Materiały źródłowe

• #1 Therapeutic options for premature ovarian insufficiency: an updated review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8815154/

  Primary ovarian insufficiency (POI) is a rare gynecological condition. This disease causes menstrual disturbances, infertility, and various health problems. […] Women diagnosed with POI are left with limited therapeutic options. In order to remedy this situation, a new generation of therapeutic approaches, such as in vitro activation, mitochondrial activation technique, stem cell and exosomes therapy, biomaterials strategies, and platelet-rich plasma intra-ovarian infusion, is being developed. […] POI may be treated in one of several ways. Hormone replacement therapy (HRT) should be regarded as a physiological replacement of estrogens (+ progestin), but it fails to restore ovarian function. Currently used novel strategies mainly include in vitro activation (IVA), mitochondrial activation, stem cell and exosomes therapy, biomaterials strategies and intra-ovarian infusion of platelet-rich plasma (PRP).

• #2 Committee Opinion No. 698: Hormone Therapy in Primary Ovarian Insufficiency – PubMed

  https://pubmed.ncbi.nlm.nih.gov/28426619/

  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. […] Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 50-51 years). […] Finally, 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.

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

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

  You cant usually prevent primary ovarian insufficiency. However, women at higher risk for POI may choose to pursue fertility preservation if they wish to have children. Talk to your healthcare provider if youre concerned about POI. […] People at higher risk for primary ovarian insufficiency include those who: […] Have had pelvic surgery, chemotherapy or radiation.

• #4 Primary Ovarian Insufficiency – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/uf6200spec

  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. Getting enough calcium and vitamin D may help slow bone loss. Talk to your doctor about other steps you can take.

• #5 Premature Ovarian Failure (POF) Panel Test – PreventionGenetics

  https://www.preventiongenetics.com/testInfo?val=Premature-Ovarian-Failure-%28POF%29-Panel

  This test is for patients with premature ovarian failure and/or infertility. […] Premature Ovarian Failure (POF), also known as primary ovarian insufficiency, is a genetically and phenotypically heterogeneous disorder characterized by primary amenorrhea or loss of menstrual function before the age of 40. […] There are several causes of premature ovarian failure, including chromosomal abnormalities, pathogenic sequence variants, autoimmune disorders, and environmental factors. […] Approximately 10-30% of POF cases have familial inheritance. […] To date, defects in at least 21 genes have been documented to cause POF. […] Pathogenic variants in genes involved in meiosis, in DNA repair, in genes encoding transcription factors, and in genes encoding TGF- signaling pathway have all been reported in POF.

• #6 Premature ovarian insufficiency and infertility

  https://www1.racgp.org.au/ajgp/2023/january-february/premature-ovarian-insufficiency-and-infertility

  Premature ovarian insufficiency (POI) is the loss of ovarian function before the age of 40 years and can be spontaneous or iatrogenic. It is an important cause of infertility, and the diagnosis should be considered in any woman presenting with oligo/amenorrhoea, even in the absence of menopausal symptoms such as hot flushes. […] Fertility preservation should be considered for those at risk of POI. […] Women at risk of developing POI should be referred for counselling (including pregnancy planning/timing) and consideration of fertility preservation. This includes women who are to receive gonadotoxic therapies, women with autoimmune disorders such as Addison’s disease or type 1 diabetes mellitus and women with known genetic mutations, such as FMR1 premutation or Turner syndrome. Administration of gonadotropin-releasing hormone analogues may help prevent chemotherapy-induced POI in women with early breast cancer or lupus nephritis. Oocyte and ovarian tissue cryopreservation are recognised fertility-preservation techniques. […] For most women with POI, oocyte or embryo donor conception is required for pregnancy.

• #7 Guide to primary ovarian insufficiency

  https://www.pollie.co/blog/guide-to-poi

  Primary ovarian insufficiency (POI) can lead to premature menopause, or menopause before the age of 40, it should be noted that it differs from menopause as roughly 50% of individuals still experience sporadic ovarian function. […] POI is oftentimes not diagnosed until the ovaries have lost a great deal of their function. This is not ideal, as earlier detection would allow people more time to decide if they want to pursue any preventative fertility treatments like egg freezing or in-vitro fertilization (IVF) and would also enable people to begin hormone therapy earlier to minimize undesirable symptoms and long-term health impacts. […] It’s important for people with POI to work with their healthcare provider to manage their overall health and minimize any potential long-term complications. Fortunately, there are treatments available that can help minimize risk of these complications.

• #8 Premature Ovarian Insufficiency: A Review – European Medical Journal

  https://www.emjreviews.com/reproductive-health/article/premature-ovarian-insufficiency-a-review/

  HRT has to be started soon after the diagnosis of POI and should be continued until the age of natural menopause. […] To avoid follicular damage in young women requiring chemotherapy or radiotherapy for cancer, the following measures can be taken: gonadal shielding, ovarian transposition, ovarian suppression by GnRH analogues, cryopreservation of oocyte/embryo/ovarian tissue. […] Because 5-10% of women with POI can have spontaneous resumption of ovulation, contraception should be provided to women not desirous of future fertility. […] Psychological support should be given in the form of counselling to the patients and appropriate treatment to those suffering from anxiety or depression.

• #9 Premature ovarian failure – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1004

  Hormone replacement therapy is recommended for treatment of symptoms and prevention of diseases including osteoporosis. […] Screening for underlying medical conditions is recommended (as is karyotyping), especially in women younger than 30 years of age. […] Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women.

• #10

  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). […] The approach to HT for primary ovarian insufficiency is full replacement doses of hormone for long-term treatment. […] Comprehensive longitudinal management of this condition is essential.

• #11 Primary Ovarian Insufficiency | POI | MedlinePlus

  https://medlineplus.gov/primaryovarianinsufficiency.html

  Currently, there is no proven treatment to restore normal function to a woman’s ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause: […] Hormone replacement therapy (HRT) is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. HRT improves sexual health and decreases the risks for heart disease and osteoporosis. You usually take it until about age 50; that’s about the age when menopause usually begins. […] Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day. […] Regular physical activity and a healthy body weight. Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease. […] Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

• #12 Premature ovarian insufficiency – British Menopause Society

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

  Premature ovarian insufficiency […] Advice should be given to women with POI regarding lifestyle modification and bone health. This should include information on a balanced diet, adequate calcium and vitamin D intake, exercise, smoking cessation as well as avoidance of excessive alcohol intake. […] Women with POI are at increased risk of cardiovascular disease, osteoporosis and cognitive impairment. Sex steroid hormone replacement is likely to lower the long-term risk of cardiovascular disease in women with POI, prevent osteoporosis and have a beneficial effect on cognitive function. […] Women with POI should be advised to take hormone replacement and continue to do so until the natural age of the menopause in the absence of a contra-indication to minimise this risk. The aim of hormone replacement in women with POI should be to achieve physiological levels of estradiol.

• #13 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 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). Findings from the Womens Health Initiative study do not apply to young women with POI who have a reduced risk of breast cancer but an increased risk of CVD, osteoporosis and premature mortality. […] 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. […] Menopausal symptoms and reduction of CVD or osteoporosis risk can be addressed by dietary and lifestyle modification. These include smoking cessation, healthy weight maintenance, adhering to recommended alcohol intake, regular weight-bearing exercises, adequate calcium intake and sufficient vitamin D levels.

• #14 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. […] 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.

• #15 Primary ovarian insufficiency – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683

  Treatment can restore estrogen levels in people with primary ovarian insufficiency. This helps prevent some conditions that can happen due to low estrogen, such as heart disease and weak, brittle bones. […] Treatment for primary ovarian insufficiency helps prevent these other health conditions.

• #16 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. […] Assessment of bone mineral density should be considered at the time of diagnosis of POI. […] Further research is required to assess the optimal regimen, dose or route of administration of hormone replacement in women with POI.

• #17 How to manage premature ovarian insufficiency

  https://www.healthcert.com/blog/how-to-manage-premature-ovarian-insufficiency

  Premature ovarian insufficiency (POI) is associated with osteoporosis; therefore, women should be screened for osteoporosis (e.g. via DEXA scan) and bone health optimised (e.g. ensuring vitamin D replacement if required, encouraging regular weight-bearing exercise, smoking cessation). […] POI is also associated with an increased risk of cardiovascular disease (CVD), and women should be screened for CVD, and any modifiable risk factors addressed. […] All women with POI should be offered hormone replacement therapy (HRT) with oestrogen in the absence of any contraindications. HRT should be continued until age 50 as it has been shown to lower the risk of osteoporosis and cardiovascular disease in women with POI.

• #18

  https://link.springer.com/article/10.1007/s40618-016-0467-z

  Premature ovarian insufficiency (POI) is defined as the cessation of the ovarian function before the age of 40 years. […] The aim of this review was to characterize the long-term consequences of POI. […] With every patient, an individualized approach is required to properly recognize and prevent these risks. […] Protection against iatrogenic POI caused by chemotherapy, radiation therapy or surgery assumes a high priority. […] The cardiovascular evaluation should consist of monitoring annually blood pressure, weight and smoking status. […] The risk of BMD decrease and osteoporosis requires proper management, i.e. lifestyle interventions, sufficient intake of calcium and vitamin D and hormonal replacement therapy. […] Due to the risk of psychological problems, patients should be allowed to obtain psychological help.

• #19 SciELO Brazil – Premature ovarian insufficiency: A hormonal treatment approach Premature ovarian insufficiency: A hormonal treatment approach

  https://www.scielo.br/j/rbgo/a/vwxj4zQhW3cQXVrgvcZZW6q/?lang=en

  Annual clinical follow-up is recommended to verify patients adaptation and adherence to the proposed hormone replacement therapy. However, screening for cancer (cervix, breast, and colon) and metabolic disease should be conducted under the same indications and periodicity as set for women of the general population. […] Considering the increased risk for hypoestrogenism-associated diseases, the following general guidance should be provided to women with POI: A healthy lifestyle including resisted exercise (weight lifting), no smoking, and maintenance of proper body weight; Adequate ingestion of calcium and vitamin D (preferably included in their diet, however, if necessary, patient may use supplements); Assessing cardiovascular risks, including blood pressure (at least annually) and lipid panel (every five years); HRT regimen may be adjusted based on clinical response and annual reassessment. […] HRT is recommended to be continued until the usual age of menopause, i.e., around 50 years of age.

• #20 Primary Ovarian Insufficiency | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/primary-ovarian-insuffiency

  If you are younger than 40 and have stopped having periods or are having irregular ones, talk with your doctor to find the cause of the problem. […] Treatment depends on whether you have symptoms or are at risk for serious health problems. Hormone therapy (HT) is the most common treatment. HT combines estrogen and progesterone, another sex hormone. HT relieves menopausal symptoms and also helps prevent osteoporosis. […] In addition to medical treatment, you can lower your risk of osteoporosis and heart disease by eating a healthy diet and exercising regularly.

• #21 Premature ovarian insufficiency in adolescents: an update – GREM – Gynecological and Reproductive Endocrinology & Metabolism

  https://gremjournal.com/journal/01-2021/premature-ovarian-insufficiency-in-adolescents-an-update/

  Once the diagnosis, implications, and future repercussions have been understood, it is essential, and a priority, to initiate replacement hormone therapy (HT), typically with estrogens and a progestogen, with the dual aim of correcting the clinical manifestations secondary to hypoestrogenism, including symptoms that deteriorate quality of life, and minimizing or avoiding long-term morbidities and pathologies at cardiovascular, neurological and bone levels. […] There are various modifiable risk factors associated with the risk of fracture that are relevant to young women with POI, and should therefore be borne in mind. These include smoking, lack of exercise, calcium and vitamin D status, alcohol consumption, and low body weight. […] There are no validated tools for assessing the risk of developing CVD in women with POI, and the conventional ones are not suitable for women with this condition, as they have a higher relative risk of CVD compared with healthy women of the same age. However, investigation of CVR factors at the time of diagnosis may be indicated, since healthy lifestyle measures during perimenopause, such as smoking cessation, regular physical activity, and a healthy and balanced diet, improve health in later years, and should be advised.

• #22 Melatonin and Fertoprotective Adjuvants: Prevention against Premature Ovarian Failure during Chemotherapy

  https://www.mdpi.com/1422-0067/18/6/1221

  Premature ovarian failure is one of the side effects of chemotherapy in pre-menopausal cancer patients. Preservation of fertility has become increasingly important in improving the quality of life of completely recovered cancer patients. […] Major international guidelines recommend that physicians should discuss with their female cancer patients at risk of chemotherapy-induced POF and ovarian dysfunction, and help with the decision of fertility preservation as early as possible. […] Protective adjuvants that can protect the dormant follicle pool and prevent follicle loss during chemotherapy would provide considerable advantages over current fertility preservation strategies, in that they would be appropriate for young patients. […] The data suggest that melatonin could be a potential agent in the field of fertility preservation for chemotherapy-treated female cancer patients.

• #23 Melatonin and Fertoprotective Adjuvants: Prevention against Premature Ovarian Failure during Chemotherapy

  https://www.mdpi.com/1422-0067/18/6/1221

  The treatment of melatonin reduces the adverse effects of chemotherapy by removing superoxide anion, hydrogen peroxide, and peroxyl radical. […] Several studies have demonstrated that melatonin treatment protects depletion of germ cells in the gonads during chemotherapy. […] The supplementation of melatonin for in vitro maturation of oocytes improves the oocyte quality. […] These indicate that the endogenous melatonin is not enough for preventing chemo-induced primordial follicle loss in the ovary even though it is critical for oocyte development. […] Consequently, melatonin may be useful in preventing or ameliorating chemotherapy-induced ovarian disorders.

• #24 Therapeutic options for premature ovarian insufficiency: an updated review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8815154/

  PRP may be considered as a putative alternative strategy for treating POI. […] The mechanisms underlying the role of PRP in the treatment of POI remain elusive. Several studies have reported that PRP promotes the development of primitive and primary follicles into the presinus stage. […] Clinical application of PRP in human ovaries was first introduced by Pantos et al. […] These research results indicated that PRP therapy effectively restored ovarian functionality and hormonal profile. […] Intra-ovarian infusion of PRP is another novel approach to the treatment of POI. PRP is composed of high concentrations of platelets obtained from the peripheral blood of patients via centrifugation. […] The efficiency of PRP depends mainly on their -granule content, which is highly enriched in proteins, hormones, and growth factors.

• #25 Prevention of chemotherapy-induced premature ovarian insufficiency in mice by scaffold-based local delivery of human embryonic stem cell-derived mesenchymal progenitor cells | Stem Cell Research & Therapy | Full Text

  https://stemcellres.biomedcentral.com/articles/10.1186/s13287-021-02479-3

  Premature ovarian insufficiency (POI) is one of the most serious side effects of chemotherapy in young cancer survivors. […] Recently, administration of embryonic stem cell-derived mesenchymal progenitor cells (ESC-MPCs) has been considered a new therapeutic option for preventing POI. […] This study aimed to develop safe and effective local delivery methods for the prevention of POI using two types of bioinspired scaffolds. […] The local administration of human ESC-MPCs using the bioinspired scaffold to the backs of mice effectively prolonged the cell survival rate in vivo. […] HA GEL scaffolds can be used as new delivery platforms for ESC-MPC therapy, and this method may provide a novel option for the clinical treatment of chemotherapy-induced POI. […] Thus, it is important to consider the prevention of ovarian insufficiency in premenopausal patients with cancer.

• #26 Prevention of chemotherapy-induced premature ovarian insufficiency in mice by scaffold-based local delivery of human embryonic stem cell-derived mesenchymal progenitor cells | Stem Cell Research & Therapy | Full Text

  https://stemcellres.biomedcentral.com/articles/10.1186/s13287-021-02479-3

  Our approach may provide a new, simple, and effective method to preserve ovarian function and lifelong health in cancer survivors. […] Therefore, we aimed to develop an alternative delivery method for MPC therapy that is minimally invasive, avoids nontarget tissue integration, offers a homogenous cell distribution, and increases the residual cell proportion in vivo. […] The poor survival rate of cells after transplantation and safety issues are major obstacles to MPC therapy. […] To address these issues, in the present study, we evaluated whether scaffolds would help human ESC-MPCs survive, resulting in improved efficacy of stem cell therapy. […] Our study provides new insights into the administration methods of stem cell therapy. The human ESC-MPC/scaffold method could be a clinically promising and safe method to reduce chemotherapy-induced POI.

• #27 Primary Ovarian Insufficiency (POI): Causes, Symptoms and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/primary-ovarian-insufficiency

  Your health care provider will ask questions about your health, past medical history, menstrual history, complete a physical exam, order lab work, and may order imaging (i.e. ultrasound, bone density scan). […] The goal of POI treatment is to replace the hormones the ovary should be making until the natural age of menopause. Hormone replacement therapy is important for pubertal development (if this was not completed prior to the POI), symptom relief (i.e. hot flushes, vaginal dryness), bone health, cardiovascular health, and sexual health. […] Women with POI should be sure to take enough calcium and vitamin D and get regular exercise. This will help optimize bone and cardiovascular health. They should avoid tobacco. […] Because the diagnosis of POI can be stressful, many patients benefit from seeing a behavioral health team for emotional and psychological support.

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

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

  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. Estrogen is also important for keeping the heart and brain healthy. Patients usually get estrogen replacement through a skin patch that they change one to two times each week. […] 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.

• #29 Primary Ovarian Insufficiency (POI): Causes, Symptoms and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/primary-ovarian-insufficiency

  As patients with POI grow older and start to focus on family planning, they may choose to meet with a fertility specialist to discuss fertility and family building options. […] Because some women with POI may have residual ovarian function, if a woman is sexually active and does not desire pregnancy, effective contraception should be used.

• #30 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

  As HRT is not contraceptive, counselling regarding contraceptive options is important for women not desiring pregnancy. COCP can provide both hormone replacement and contraception and, if prescribed, women should be advised to take it continuously or long cycle, without the inactive pills, to avoid intermittent periods of symptomatic oestrogen deprivation. […] Principles for managing the potential long-term sequelae of POI are listed in Figure 3, and include the issues of infertility, CVD and osteoporosis risk assessment; consideration of specialist referral; autoimmune screening; and management of the underlying cause of POI (eg Turner syndrome, autoimmune conditions). […] Referral for psychological support should be considered, and women should be made aware of available support groups and educational resources. […] Following diagnosis, the aetiology of POI and long-term consequences should be evaluated, and specialist referral may be necessary.

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