علاج قصور المبيض الأولي: الإدارة الهرمونية في الخط الأول

References

• HRT is recommended until at least the average age of menopause to treat symptoms and as primary prevention of cardiovascular disease (CVD) and osteoporosis.
• Combined (oestrogen + progesterone) required if uterus is intact.
• Transdermal oestrogen avoids first-pass hepatic metabolism so there is no increased VTE/stroke risk.
• Micronised progesterone is recommended as body-identical, not pro-thrombotic and more breast friendly.
• 52mg-LNG-IUDs are an alternative, providing contraception and endometrial protection even at higher doses of oestrogen.
• Typically need high oestrogen doses: 75-100mcg/3 or 4 pumps/2mg oral oestradiol.
• May be more acceptable and familiar to younger women.
• Offer lifestyle advice: weight bearing exercise, 800-1000IU Vit D daily and a calcium rich diet.
• Titrate to symptoms but may benefit from oestradiol levels (aiming for 250-500mmol/L) to achieve levels for primary prevention of osteoporosis & CVD.