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Premature Menopause: Management

Appropriate information and support should be provided since Premature ovarian insufficiency (POI) can be a very difficult diagnosis to come to terms with.
The main aspect of treatment is the provision of adequate estrogen replacement to both control menopausal symptoms and to reduce the risk of later health consequences. Estrogen can be in the form of HRT, which will include a progestogen to protect the womb lining if the womb is still present. If HRT is used, it should usually be continued until the early 50s, ie the average age of the menopause, for both symptom control and bone protective effect.

Women who have a sudden premature menopause, may require higher doses of estrogen in HRT to control the symptoms than would usually be used by women in their 50s.
Previous concerns about risks of HRT should not apply to women with POI taking HRT since they are simply replacing the hormones which would usually be produced anyway at this stage.

Some young women may prefer to take the combined contraceptive pill which can both control menopausal symptoms and provide contraception, but there is currently uncertainty about whether HRT or combined pill offers the best protection in terms of bone and cardiovascular disease.

Some women with POI, especially if they have had their ovaries removed, may benefit from testosterone replacement as well as HRT. This option would often be discussed with a specialist.

Women who have chromosomal disorders often do not have periods at all since their hormone levels have always been low. They may not experience the usual menopausal symptoms since they do not have changing hormone levels. Despite the lack of symptoms, discussion about hormonal treatment is vitally important, as it is for all women with premature menopause because of the increased risk of osteoporosis; estrogen, either when produced naturally or when taken as medication, is very important in maintaining bone density and preventing bone loss. The lack of estrogen at a younger age than normal therefore increases the risk of bone loss and osteoporosis and so generally, women with POI should be advised to take HRT until the average age of the menopause, whether or not they have menopausal symptoms.

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