seeking emotional support, and discussing treatment options with me are vital steps in managing this condition effectively.

• #2 Ovarian Insufficiency Treatment & Management: Medical Care, Further Outpatient Care, Consultations

  https://emedicine.medscape.com/article/271046-treatment

  Progestins should be administered cyclically, 10-14 days each month, to prevent endometrial hyperplasia that unopposed estrogen may cause. […] Patients with POI/POF can have successful pregnancy with a donor egg. A decision to proceed with such a procedure should be made after a fair discussion of different options. […] Patients with ovarian failure should be seen annually to monitor their HT. […] Women with POI/POF should be encouraged to engage in weight-bearing exercises for 30 minutes per day, at least 3 days per week, to improve muscle strength and maintain bone mass.

• #2 Watching Out for Primary Ovarian Insufficiency

  https://consultqd.clevelandclinic.org/watching-out-for-primary-ovarian-insufficiency

  In general, if a patient loses estrogen before age 40 and theres no compelling medical reason not to give it back, its advantageous to prescribe hormone replacement therapy. […] Hormone replacement therapy can be administered systemically via a higher-dose vaginal ring, skin patch, skin gel or oral pill. This treatment can help with symptom management in addition to protecting bone and heart health. […] There is a high risk of osteoporosis for those with premature loss of estrogen, so patients should receive baseline and then periodic DXA scans to check bone density. […] Primary ovarian insufficiency can also have a widespread mental and physical toll on patients. Bringing together a care team, including hormone specialists as well as those providing psychological support, is beneficial to help improve patients quality of life.

• #2 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends shared decision making and support for continuity of care in managing POI. […] The guideline group recommends referral of women with POI to appropriate support groups and mental health care. […] The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including avoiding smoking, having a healthy diet and regular physical activity, and maintaining a healthy weight range) to reduce cardiovascular risk. […] The guideline group recommends that women with POI should have a regular clinical review, addressing individualised risk factors and adherence to therapy. […] The guideline group recommends that HCPs should offer vaginal estrogen therapy to improve genitourinary and sexual symptoms. […] The guideline group recommends that HCPs should be aware that a diagnosis of POI can have a significant impact on psychological wellbeing and quality of life.

• #2 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  ABSTRACT: Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. […] Health care providers who make this clinical diagnosis should be mindful of the sensitive nature of this medical condition. Patients and their families should be counseled on the effect of the patients condition on future fertility, on the risk of comorbidities associated with primary ovarian insufficiency, and on the conditions potential for genetic inheritance. […] Psychologic counseling also should be offered because impaired self-esteem and emotional distress have been reported after diagnosis of primary ovarian insufficiency. Once primary ovarian insufficiency is diagnosed, patients should be evaluated at least annually. The goals of hormonal therapy extend beyond simply symptom relief to levels that support bone, cardiovascular, and sexual health.

• #2 Premature ovarian insufficiency: why is it not being diagnosed enough in primary care? | British Journal of General Practice

  https://bjgp.org/content/68/667/83

  How good are we in primary care at diagnosing and managing premature ovarian insufficiency (POI)? Unfortunately, not very, as this condition is still underdiagnosed and undertreated. […] POI is defined as a loss of ovarian activity before the age of 40 and is characterised by irregular or absent periods and reduced fertility. Symptoms of oestrogen deficiency often occur, which include hot flushes, night sweats, mood changes, memory problems, vaginal dryness, dyspareunia, and low libido. […] Clearly it is important that their symptoms are addressed as these will often improve dramatically with the right type and dose of hormones. […] The reduced life expectancy is largely due to cardiovascular disease. […] A history of menstrual disturbance (especially oligomenorrhoea or amenorrhoea) in woman under 40 should alert healthcare professionals to consider prompt testing for POI by measuring serum FSH levels.

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