Premature Ovarian Insufficiency: Hormone Replacement Therapy and Follow-Up

Abstract

This chapter describes causes, diagnostic and therapeutic procedures in the event of premature ovarian insufficiency (POI) induced either by gonadotoxic treatments or caused by genetic defects, autoimmunological disease, infection, surgical interventions, etc. POI is defined by oligo-/amenorrhea for at least 4 months and a serum concentration of FSH > 25 IU/I measured twice at least 4 weeks apart in women before the age of 40 years. Women with POI generally show the typical symptoms of menopause such as cycle disorders, hot flushes, vaginal dryness, sleep disorders and psychological changes such as nervousness, irritability, fatigue and others. Fertility of POI patients is severely reduced and total infertility can occur. The lack of estrogen leads to considerable long-term consequences. These are primarily effects on bone metabolism, the cardiovascular system and changes in the nervous system that result in a reduced life expectancy. The misinterpretation of the WHI (Women’s Health Initiative) study has led to an irrational fear of hormone replacement therapy (HRT) for both patients and doctors. However, with the increased risk associated with POI/early menopause HRT is advantageous if the oncological and other contraindications to HRT are followed. The risks of non-HRT must therefore be weighed individually against the risks of HRT.