What are the treatments for POI?

Currently, there is no proven treatment to restore normal function to a woman's ovaries.1,2 But there are treatments for some of the symptoms of POI, as well as treatments and behaviors to reduce health risks and conditions associated with POI.

It is also important to note that between 5% and 10% of women with POI get pregnant without medical intervention after they are diagnosed with POI.3 Some research suggests that these women go into what is known as "spontaneous remission" of POI, meaning that the ovaries begin to function normally on their own. When the ovaries are working properly, fertility is restored and the women can get pregnant.3

Select one of the following topics to learn more about common treatments for POI and its associated conditions.

HRT is the most common treatment for women with POI. It gives the body the estrogen and other hormones that the ovaries are not making. HRT improves sexual health and decreases the risks for cardiovascular disease (including heart attacks, stroke, and high blood pressure) and osteoporosis.4

If a woman with POI begins HRT, she is expected to start having regular periods again. In addition, HRT is expected to reduce other symptoms, such as hot flashes and night sweats, and help maintain bone health.1,5,6,7 HRT will not prevent pregnancy, and evidence suggests it might improve pregnancy rates for women with POI by lowering high levels of luteinizing hormone — which stimulates ovulation — to normal in some women.8

HRT is usually a combination of an estrogen and a progestin. A progestin is a form of progesterone. Sometimes, the combination might also include testosterone, although this approach is controversial.9 HRT comes in several forms: pills, creams, gels, patches that stick onto the skin, an intrauterine device, or a vaginal ring.10 Estradiol is the natural form of human estrogen. The optimal method of providing estradiol to women with POI is by a skin patch or vaginal ring. These methods are linked with a lower risk of potentially fatal blood clots developing. Most women require a dose of 100 micrograms of estradiol per day. It is important to take a progestin along with estradiol to balance out the effect of estrogen on the lining of the womb. Women who do not take a progestin along with estradiol are at increased risk of developing endometrial cancer. The progestin with the best evidence available to support use in women with POI is 10 mg of medroxyprogesterone acetate by mouth per day for the first 12 calendar days of each month.

A healthcare provider may suggest that a woman with POI take HRT until she is about 50 years old, the age at which menopause usually begins.

After that time, she should talk with her healthcare provider about stopping the treatment because of risks associated with using this type of therapy in the years after the normal age of menopause.3

In general, HRT treatment for women with POI is safe and is associated with only minimal side effects. Women with POI take HRT to replace hormones their bodies would normally be making if they didn't have POI.

The HRT taken by women with POI is different from the hormone therapies taken by women who are going through or have gone through natural menopause, which are often called menopausal or post-menopausal hormone therapy (PMHT).

A large, long-term study—called the Women's Health Initiative—examined the effects of a specific type of PMHT, taken for more than 5 years, by women ages 50 to 79 who had already gone through menopause. This study showed that PMHT was associated with an increased risk of stroke, blood clots, heart disease, heart attacks, and breast cancer in these women.11

These results do not apply to young women with POI who take HRT.3,10 The type and amount of HRT prescribed to women with POI is different from the PMHT taken by older women.3

A woman should talk to her healthcare provider if she has questions about HRT as a treatment for POI. Also, she should tell her healthcare provider about any side effects she experiences while taking HRT. There are many different types of HRT. Women should work with their healthcare providers to find out the best type of treatment.

Because women with POI are at higher risk for osteoporosis, they should get at least 1,200 to 1,500 mg of elemental calcium and 1000 IU (international units) of vitamin D, which helps the body absorb calcium, every day.12 These nutrients are important for bone health.10 A healthcare provider may do a bone mineral density test to check for bone loss.8

Weight-bearing physical activity, such as walking, jogging, and stair climbing, helps build bone strength and prevents osteoporosis.10 Maintaining a healthy body weight and getting regular physical activity are also important for reducing the risk of heart disease. These factors can affect cholesterol levels, which in turn can change the risk for heart disease.13

POI is associated with other health conditions, including (but not limited to) Addison's disease, Fragile X permutation, thyroid dysfunction, depression, anxiety, and certain other genetic, metabolic, and autoimmune disorders.

Women who have POI as well as one of these associated conditions will require additional treatment for the associated condition. In some cases, treatment involves medication or hormone therapy. Other types of treatments might also be needed.

For many women who experience infertility, including those with POI, feelings of loss are common. In one study, almost 9 out of 10 women reported feeling moderate to severe emotional distress when they learned of their POI diagnosis.10,14 Several organizations offer help finding these types of professionals. Visit the Resources and Publications section for more information.

Receiving a diagnosis of POI can be emotionally difficult for teenagers and their parents. A teen may have a similar emotional experience as an adult who receives the diagnosis, but there are many aspects of the experience that are unique to being a teenager.16 It is important for parents, the teenager, and healthcare providers to work closely together to ensure that the teenager gets the right treatment and maintains her emotional and physical health in the long term. There are resources to provide advice and support for parents, teenagers, and healthcare providers. Visit the Resources and Publications section for more information.

Citations

  1. American Congress of Obstetricians and Gynecologists. (2009). Premature ovarian failure. ACOG medical student teaching module [PowerPoint slides].
  2. National Library of Medicine. (2011). Premature ovarian failure. Retrieved January 4, 2012, from https://medlineplus.gov/primaryovarianinsufficiency.html
  3. Nelson, L. M. (2009). Primary ovarian insufficiency. New England Journal of Medicine, 360, 606–6.
  4. Shelling, A. N. (2010). Premature ovarian failure. Reproduction, 140, 633-641.
  5. Fridovich-Keil, J. L., Gubbels, C. S., Spencer, J. B., Sanders, R. D., Land, J. A., & Rubio-Gozalbo, E. (2011). Ovarian function in girls and women with GALT-deficiency galactosemia. Journal of Inherited Metabolic Disease, 34, 357–366.
  6. National Institutes of Health. (2010). Too young for hot flashes? When menopause-like symptoms come too soon. NIH News in Health. Retrieved January 4, 2012, from  https://newsinhealth.nih.gov/2010/06/too-young-hot-flashes
  7. Rebar, R. W. (2009). Premature ovarian failure. Obstetrics and Gynecology, 113(6), 1355–1363.
  8. Popat, V.B., Vanderhoof, V.H., Calis, K.A., Troendle, J.F., & Nelson, L.M. (2008). Normalization of serum lutenizing hormone levels in women with 46,XX spontaneous primary ovarian insufficiency. Fertility and Sterility, 89(2), 429-433
  9. Kodaman, P. H. (2010). Early menopause: Primary ovarian insufficiency and surgical menopause. Seminars in Reproductive Medicine, 28, 360–369.
  10. National Library of Medicine, MedlinePlus. (2010). Estrogen vaginal. Retrieved February 24, 2012, from https://medlineplus.gov/druginfo/meds/a606005.html
  11. NHLBI. (n.d.). Women's Health Initiative background and overview. Retrieved January 4, 2012, from https://www.nhlbi.nih.gov/science/womens-health-initiative-whi
  12. Institute of Medicine of the National Academies. (2010). DRIs for calcium and vitamin D. Retrieved February 25, 2012, from https://www.nap.edu/resource/13050/Vitamin-D-and-Calcium-2010-Report-Brief.pdf external link (PDF 320 KB)
  13. National Heart, Lung, and Blood Institute. (2009). At-a-glance: What you need to know about high blood cholesterol. Retrieved May 23, 2012, from https://www.nhlbi.nih.gov/resources/cholesterol-your-heart-what-you-need-know (PDF 2.15 MB)
  14. Groff, A. A., Covington, S. N., Halverson, L. R., Fitzgerald, O. R., Vanderhoof, V., Calis, K., et al. (2005). Assessing the emotional needs of women with spontaneous premature ovarian failure. Fertility and Sterility, 83, 1734–1741.
  15. Ventura, J. L., Fitzgerald, O. R., Koziol, D. E., Covington, S. N., Vanderhoof, V. H., Calis, K. A., et al. (2007). Functional well-being is positively correlated with spiritual well-being in women who have spontaneous premature ovarian failure. Fertility and Sterility ;87: 584–590.
  16. Covington, S. N., Hillard, P. J., Sterling, E. W., Nelson, L. M., & POI Recovery Group. (2011). A family systems approach to primary ovarian insufficiency. Journal of Pediatric and Adolescent Gynecology, 24, 137–141.
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