For managing symptoms in patients diagnosed with premature ovarian insufficiency (POI), the recommended hormone replacement therapy (HRT) options include offering sex steroid replacement either with HRT or a combined hormonal contraceptive, unless contraindicated (for example, hormone-sensitive cancer) NICE NG23.
Specifically, for people with POI, it is advised to start hormonal treatment with either HRT or combined hormonal contraceptives and continue treatment until at least the age of natural menopause, unless contraindicated NICE NG23. The choice of HRT should be individualized based on the presence of a uterus: combined HRT (oestrogen plus progestogen) is offered to those with a uterus, and oestrogen-only HRT to those who have had a total hysterectomy NICE NG23.
Transdermal oestrogen with a cyclical oral progestogen is usually recommended, but the preparation may vary depending on the cause of amenorrhoea and contraception needs NICE CKS. Higher oestrogen doses may be needed for symptom relief in women with premature ovarian insufficiency compared to older women NICE CKS.
It is important to explain to patients that HRT is not a contraceptive and to discuss the benefits and risks, including the low baseline risk of breast cancer and cardiovascular disease in people under 40 NICE NG23. Both HRT and combined oral contraceptives provide bone protection NICE NG23.
If hormonal treatments are contraindicated or not tolerated, advice on lifestyle measures and non-hormonal symptom management should be provided NICE NG23,NICE CKS.