What are the treatments for POI?

 

Currently, there is no proven treatment to restore normal function to a woman's ovaries.  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.  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.


    See below to learn more about common treatments for POI and its associated conditions.


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Hormone Replacement Therapy (HRT)

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.
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.  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.


HRT is usually a combination of an estrogen and a progestin. Progestin is a form of progesterone. Sometimes, the combination might also include testosterone, although this approach is controversial. HRT comes in several forms:  patches that stick onto the skin, a vaginal ring, pills, creams and gels.  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 health care 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 health care provider about stopping the treatment because of risks associated with using this type of therapy in the years after the normal age of menopause.  

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Is it Safe for Women with POI to Take HRT?

 

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.

These results do not apply to young women with POI who take HRT.  The type and amount of HRT prescribed to women with POI is different from the PMHT taken by older women.  A woman should talk to her health care provider if she has questions about HRT as a treatment for POI. Also, she should tell her health care provider about any side effects she experiences while taking HRT. There are many different types of HRT. Women should work with their health care providers to find out the best type of treatment.  

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A Plan for POI Care

 

Calcium and Vitamin D Supplements

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.  These nutrients are important for bone health.  A health care provider may do a bone mineral density test to check for bone loss.  

Regular Physical Activity and Healthy Body Weight

Weight-bearing physical activity, such as walking, jogging, and stair climbing, helps build bone strength and prevents osteoporosis.  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.

Treatments for Associated Conditions
POI is associated with other health conditions, including (but not limited to) Addison's disease, Fragile X permutation, thyroid dysfunction, depression, anxierty, 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.

Emotional Support

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.  Several organizations offer help finding these types of professionals. 

POI in Teens

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. It is important for parents, the teenager, and health care 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 health care providers. 

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