Premature Ovarian Failure - menopausematters.co.uk · 27th Mar 2006 29 West London Menopause & PMS...
Transcript of Premature Ovarian Failure - menopausematters.co.uk · 27th Mar 2006 29 West London Menopause & PMS...
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Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
2727thth Mar 2006Mar 2006RCOG SSM RCOG SSM
Nick PanayConsultant Gynaecologist
West London Menopause & PMS CentreHonorary Senior Lecturer, Imperial College London
27th Mar 2006 2 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined Pill– Alternatives
Conclusions
27th Mar 2006 3 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 4 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureDefinitionsDefinitions
Premature Ovarian Failure– Menopause before the age of 40y– Affects 1% of women
Early Menopause– Menopause between 40 – 45y– Up to 20% of women
27th Mar 2006 5 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailurePresentationPresentation
Ovarian cycle may cease abruptly (esp if iatrogenic aetiology) or fluctuate leading to– Amenorrhoea or erratic periods
– Climacteric Symptoms
– Raised FSH (or fluctuating levels) ?Inhibin assays
– Reduced Oestradiol (or fluctuating levels)
27th Mar 2006 6 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureConsequencesConsequences
Symptoms – vasomotor, psychological, urogenital
Infertility (< 1% return of fertility after 6/12 amenorrhoea with idiopathic POF)
Bone loss
Heart disease
27th Mar 2006 7 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureConsequencesConsequences
• Fertility in Premature Ovarian Failure
• Success of oocyte donation (dependent on donor age) suggests that
endometrium remains healthy & receptive • Navot Fertil Steril 1994
• Large doses of HRT in donor cycles may mask underlying defects in
receptivity, perfusion & hormone receptor no in endo. of atrophic uterus
• Yaron Fertil Steril 1993; Meldrum Fertil Steril 1993; Goswamy Hum Reprod
27th Mar 2006 8 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureOsteoporosisOsteoporosis
Rate of bone loss is the same as following natural menopause but consequences are more severe as longer life expectancy
Dimitrios et al Maturitas 2003 – 514 women studied in total– Women with POF exhibited lower BMD compared
with normally menopaused women @ ages 45-55
27th Mar 2006 9 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureOsteoporosisOsteoporosis
Van der Voort et al Ost Int 2003– 4725 postmenopausal women (2757 natural
menopause) filled in questionnaires
– Those with early menopause had significantly higher fracture rates OR 1.5 (CI 1.2-1.8)
27th Mar 2006
Premature Ovarian FailurePremature Ovarian FailureCoronary artery diseaseCoronary artery disease
Related to number of years past menopause rather than ageDavies, Br J Cardiol 1997
27th Mar 2006
Hormonal changes at menopause and risk of Hormonal changes at menopause and risk of coronary eventcoronary event
Age of menopause and Coronary Heart Disease risk : Nurse’s Health Study
Significant correlation between younger age of menopause & CHD in non HRT users
Hu et al Arch Int Med 1999; Grodstein 2006
27th Mar 2006
Cardiovascular disease risk in premature Cardiovascular disease risk in premature ovarian failureovarian failure
– Endothelial dysfunction due to hypo-estrogenic state
– 6 months HRT restored endothelial dysfunction
• Kalantaridou J Clin Endoc Metab 2004
27th Mar 2006 13 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 14 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureOptimising Hormone TherapyOptimising Hormone Therapy
Multidisciplinary collaborationMultidisciplinary collaboration
Menopause / Reproductive medicine collaboration
Specialist GP’s & Nurses– Menopause nurse specialists– Gynae oncology nurse specialist (Macmillan) – GPSI in menopause
Other specialists– Haematology / Gynae Oncology– Dietician– Psychologist / Councellors– Physios
27th Mar 2006 15 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 16 West London Menopause & PMS Centre
Fertility Options after POFFertility Options after POF• Realistic options:
• Oocyte Donation• Embryo Donation• Surrogacy
• Potential Future Options:
• Cloning with somatic cell nuclear transfer to enucleated oocytes
• Stem Cell technology - UK 10 years; USA 2 years!
27th Mar 2006 17 West London Menopause & PMS Centre
OocyteOocyte DonationDonationTypical Pregnancy RatesTypical Pregnancy Rates
539 Cycles with fresh ET198 Pregnancies
37% per cycle
191 cases frozen ET34 pregnancies
18% per cycle
27th Mar 2006 18 West London Menopause & PMS Centre
OocyteOocyte Donation Donation -- problemsproblems
Donor difficultiesDemand far greater than availability of donorsTime and commitment for donorInvasive treatmentNon Payment
Maternal DifficultiesHealth Long term sequelae of maternal illnessTreatment physically and emotionally tiring
27th Mar 2006 19 West London Menopause & PMS Centre
Obstetric outcome in Egg Donation Obstetric outcome in Egg Donation PregnanciesPregnancies
Higher incidence ofMiscarriage
Pregnancy Induced Hypertension
Growth Restriction
27th Mar 2006 20 West London Menopause & PMS Centre
Options for women at risk of ovarian failureOptions for women at risk of ovarian failure
Surgery– Ovarian transposition
– Ovarian Tissue CryopreservationTransplantationIn Vitro maturation
IVF– Embryo Cryopreservation
– Oocyte Cryopreservation
27th Mar 2006 21 West London Menopause & PMS Centre
Ovarian tissue CryopreservationOvarian tissue Cryopreservation
Increasingly done world wide in spite of still being an experimental technique
9 cases in literature so far of successful transplantation withtemporary reproductive function
27th Mar 2006 22 West London Menopause & PMS Centre
Ovarian Ovarian AutotransplantAutotransplant
Oktay & Karlikaya ’00 CP 1 othotopic TRadford ’01 CP 1 othotopic TOktay ’01 CP 2 heterotopic TCallejo et al ’01 fresh 3 heterotopic T
“ CP 1 heterotopic TOktay ’04 CP 1 heterotopic T
27th Mar 2006 23 West London Menopause & PMS Centre
Ovarian tissue Ovarian tissue CryopreservationCryopreservation
Potential to restore normal ovarian function and natural fertility
Can be used for girls who are both pre and post menarche
Little delay in commencing chemo / irradiation
27th Mar 2006 24 West London Menopause & PMS Centre
IVFIVFEmbryo CryopreservationEmbryo Cryopreservation
Most successful, tried and tested (can be frozen for 5-10 years) but problems
Risks of IVF e.g. high estrogen levels
Need partner in stable relationship
Time restraints ; “ Funding “
Ethical issues in event of death of patient
27th Mar 2006 25 West London Menopause & PMS Centre
IVFIVFOocyteOocyte CryopreservationCryopreservation
– Ideal for Single women– Avoids legal, regulatory and social dilemma
– But, Overall low success ratesLive birth rate 2% per oocyte
27th Mar 2006 26 West London Menopause & PMS Centre
Effect of cooling on Effect of cooling on oocytesoocytes
27th Mar 2006 27 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 28 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Therapeutic Options – HRT
– Impact of Adverse Media on HRT use in POF
– “Minimising side effects – maximising benefits” RoutesSequential v Continuous CombinedDosageProgestogens
27th Mar 2006 29 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Impact of Alarmist Media on HRT use for Premature Menopause
Ng C., Reddy N., Panay N. 2004 ESHRE Berlin
Conclusions
– All aware of adverse publicity
– Majority continuing with HRT BUT 37% (1/3) were contemplating stopping HRT because of breast cancer fears
– Less than half realised that risks did not apply to their age group
27th Mar 2006 30 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Therapeutic Options – HRT
– Impact of Adverse Media on HRT use in POF
– “Minimising side effects – maximising benefits” RoutesSequential v Continuous CombinedDosageProgestogensRisks
27th Mar 2006 31 West London Menopause & PMS Centre
Choice of HRT for post pubertal women with Choice of HRT for post pubertal women with premature ovarian failure premature ovarian failure Bath et al 2001 Bath et al 2001 ClinClin EndocrinolEndocrinol
UK Soc Paediatric Endocrinology 42 questionnaires (28 responses)
COCP 18 (64%) Loestrin (20-30) 12(67%)
Oral HRT (sequential) 5 (18%) Prempak C 5 (100%)
Transdermal HRT (sequential) 3 (11%) Estracombi 2 (66%)
Ethinyloestradiol (sequential) 2 (7%)
– Two respondents had no preferred HRT preparation!
– “No consensus for prescribing in POF to optimise skeletal & cardiovascular health”
27th Mar 2006 32 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Route / Type – Conclusion
In the absence of better prospective randomised data…
GIVE WOMEN WHAT THEY WANT
…………particularly if you want them to use it!
27th Mar 2006 33 West London Menopause & PMS Centre
Sequential v Continuous CombinedSequential v Continuous Combined
Sequential – Pros
“More normal to have periods”Endometrial Generation Pre Fertility TreatmentLess Unscheduled Bleeding
– ConsPossible risk of endometrial hyperplasia (Sturdee 2000)“Why should I bleed if I don’t have to?”More side effects in progestogen phase
27th Mar 2006 34 West London Menopause & PMS Centre
Sequential v Continuous CombinedSequential v Continuous Combined
Continuous Combined– Pros
No risk of endometrial hyperplasia (?protective)Less Progestogen overall
– ConsPossible risk of endometrial atrophy/necrosis pre IVFUnscheduled bleeding Un-physiological
27th Mar 2006 35 West London Menopause & PMS Centre
Dosage of HRTDosage of HRTOestrogenic side effectsOestrogenic side effects
Management– Start with standard dose oestrogen in most cases –
benefits still maintained
– 0.625mg CEE /1.0mg E2 / 50mcg patch / 25-50mg implant
– Warn re possibility of SE’s initially & reassure
27th Mar 2006 36 West London Menopause & PMS Centre
Dosage of HRTDosage of HRTOestrogenic side effectsOestrogenic side effects
Exceptions to starting standard dose oestrogen– Very symptomatic premature ovarian failure
– Severe osteoporosis
– Predominance of psychological problems (mental tonic effect of higher doses)
27th Mar 2006 37 West London Menopause & PMS Centre
Dosage of HRTDosage of HRTOestrogenic side effectsOestrogenic side effects
Management– Liaise with gynae onc / oncologists re time to start
– Immediately if curative procedure (after histol)
– Delay (1 year disease free interval) if advanced oestrogen sensitive tumour e.g. endometrial carcinoma
27th Mar 2006 38 West London Menopause & PMS Centre
ProgestogenProgestogen?use at all?use at all
27th Mar 2006 39 West London Menopause & PMS Centre
ProgestogenProgestogen –– the dilemmathe dilemma10 years use E2 alone in non - hysterectomised women
– Excess 5:1000 breast cancer cases – Excess 10:1000 endometrial cancer cases– Total 15:1000 cases
10 years use E2: Prog: – 19:1000 breast cancer cases – No Excess endometrial cancer cases with ccHRT– Total 19:1000 cases
– BUT…..
27th Mar 2006 40 West London Menopause & PMS Centre
ProgestogenProgestogen –– the dilemmathe dilemma
Increased morbidity & mortality due to bleeding problems leading to increased intervention– Endometrial sampling– Scans– Hysteroscopy– Hysterectomy
?Local or tissue selective progestogen (in future SERMS / SPRMS e.g. asoprisnil)
27th Mar 2006 41 West London Menopause & PMS Centre
Avoiding Major Adverse Events Avoiding Major Adverse Events Local delivery of Local delivery of progestogenprogestogen
LNG IUS (Mirena) -20mcg
MLS (Menopause Levo. System) - 10mcg
BUT STILL SIG. SYSTEMIC EFFECTS!
27th Mar 2006 42 West London Menopause & PMS Centre
Avoiding Major Adverse Events Avoiding Major Adverse Events Local delivery of Local delivery of progestogenprogestogen
Mirena data
Backman et al 2005 Obstet GynecolFinnish Cancer Registry17, 360 Mirena Users : 30-54ys
No difference in breast cancer rates compared to average Finnish breast cancer rates
27th Mar 2006 43 West London Menopause & PMS Centre
Avoiding Major Adverse EventsAvoiding Major Adverse EventsCHOICE: CHOICE: MammographicMammographic density Digitized quantificationdensity Digitized quantification
Buenos Aires IMS 2005Buenos Aires IMS 2005
0
5
10
15
20
25
30
Placebo ALD 0.1 ALD 0.25
Mean b
reast
density
(%
)
Screening Week 24 No significant difference between groups
27th Mar 2006 44 West London Menopause & PMS Centre
HRT RisksHRT RisksPrevious Gynaecological MalignancyPrevious Gynaecological Malignancy
Cervical (squamous)
Endometrium
Ovaries
Vagina / Vulva
27th Mar 2006 45 West London Menopause & PMS Centre
HRT RisksHRT RisksPrevious Gynaecological MalignancyPrevious Gynaecological Malignancy
Cervical Cancer (squamous)– Not Oestrogen sensitive– No evidence of excess risk
Cervical Cancer (adenocarcinoma)– No evidence– But, more cautious approach
27th Mar 2006 46 West London Menopause & PMS Centre
HRT RisksHRT RisksPrevious Gynaecological MalignancyPrevious Gynaecological Malignancy
Endometrial Cancer – 3 retrospective studies
– Stage 1 & 2 & 3 Endometrial Cancer
– Matched Control Study
– 2/75 (1%) recurrences in HRT group v 11/75 (14%) in non users (83 v 69 month observation period)
– Hormone users had a statistically longer disease free interval than non users
• Suriano et al Obstet Gynecol 2001
27th Mar 2006 47 West London Menopause & PMS Centre
HRT RisksHRT RisksPrevious Gynaecological MalignancyPrevious Gynaecological Malignancy
Ovaries– “HRT does not seem to have a noteworthy
effect on the progression of epithelial carcinoma of the ovary”
– 31 patients with 55 month follow up
Bebar et al Eur J Gynecol Oncol 2000
27th Mar 2006 48 West London Menopause & PMS Centre
HRT RisksHRT RisksPrevious Gynaecological MalignancyPrevious Gynaecological Malignancy
Vagina / Vulva (squamous)
No evidence
Vaginal Adenocarcinoma
No evidence
27th Mar 2006 49 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 50 West London Menopause & PMS Centre
HRT: Maximising Efficacy HRT: Maximising Efficacy Minimising ProblemsMinimising Problems
TestosteroneTestosterone
Management
– Always consider testosterone as well as oestrogen replacement
– Especially in women with low energy / libido / depressed mood
– 50% loss of testosterone with POF esp surgical
27th Mar 2006 51 West London Menopause & PMS Centre
HRT: Maximising Efficacy HRT: Maximising Efficacy Minimising ProblemsMinimising Problems
TestosteroneTestosteroneManagement– Implants (25 - 100mg) only licensed preparation for use in
women
– However, trial data and limited experience exists for use of tailor made doses of
Methyltestosterone (oral)Gel (Testogel)Patch (Phase III trials)Injection (Sustanon)Sublingual
27th Mar 2006 52 West London Menopause & PMS Centre
Testosterone gelTestosterone gel
Unlicensed for women5ml gel 50mg sachet0.5 – 1.0ml / dayAbdo / inner thighsFAI up to 6.5%
27th Mar 2006 53 West London Menopause & PMS Centre
27th Mar 2006 54 West London Menopause & PMS Centre
Testosterone Patch Testosterone Patch –– Improves sexual activity Improves sexual activity and desire in surgically menopausal womenand desire in surgically menopausal women
Simon et al Abstract AMS 2004– 562 oophorectomised women : “Hypo Sexual Desire Disorder”– Oral / transdermal estradiol– 300mcg /day patch v placebo 24 weeks
Results– 74% increase in frequency of total sexual activity
2.13 v 0.98 episodes / 4 weeks (p=0.003)
– 56% increase in sexual desire score11.85 v 6.90 points (p=0.006)
27th Mar 2006
Effect on mood: Effect on mood: LivialLivial®® versus placeboversus placebo
LivialPlaceboCross-over
Weeks
Mea
n w
eekl
y su
msc
ore
(16
item
s)
0 1 5 10 15 20 25 30
40
50
60
70
Tax et al., Maturitas
27th Mar 2006 56 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 57 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Combined pill– “Use of ethinylestradiol has been driven by
practicalities rather than science”
• Conway et al (1996)
27th Mar 2006 58 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Combined pillPros: – Convenient
– “Peer Friendly”
– Free
27th Mar 2006 59 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Combined PillCons– Un-physiological
– Difficult to monitor – what is correct dose anyway?
– Pill free week can lead to symptom resurgence
– ?Risks of long term ethinylestradiol v “natural hormone replacement
27th Mar 2006 60 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Combined Pill v HRT– Guttmann et al 2001 Clin Endocrinol
– 0.625mg v 30mcg EE in 17 adult women with Turner’s Syndrome
– 6 month cross over study :Hormones, Lipids, Bone Turnover etc
– FSH most suppressed by EE, BUT HRT was superior at minimising hyperinsulinaemia & bone turnover
27th Mar 2006 61 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 62 West London Menopause & PMS Centre
Why not HRT?Why not HRT?
Woman does not want
Medical contraindication
Media terror
Alternatives better
27th Mar 2006 63 West London Menopause & PMS Centre
LifestyleLifestyleRegular Exercise– CVS & Bone Health
Well balanced diet– Complex carbohydrates– Oily fish
Moderating Smoking / Alcohol / Caffeine
Phytoestrogen rich diet– Soy, legumes, pulses etc
27th Mar 2006 64 West London Menopause & PMS Centre
27th Mar 2006 65 West London Menopause & PMS Centre
Alternatives to HRTAlternatives to HRTPharmaceutical Alternatives
– SNRIs• e.g. Venlafaxine 37.5mg bd, approx 50% symptom reduction in RCTs• Nausea / poor tolerance
– Progestogens• e.g. Megestrol acetate 30-50% symptom reduction• ?Breast cancer risk
Complementary Medicines– Phytoestrogens
• e.g. Red Clover Isoflavones, Soy, Legumes• Approx. 50-60% symptom reduction in some RCT’s
– Black Cohosh• ?CNS effect on vasomotor symptoms• Hepatotoxicity reported in a few cases
27th Mar 2006 66 West London Menopause & PMS Centre
PhytoestrogensPhytoestrogens
Use for osteoporosis prevention not confirmed though may be reduction in bone turnover
Surrogate marker studies for CVD– ⇓ cholesterol, LDL, TGs
? Effect on breast cancer
27th Mar 2006
SSelectiveelective ooEEstrogenstrogen RReceptoreceptor MModulatorodulator
Agonist
Bone CVS
Antagonist
Breast Uterus
27th Mar 2006 68 West London Menopause & PMS Centre
HRT: Current ControversiesRaloxifene : Not an HRT alternative!
HRT: Current ControversiesHRT: Current ControversiesRaloxifeneRaloxifene : : Not an HRT alternative!Not an HRT alternative!
Side effects Placebo Active – 1.Leg cramps 1.9% 5.9%
– 2.Flushes 18.3% 24.6%
Thromboembolic disease risks similar to HRT RR 2.16(95% CI 1.11-4.21)
Wyeth Bazedoxifene / HRT trial ongoing
27th Mar 2006 69 West London Menopause & PMS Centre
TiboloneTibolone: STEAR: STEAR (selective tissue estrogenic activity (selective tissue estrogenic activity regulator)regulator)
Tibolone and active metabolites
ReceptorE2 receptor activation
Pre-receptorEffect on Metabolism local enzymes
Bone, Vagina, ?Brain
Tissue stimulation
Less activeestrogenic compounds
Breast
No tissue stimulation
∆ -isomer4
Endometrium
rrrr
27th Mar 2006 70 West London Menopause & PMS Centre
THEBES THEBES Endometrial Histology Results Oct 2005Endometrial Histology Results Oct 2005
Tibolone (1.25 + 2.5)
CEE + MPA
Subjects as treated 1598 1626
Women-years 2402 2415
Hyperplasia 0 (0.0%) 2 (0.1%)Endometrial cancer* 0 (0.0%) 1* (0.1%)
Polyps at year 1 33 (2.6%) 40 (3.1%)
Polyps at year 2 24 (2.5%) 25 (2.5%)
27th Mar 2006 71 West London Menopause & PMS Centre
ANGELS (Activators of non genomic ANGELS (Activators of non genomic estrogenestrogen like signalling) like signalling) EstrenEstren
Ligand dependent i.e. oestradiol, genomic pathway is major route to osteoblast activation
Estren stimulates non genomic pathways to suppress osteoblast apoptosis – bone strengthening in mice (UAMS 2002)
Avoids stimulation of ligand dependent genomic pathways in endometriumand breast
Tobias J Osteoporosis Review 2003; 11 1-5.
27th Mar 2006 72 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureTherapeutic OptionsTherapeutic Options
Definition and pathophysiology
Delivery of treatment – how best to do it
Therapeutic Options
– Fertility– HRT– Testosterone– Combined pill– Alternatives
Conclusions
27th Mar 2006 73 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureFuture ObjectivesFuture Objectives
Multidisciplinary Working Group to:
– Identify clinics seeing POF patients
– Develop National Register of POF patients
– Establish National Guidelines for Mx of POF
– Propose future research : particularly to determine optimum therapeutic regimens
27th Mar 2006 74 West London Menopause & PMS Centre
Premature Ovarian FailurePremature Ovarian FailureConclusionsConclusions
HRT is for quality of life AND for primary prevention in POF
HRT & Alternatives – research urgently required!
Future RegimensSelective targeting of desired organs/tissues with
receptor selective agents
27th Mar 2006 75 West London Menopause & PMS Centre
“Longevity has no meaning withoutQuality of Life”
27th Mar 2006 76 West London Menopause & PMS Centre
Thank you for your Thank you for your attention!attention!
77
Postmenopausal HealthJoint RCOG/BMS Special Skills Meeting