title: Hormone replacement therapy in young women with surgical primary ovarian insufficiency.
abstract: Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency, an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy (HRT) most of these women develop severe symptoms of estrogen (E) 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 E2replacement 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 HRTs has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of E therapy, even in women in whom HRT 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 HRT for women who will experience surgical primary ovarian insufficiency is clearly indicated.
authors: Departments of Obstetrics, Gynecology and Reproductive Sciences and PsychiatryYale University, New Haven, Connecticut.
authors: Philip M
authors: PM
authors: Sarrel
authors: U.S. Food and Drug Administration, Silver Spring, Maryland.
authors: Shannon D
authors: SD
authors: Sullivan
authors: CAPT US Public Health Service, Intramural Research Program, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Electronic address: Lawrence_Nelson@nih.gov.
authors: Lawrence M
authors: LM
authors: Nelson
mesh_terms: D000367:Age Factors; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010052:Ovariectomy / Q000009:adverse effects*; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Premenopausal oophorectomy; estrogen therapy; ovarian insufficiency; surgical menopause