Table 5.

Treatment of primary ovarian insufficiency

Hormone replacement therapy

Example regimen: 50–100 μg transdermal estradiol daily

If uterus is present, add 5–10 mg of medroxyprogesterone acetate for 12 days of the month

Contraception

Combined oral contraceptives have the added benefit of providing HRT

Intrauterine devices or barrier methods are also acceptable alternatives (supplemental HRT should be advised)

Fertility management

Options for fertility preservation: ovarian hyperstimulation with oocyte retrieval followed by oocyte or embryo cryopreservation, ovarian tissue cryopreservation

Ovarian suppression with GnRH agonist prior to chemotherapy

In vitro fertilization with use of donor oocytes

Psychosocial support

Psychologist referral

Support groups

Screening

6–12-month intervals with periodic testing of TSH, calcium, and cortisol levels

If antiadrenal antibodies are present, an ACTH stimulation test to assess adrenal reserve or referral to an endocrinologist is advised Bone mineral density screening if HRT declined

Abbreviations: ACTH, adrenocorticotropic hormone; HRT, hormone replacement therapy; TSH, thyroid-stimulating hormone; GnRH, gonadotropin-releasing hormone.