Premature Ovarian Insufficiency – Recent Advances and Treatment Options | HOG

Premature ovarian insufficiency (POI) presents a significant challenge for women, demanding a multifaceted approach to treatment. Recent research has focused on refining existing therapies and exploring novel options to address the hormonal deficiencies and fertility concerns associated with this condition. Here’s a look at the latest advancements in POI treatment:  

Hormone Therapy (HT): The Foundation of Management

• Optimizing HT Regimens:
  • Research continues to emphasize the importance of HT in managing the symptoms and long-term health risks of POI, including cardiovascular disease and osteoporosis.  
  • Studies advocate for the use of body-identical hormones, such as transdermal estradiol and micronized progesterone, which closely mimic the body’s natural hormones, to minimize potential side effects.  
  • The duration of HT is a critical consideration. Current guidelines recommend continuing HT until the average age of menopause (around 50 years) to provide adequate protection.  
• Addressing Specific Symptoms:
  • Research is also investigating the use of localized estrogen therapy for vaginal dryness and atrophy, improving quality of life for women with POI.  

Fertility Preservation and Management: A Complex Challenge

• Oocyte Cryopreservation:
  • For women diagnosed with POI before significant ovarian decline, oocyte cryopreservation remains a viable option. However, this is rarely an option due to the nature of POI.
• Ovarian Tissue Cryopreservation:
  • This technique, which involves freezing and storing ovarian tissue before it loses function, is gaining traction, particularly for women facing cancer treatment or other causes of iatrogenic POI.  
  • Research is ongoing to improve the success rates of ovarian tissue transplantation and in vitro maturation of follicles.
• Donor Eggs and IVF:
  • For women with established POI, in vitro fertilization (IVF) using donor eggs remains the most effective option for achieving pregnancy.
  • Studies are focusing on optimizing IVF protocols and improving the selection of donor eggs to enhance success rates.  
• Experimental Therapies:
  • Researchers are exploring novel approaches to stimulate ovarian function in women with POI.  
  • These include:
    • Platelet-rich plasma (PRP) injections: Some studies are investigating the potential of PRP to rejuvenate ovarian tissue.  
    • Stem cell therapy: Research is in early stages, but stem cell therapy holds promise for regenerating ovarian follicles.  
    • In vitro activation (IVA): This experimental technique involves removing ovarian tissue, activating dormant follicles in the lab, and then transplanting the tissue back into the body.  

Addressing Psychological and Emotional Well-being

• Psychosocial Support:
  • Recognizing the significant emotional impact of POI, research emphasizes the importance of providing comprehensive psychosocial support.  
  • This includes counseling, support groups, and cognitive behavioral therapy to help women cope with the emotional challenges of POI.  
• Multidisciplinary Care:
  • A multidisciplinary approach, involving endocrinologists, reproductive specialists, and mental health professionals, is essential for providing holistic care to women with POI.

Sources : ESHRE OUP NLM