As the a first-range strategy, HT (sometimes by mouth otherwise transdermally) that achieves substitute for estrogen levels is advised 1 step three 65

As the a first-range strategy, HT (sometimes by mouth otherwise transdermally) that achieves substitute for estrogen levels is advised 1 step three 65

Hormone Procedures Choices

Regardless of if exogenous estrogen replacement for is recommended for women which have primary ovarian insufficiency, study contrasting individuals hormonal routines having disease reduction, symptom amelioration, and safety lack in this people. However, solution estradiol top investigations is not necessary observe the consequences regarding procedures. The hormone estrogen replacement can be done toward pursuing the estradiol agreements: 1–2 milligrams oral 17 ? -estradiol every day, one hundred micrograms transdermal 17 ? -estradiol day-after-day, otherwise conjugated equine estrogens 0.625–step one.twenty-five milligrams daily Table step 1 step one 65 67. The option of estrogen treatment are in addition to correctly dosed progestogen medication (given continuously or sequentially) to stop endometrial hyperplasia and you may cancer. However with proceeded progestogen medication, cyclic government allows for before detection from a pregnancy. People having no. 1 ovarian deficiency may spontaneously ovulate to your a rare basis, as well as the absence of a withdrawal bleed should fast the patient to evaluate for maternity.

Another prominent means is the the means to access mutual hormones contraceptives, which could accommodate ease of administration and less diligent stigma weighed against an excellent HT program. However, the fresh new amount away from the hormone estrogen and you can progestin from inside the combined hormones contraceptives was not replacement for dose; this type of hormones agreements are a great deal more effective compared to the latter HT possibilities 65. Thus far, no well-pushed randomized examples exist comparing HT which have combined hormonal contraceptives when you look at the lady having no. 1 ovarian deficiency to choose cardiovascular risk (either coronary artery state protection otherwise chance of venous thromboembolism), quality-of-existence steps (such as, vasomotor episodes, bleeding character, sexual dysfunction, patient fulfillment), or bone health. As substitute for dosages of the hormone estrogen offered for the HT is quicker strong compared to estrogen when you look at the combined hormones contraceptives, HT could have a reduced danger of venous thromboembolism. To help expand reduce the danger of venous thromboembolism which have HT, specific experts recommend medication of the transdermal station, removing this new “first-pass” effect on the liver 68 69.

Combined hormonal contraceptives avoid ovulation and you will maternity a lot more dependably than simply HT; even with just more compact odds of spontaneous maternity in females that have top ovarian deficit, this is certainly a critical attention just in case you consider maternity avoidance important. To have a woman which likes noncontraceptive the hormone estrogen replacement for and you will desires very productive birth prevention, insertion from a good levonorgestrel intrauterine product is simpler to dental progestin medication 62 70. Barrier methods of contraception as well as may be used. Answer to all women that have no. 1 ovarian insufficiency is to keep until an average age of sheer menopause try hit (age fifty–51 many years) 2. Medication may keep earlier in the day decades 50–51 decades in the event that a lady have medical attacks or signs. Regardless of ages, the choice to remain HT can be customized and you may considering a female’s symptoms and the risk–benefit ratio.


No. 1 ovarian deficiency is actually a lifetime-changing diagnosis that presents numerous medical and you will psychosocial demands getting influenced people. Regardless if a lot more research is needed seriously to determine optimal solutions you to balance experts and you will dangers, HT is the central part of the fresh enough time-identity systematic handling of these patients. No. 1 ovarian insufficiency is a beneficial pathologic condition which should not be felt a good hastening off absolute menopausal. Although women having number 1 ovarian insufficiency show well-known health threats that have however menopause women, the latest method to wellness repair in these female is actually type of. The fresh new approach to HT to own primary ovarian insufficiency is actually complete replacement for amounts regarding hormonal for very long-term cures. Fundamentally, because of the demands you to teens and you can ladies get face inside managing the new bodily, reproductive, and you will public results of number one ovarian lack, total longitudinal management of this condition is important.

Overt ovarian insufficiency identifies female young than forty years who have increased follicle-revitalizing hormonal account from the menopausal diversity (at the very least 30–forty mIU/mL) and amenorrhea step 1 step 3 8. This systematic county, traditionally also known as “untimely menopausal” or “premature ovarian inability,” influences step one% of females. The term “first ovarian insufficiency” more precisely grabs the sort of ovarian breakdown shown when you look at the inspired females, 50% of who experience infrequent ovulation and you will menstrual time periods just after analysis and you can 5–10% off which can get achieve impulsive pregnancies step one.

Epidemiologic evidence giving support to the the means to access HT to quit cardio occurrences in females that have number one ovarian lack is currently lacking. However, truth be told there also are zero studies one to mean that lady with number one ovarian insufficiency who’re given HT feel a greater risk out of cardio side effects compared with unchanged female playing with HT otherwise consolidation hormones contraceptives (each and every day joint estrogen–progestin when it comes to consolidation oral birth control pills, this new contraceptive band, otherwise transdermal spots) step three thirty two.

Unopposed estrogen replacement therapy is an important risk factor for endometrial hyperplasia (10–50% chance per year) and you can disease (doing a good 10-flex escalation in absolute exposure) and, thus, isn’t required 41 58 59 60 61 62. Incorporating progestogen medication (synthetic or absolute agonists of your progesterone receptor in the suitable sequential or continuous amounts) to help you the hormone estrogen replacement reduces the danger; latest combined HT regimens aren’t regarding the an elevated risk out of endometrial hyperplasia otherwise cancer tumors 41 63 64. The current regimens add continuous or sequential progestogen therapy so you’re able to the hormone estrogen substitute for 65 66 Desk 1.


    *24 Horas
    com hora marcada