Premature Ovarian Failure
(continued)

Treatment of Premature Menopause:

1. Drugs:
  POF causes a lack of estrogen; in many cases the treatment is simply estrogen therapy (ET). This can come in the form of a pill, patch, vaginal creams, vaginal ring, or long-acting injections. Estrogen may increase the risk of endometrial cancer (cancer of the lining of the womb), however, so most women will also take a progestin. Some preparations combine the estrogen and progesterone in one pill or one patch. Women who have had a hysterectomy (surgical removal of the uterus) do not have to take a progestin.

Estrogen has certain contraindications (reasons it cannot be taken), however, so it cannot be given to all patients with POF. Your doctor will advise you as to alternative treatments if you are one of those patients. Additional side effects of estrogen include: breast tenderness, blood clots, nausea, vomiting, acne, gallbladder disease, and headache. Side effects of progesterone may include headache, irritability, depression, nausea, vomiting, and bloating. Taking estrogen may also increase your risk of breast cancer, heart attacks, and strokes.

Many patients with POF are unhappy to hear their diagnosis; some may become clinically depressed. If you have depression, you may also be offered antidepressant therapy &/or referred to a psychologist or psychiatrist. This does not mean you are weak or have a mental illness. It does not mean you will need this forever. It means this is one more therapeutic option your physician can offer you. In addition, anti-depressants may also treat some of the menopausal symptoms.

Treatment of Infertility: In those patients with POF who would like to get pregnant, treatment can be very frustrating, time consuming and expensive. It is important to consult a reproductive endocrinologist as soon as the diagnosis has been made if preserving your fertility is important to you. Use of GnRH (gonadotropin-releasing hormone), estradiol and steroids (e.g. prednisone) have not proven effective, nor has Clomid® (clomiphene citrate), Danazol®, or human menopausal gonadotropins (hMG). Generally, the women with POF who have ovulated and conceived have taken hormone replacement therapy (HRT). In vitro fertilization of a donor egg may be an option for some women.

2. Diet:
Remember that menopausal women need increased calcium (1,500 mg/day) and Vitamin D regardless of their age, so ask your physician if you should be taking supplements. There are numerous new soy based food products on the market now targeting menopausal women because of evidence that soy may have an impact on menopausal symptoms. By all means eat them if you enjoy them, and as a good source of dietary protein. But be aware that women who are taking estrogen therapy don't “need” these foods as a source of estrogen.


3. Stress management:
Since stress is high on the list of consequences of POF, stress management techniques are high on the list of POF management strategies. Lifestyle modifications can also help get enough rest; exercise, and eat healthfully.  


4. Ovarian transplantation:
This has gotten a great deal of media attention, but should still be regarded as experimental. The most promising report was in a Nov. 2009 paper, in which a group of researchers from St. Louis reported their findings of 10 pair of identical twins in which one twin had POF & one didn’t. They were able to transplant ovarian tissue from the menstruating twin to the other with successful pregnancies in 7 out of 10 twins.


5. Support groups: Women
with POF consistently cite the need for more support and understanding of their condition; the POF Support Group (www.POFsupport.org) is a great resource.  Founded in 1995, they now have support groups in several cities and are continuing to grow.  For POF patients with infertility, there are numerous support groups. ).

Whatever your choice of therapy, remember that you're not committed to that choice for life! You and your physician will monitor your progress and your comfort level with your treatment plan. If there are factors that change--including your level of satisfaction--discuss these with your physician.

Created: 9/27/2000  -  Donnica Moore, M.D.
Reviewed: 2/12/2010  -  Donnica Moore, M.D.