Table 4.
Summary of treatment options in female adult affected by Isolated Hypogonadotropic Hypogonadism.
| ADULT FEMALE HYPOGONADISM | PROS | CONTRAS | ||
|---|---|---|---|---|
| Estrogenic therapy (patch) | 50-100 micrograms/24 h Applied twice/week |
Titrating dose based on clinical signs and symptoms | No first passage effect | Skin irritation, Possible issues with frequent showering or certain lifestyle |
| Estrogenic therapy (gel) | Estradiol or estradiol hemihydrate 0,5 to 2 mg/die |
No first passage effect | Skin irritation; need to be accurately dried |
|
| Estrogenic therapy (tablets) | Micronized or valerate estradiol 1-4 mg/die | First passage effect | ||
| Progesterone | e.g., Micronized progesterone (100-200 mg/die for last 10 days/month) vaginal route |
|||
| ADULT OVULATION INDUCTION | ||||
| Gonadotropins |
Follicular Phase: FSH + LH) 75 to 150 IU SC daily, Ovulation phase: induced by hCG 6500 IU Luteal phase: hCG 1500 UI every 3 days, thrice or progesterone 200 mg intravaginally daily |
Follicular phase: depending on follicular growth (serum estradiol and ultrasonography) | Self-injection | Higher risk of overstimulation and multiple pregnancies |
| Pulsatile GnRH | SC pump: 15 mg per pulse every 90 min | Dose adapted based on response, up to 30 mg per pulse | Less risk in multiple pregnancy; most physiological treatment | Pituitary resistance (rare) |