Hormone replacement therapy in young women with surgical primary ovarian insufficiency

摘要

Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency (Surgical POI), an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy most of these women develop severe symptoms of estrogen deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality. In cases in which a hysterectomy has been performed at the time of bilateral oophorectomy transdermal or transvaginal estradiol replacement therapy without cyclic progestin replacement is the optimum hormonal management for these women. There is substantial evidence this approach even reduces the risk for breast cancer. Unfortunately, unwarranted fear of all menopausal hormone therapies has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of estrogen therapy even in women in whom hormone replacement therapy is clearly indicated. Discussion of possible ovarian conservation in women who are premenopausal is an integral part of the preoperative planning for any women undergoing hysterectomy. Timely and effective hormone replacement therapy for women who will experience Surgical POI is clearly indicated.