Hormone Therapy of Premature Ovarian Failure

Abstract

Ovarian hormones play an important role in women’s health, providing the most reliable and convenient means of contraception and of relieving menopausal symptoms.1,2 Hormone therapy also has other benefits, eg, regulation of menstrual irregularities and relief of dysmenorrhea in menstruating women and prevention of vulvovaginal atrophy and osteoporosis/fractures in postmenopausal women. In addition, natural estrogens, principally 17β-estradiol, and natural progesterone (but not synthetic progestins) have biological effects that protect the vasculature from oxidative and inflammatory injury and prevent cardiovascular disease.3 These functions have been adduced by some to account for the 10- to 15-year delay in presentation of clinical cardiovascular disease and events in women compared with men. In contrast to the unquestioned benefits of endogenous ovarian hormones, hormone therapy of women with ovarian failure, whether naturally occurring or surgically induced, continues to be a topic of active debate in the scientific and popular literature. Although observational studies have shown substantial (≈50% reduction in coronary heart disease) benefit of menopausal hormone therapy (also referred to as “menopausal hormone replacement therapy” or “hormone replacement therapy”) in women who choose to take them (usually beginning treatment in the perimenopausal or early postmenopausal period), randomized, controlled trials have not confirmed a cardioprotective effect and have even shown evidence of harm. Accordingly, current guidelines do not recommend use of menopausal hormone therapy for the prevention or treatment of cardiovascular disease in women. Important limitations of the available randomized, controlled trials are that they typically enrolled women who were >60 years of age and, thus, were ≥10 years postmenopause and that they typically used nonphysiological hormone preparations, eg, conjugated equine estrogen and the synthetic progestin medroxyprogesterone …