Treatment is required for the two major consequences of premature ovarian failure – the lack of oestrogen and infertility.
Treatment for oestrogen lack:
Lifestyle changes are important to minimise the risks for heart and bone problems. This includes stopping smoking, undertaking regular exercise and maintaining a healthy diet and weight. It is important to ensure adequate calcium and vitamin D intake, and if dietary intake is inadequate, supplements should be used.
Drug treatment involves hormonal therapy with oestrogen. Systemic oestrogen treatment (e.g. tablets and patches) is essential to prevent the problems outlined in prior sections such as heart disease and bone thinning. Treatment should be continued at least until the age that natural menopause would occur, that is, 50.
Hormone treatment follows similar principles as for hormonal treatment after a natural menopause. For more details, see my section on Menopause.
Progesterone is only required for women who have a womb in order to protect the womb lining from the effects of oestrogen. Progesterone is not needed if the womb has been removed by hysterectomy.
The combined oral contraceptive pill is an option for replacing oestrogen in young women with premature menopause provided there are none of the usual risk factors (e.g. smoking). However, the pill contains so-called “synthetic” oestrogen formulations (ethinyl oestradiol) and preparations containing oestrogens that are more like those found in the body (17β oestradiol) are preferred.
Vaginal oestrogen and/or vaginal lubricants may also be required if vaginal symptoms (e.g. dryness and painful sexual intercourse) persist with systemic oestrogen treatments.
For a full discussion surrounding the range of treatments, including the various oestrogen preparations and treatments for thin bones, see my section on Menopause.
Treatment for infertility:
Premature menopause occurs because the ovaries have become depleted of follicles, and hence no longer contain eggs. Very occasionally, there may be very transient episodes of ovarian activity and follicular development that lead to the release of an egg. Because of this, pregnancy may occur in 1-5% of cases of premature menopause.
For more information on follicles, hormones and ovulation see my sections on The Menstrual Cycle and Ovulation Cycle Tracking and Anovulation and Ovulation Induction.
In most cases, however, premature menopause reflects an absence of eggs. Because there are no more eggs in the ovary, no treatment, including IVF, will be successful. Treatment to achieve a pregnancy will require the use of eggs donated from another woman. For more information on donor egg treatment see my section on Donor Treatment.