Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause

Fertil Steril. 2016 Dec;106(7):1588-1599. doi: 10.1016/j.fertnstert.2016.09.046.


Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychologic impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy (HRT) to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective HRT options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ∼50 years. We address special populations of women with POI, including women with Turner syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women.

Keywords: Primary ovarian insufficiency; androgen; early menopause; estrogen; hormone replacement therapy; management; menopausal hormone therapy; morbidity; mortality; premature menopause; premature ovarian failure; progestin.

Publication types

  • Review

MeSH terms

  • Adult
  • Estrogen Replacement Therapy / adverse effects
  • Estrogen Replacement Therapy / methods*
  • Female
  • Fertility Agents, Female / adverse effects
  • Fertility Agents, Female / therapeutic use*
  • Humans
  • Infertility, Female / diagnosis
  • Infertility, Female / drug therapy*
  • Infertility, Female / etiology
  • Infertility, Female / physiopathology
  • Menopause, Premature / drug effects*
  • Middle Aged
  • Patient Selection
  • Primary Ovarian Insufficiency / complications
  • Primary Ovarian Insufficiency / diagnosis
  • Primary Ovarian Insufficiency / drug therapy*
  • Primary Ovarian Insufficiency / physiopathology
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome


  • Fertility Agents, Female