Advertisement

Premature Ovarian Insufficiency: Hormone Replacement Therapy and Follow-Up

  • Volker ZillerEmail author
  • Petra Stute
  • Michael von Wolff
Chapter
  • 15 Downloads

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.

Keywords

Early menopause Fertility FertiPROTEKT Hormone replacement therapy Osteoporosis POI PREMATURE ovarian insufficiency 

References

  1. 1.
    Hamoda H, British Menopause Society and Women’s Health Concern. The British Menopause Society and Women's Health Concern recommendations on the management of women with premature ovarian insufficiency. Post Reprod Health. 2017;23:22–35.CrossRefGoogle Scholar
  2. 2.
    Coccia ME, Rizzello F, Mariani G, Bulletti C, Palagiano A, Scarselli G. Ovarian surgery for bilateral endometriomas influences age at menopause. Hum Reprod. 2011;26:3000–7.CrossRefGoogle Scholar
  3. 3.
    Huong DL, Amoura Z, Duhaut P, Sbai A, Costedoat N, Wechsler B, Piette JC. Risk of ovarian failure and fertility after intravenous cyclophosphamide. A study in 84 patients. J Rheumatol. 2002;29:2571–6.PubMedGoogle Scholar
  4. 4.
    Katsifis GE, Tzioufas AG. Ovarian failure in systemic lupus erythematosus patients treated with pulsed intravenous cyclophosphamide. Lupus. 2004;13:673–8.CrossRefGoogle Scholar
  5. 5.
    Oktem O, Kim SS, Selek U, Schatmann G, Urman B. Ovarian and uterine functions in female survivors of childhood cancers. Oncologist. 2018;23:214–24.CrossRefGoogle Scholar
  6. 6.
    European Society for Human Reproduction and Embryology (ESHRE) Guideline Group on POI, Webber L, Davies M, Anderson R, Bartlett J, Braat D, Cartwright B, Cifkova R, de Muinck Keizer-Schrama S, Hogervorst E, Janse F, Liao L, Vlaisavljevic V, Zillikens C, Vermeulen N. ESHRE guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31:926–37.CrossRefGoogle Scholar
  7. 7.
    Dachverband Osteologie e.v. (DVO). Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern, S3 Leitlinie des Dachverbands der Deutschsprachigen Wissenschaftliche Gesellschaften , 2017, AWMF-Register Nr.: 183–001.Google Scholar
  8. 8.
    Jacobsen BK, Heuch I, Kvale G. Age at natural menopause and all-cause mortality: a 37-year follow-up of 19,731 Norwegian women. Am J Epidemiol. 2003;157:923–9.CrossRefGoogle Scholar
  9. 9.
    Elsheikh M, Bird R, Casadei B, Conway GS, Wass JA. The effect of hormone replacement therapy on cardiovascular hemodynamics in women with Turner's syndrome. J Clin Endocrinol Metab. 2000;85:614–8.PubMedGoogle Scholar
  10. 10.
    Deli T, Orosz M, Jakab A. Hormone replacement therapy in cancer survivors - review of the literature. Pathol Oncol Res. 2019. [Epub ahead of print]Google Scholar
  11. 11.
    Stute P, Bürki R, Geissbühler V. Nicht-hormonelle Therapie von menopausalen Hitzewallungen. SGGG Expertenbrief. . https://www.sggg.ch/fachthemen/expertenbriefe/
  12. 12.
    Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF), Deutschen Krebsgesellschaft e.V. (DKG) und Deutschen Krebshilfe (DKH). S3-Leitlinie Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms (Version 4.1, 2018) AWMF-Registernummer: 032-045OL.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Volker Ziller
    • 1
    Email author
  • Petra Stute
    • 2
  • Michael von Wolff
    • 2
  1. 1.Dep. Gyn. Endocrinology and Reproductive Medicine, Clinic for Gynaecology and ObstetricsUniversity Hospital Giessen and Marburg (UKGM)MarburgGermany
  2. 2.Division of Gynaecological Endocrinology and Reproductive MedicineUniversity Women’s Hospital, University of BernBernSwitzerland

Personalised recommendations