Hormone Therapy in Primary Ovarian Insufficiency Flashcards
Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency.
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As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. However, serum estradiol level testing is not recommended to monitor the effects of treatment
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Combined hormonal contraceptives prevent ovulation and pregnancy more reliably than HT; despite only modest odds of spontaneous pregnancy in women with primary ovarian insufficiency, this is a critical consideration for those who deem pregnancy prevention a priority.
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For a woman who prefers noncontraceptive estrogen replacement and wants highly effective contraception, insertion of a levonorgestrel intrauterine device is preferable to oral progestin therapy.
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Primary ovarian insufficiency describes a spectrum of declining ovarian function and reduced fecundity due to a premature decrease in initial follicle number, an increase in follicle destruction, or poor follicular response to gonadotropins (1, 2). At least 90% of cases of primary ovarian insufficiency are idiopathic
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Young women with cancer or other serious illnesses that require chemotherapy or pelvic radiation are at risk of primary ovarian insufficiency because these agents may cause profound and rapid follicular atresia.
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Overt ovarian insufficiency refers to women younger than 40 years who have elevated follicle-stimulating hormone levels in the menopausal range (at least 30–40 mIU/mL) and amenorrhea (1, 3, 8). This clinical state, traditionally referred to as “premature menopause” or “premature ovarian failure,” affects 1% of women. The term “primary ovarian insufficiency” more accurately captures the nature of ovarian dysfunction displayed in affected women, 50% of whom experience infrequent ovulation and menstrual cycles after diagnosis and 5–10% of whom may achieve spontaneous pregnancies
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The sequelae of primary ovarian insufficiency include vasomotor symptoms, urogenital atrophy, osteoporosis and fracture, cardiovascular disease, and increased all-cause mortality
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n women with primary ovarian insufficiency, systemic HT is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks if there are no contraindications to treatment. Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency.
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Women with primary ovarian insufficiency-related estrogen deficiency are at risk of osteopenia, osteoporosis, and fracture, especially if hypoestrogenism occurs early in life and before accrual of peak bone mass
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Women with primary ovarian insufficiency-related estrogen deficiency are at risk of osteopenia, osteoporosis, and fracture, especially if hypoestrogenism occurs early in life and before accrual of peak bone mass
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n a study of more than 1,000 patients, the incidence of hip fracture in women starting menopause at age 40 years was 9.4% compared with 3.3% in those starting menopause at age 48 years (
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Postmenopausal women have less favorable lipid profiles compared with premenopausal women and the risk of metabolic syndrome has been shown to increase after menopausal transition (23, 24). Women who develop primary ovarian insufficiency are also at increased risk of cardiovascular events and cardiovascular mortality compared with women who do not experience early menopause
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patients who reported experiencing menopause between the ages of 35 years and 40 years at study entry had a 50% greater subsequent risk of ischemic heart disease-related death (risk adjusted for diabetes, hypertension, parity, age at first birth, and physical activity) compared with those who experienced menopause between the ages of 49 years and 51 years (25).
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