Follicle dysfunction in women with POI.
Published peer-reviewed evidence from the NIH demonstrating inappropriate follicle luteinization is the major cause of follicle dysfunction in women with POI.
https://pubmed.ncbi.nlm.nih.gov/7962345/
Breastfeeding and the transdermal estradiol patch.
The available evidence suggests this is unlikely to have any adverse effect on the baby.
https://www.fertstertdialog.com/posts/18277-the-value-of-transdermal-estrogen-treatment-postpartum
Are there adverse endometrial effects during long cycle hormone replacement therapy?
Scandinavian Long Cycle Study Group.
https://pubmed.ncbi.nlm.nih.gov/10515673/
Antidepressants and fertility.
Women who have depression and are taking antidepressants may have reduced fertility. As noted in the attached file, it is not clear if the cause is depression or the medication.
https://pubmed.ncbi.nlm.nih.gov/26827878/
Is libido 100 percent hormone-related?
There is a great deal more to a woman’s libido than hormones. There are many causes with many different approaches addressing this issue.
https://pubmed.ncbi.nlm.nih.gov/27916394/
Is it helpful to measure antibodies against the ovary?
The evidence suggests this test has no value because it’s positive in many normal women. Please see this article for more information.
Ovarian antibodies as detected by indirect immunofluorescence are unreliable in the diagnosis of autoimmune premature ovarian failure: a controlled evaluation https://pubmed.ncbi.nlm.nih.gov/12694633/
Does progesterone help with other parts of the body besides the uterus? For example the brain (e.g., boosting mood, having calming effects on anxiety)?
P-HRT taken correctly mimics natural physiology. For more information, please see: What could be better?
https://pubmed.ncbi.nlm.nih.gov/23647429/
Phytoestrogens in the diet.
The best evidence supports the use of the NIH P-HRT regimen for women with POI. The evidence about the beneficial effects of phytoestrogens is mixed, with no clear conclusions. Certainly, the evidence does not support using only phytoestrogens as a means of HRT in POI. Please see the attached review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722977/
Progesterone vaginal suppositories.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020701s026lbl.pdf
POI and yeast and vaginal infections.
The NIH POI research team evaluated more than 1,000 women with POI and saw no evidence of an increased prevalence of candidiasis in them. Please see the attached for more information. Some women with normal ovarian function need chronic treatment to reduce recurrence rates.
https://www.ncbi.nlm.nih.gov/books/NBK560624/
P-HRT protocols and pregnancy.
In general, P-HRT is designed to mimic the normal physiologic function of the ovaries. The regimen is designed to be taken continuously without break unless there is a specific medical indication to do otherwise.
https://www.ncbi.nlm.nih.gov/books/NBK567777/
Anxiety and estradiol deficiency.
https://www.ncbi.nlm.nih.gov/books/NBK470361/
Stress and infertility.
Women with infertility experience more symptoms of anxiety and depression. It is clear that infertility is associated with stress. It is not clear if stress causes infertility, unless in the special case of severe stress-causing amenorrhea. Please see this report:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/
Testosterone replacement for women.
https://pubmed.ncbi.nlm.nih.gov/16174721/
POI and cannabis.
See this article on the endocannabinoid system.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835826/
Bisphosphonates and reduced bone density in women who have POI.
Published reports about POI recommend against using bisphosphonates in this condition. As published by the NIH POI team in their three-year study on P-HRT, bone density returned to normal on average. Of concern, bisphosphonates are stored in bone for many years. There are concerns about potential embryonic toxicity for women who later get pregnant. Also, the rare yet difficult jaw complications with these drugs are a concern. Bisphosphonates are approved for use in post-menopuasal osteoporosis. These agents have not been proven safe and effective for use in POI.
https://www.ncbi.nlm.nih.gov/books/NBK470248/
Early first period and early menopause.
Clomiphene Citrate Challenge Test (CCCT) in women who have POI.
In the case of rare disorders, it is important for women to educate themselves about their disorder and, in the process, advocate for themselves and educate their health team about their specific needs.
https://pubmed.ncbi.nlm.nih.gov/16962116/
Transdermal estradiol, bone health and POI.
https://pubmed.ncbi.nlm.nih.gov/27340881/
Estradiol gel for POI.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2004/21166_estrogel_lbl.pdf
