Following diagnosis of POI, consider annual, routine surveillance for endocrine disorders. Test for complete blood count, complete metabolic panel, calcium, phosphorus, fasting glucose, insulin, thyroid stimulating hormone, and thyroid peroxidase antibodies.
Estrogen replacement is part of management of these patients. "They require higher doses than [do] menopausal women. Also, if you give estrogen, [they] will need progestins for endometrial protection," Dr. Rackow said. Hormone replacement therapy can improve endothelial function within 6 months, potentially improve their long-term cardiovascular health, and mitigate bone loss.
"The lowest dose oral contraceptives have the higher end dose of estrogen you would give for POI. These girls do not need more," Dr. Rackow said. For more information, including hormone replacement therapy dosing guidance, see the September 2011 American College of Obstetrics and Gynecology Committee Opinion No. 502 on primary ovarian insufficiency in the adolescent (Obstet. Gynecol. 2011;118:741-5).
Dr. Rackow said she had no relevant financial disclosures.