Premature Ovarian Failure Treatments
The treatment of choice and a new scenario
Clinical medicine has made significative steps forward in the field of premature ovarian failure treatment.
Treatment option progresses are assuring women with this condition optimization of their quality of life and of their long-term health. However, a prompt diagnosis is fundamental to avoid the development of severe symptoms and of long-term consequences of hormone deficiency.
The clinical treatment of choice for POF is hormone replacement therapy, which mostly consists in estrogen supplementation. Moreover, traditional management of this condition can involve infertility treatment.
Hormone replacement therapy helps also to improve symptoms of premature ovarian failure-associated osteoporosis and of menopause-related symptoms; in particular, local administration may address focal disturbances such as pain during intercourses. Moreover, it can lessen the atherosclerotic process acting on cholesterol metabolism, prevents coronary constriction, and decreases cognitive decline.
However, hormone replacement therapy does not restore ovarian function and does not reverse Alzheimer’s disease. What is more, it has been associated to the risk of breast and endometrial cancer, and optimization of modifiable risk factors (diet, physical activity, and smoking) remains vital to protect both cardiovascular and bone health.
Progesterone supplementation can help minimize the risk of endometrial hyperplasia or cancer, and testosterone can be supplemented to estrogen therapy for addressing decreased libido in case of medically-induced premature ovarian failure. However, the long-term efficacy and safety of this last therapy are still uncertain.
Combined hormonal contraceptives represent an alternative for symptoms management, but should be avoided by women seeking for a pregnancy.
Fertility preservation after anticancer therapy can be achieved through several options, such as suppression of ovarian function prior to chemotherapy, in vitro activation of one ovary followed by re-transplantation, or cryopreservation of ovarian tissue, mature oocytes or embryos. The possibility to exploit the first two strategies is already debated. Cryopreservation is a reasonable option particularly for women at risk of infertility because of programmed therapies possibly leading to premature ovarian failure, whereas the likelihood of success in the setting of an already diagnosed POF is slim. That is a reason why why researcher have being investigating also possible ways to restore ovarian function.
In this scenario, stem cells – a multipotent cell type characterized by self-renewal capacity and able to differentiate into different cell types – represent a new tool with a potential with no precedents.