Hormone Replacement for Young Women with Spontaneous Premature Ovarian Failure

Dr. Lawrence Nelson, NICHD/NIH, responses to recent reports regarding HRT risks

July 12, 2002 - I want to give you my thoughts about the recent report regarding hormone replacement therapy risks in postmenopausal women because the report may be confusing to some of our patients. In fact the report highlights the need for more scientific research to define how to best help young women with premature ovarian failure stay healthy. This is what we are doing with our current hormone replacement study.

The bottom line is that in our clinical judgement our recommendations for them as to what they should do to stay healthy up until age 50 has not changed. What has changed is that now there is clear evidence that they should not routinely extend their hormone replacement beyond age 50 (then it becomes hormone extension, not hormone replacement).

It is important that our patients realize that the recent report is a study about menopausal women, not young women with premature ovarian failure. As we have been emphasizing to our patients for years it is important to remember that "premature ovarian failure is not a premature menopause." There are many important ways that premature ovarian failure differs from the normal menopause.

It is not scientifically valid to make conclusions about young women with premature ovarian failure based on findings in older women with menopause. In the recent report older women with menopause extended their exposure to hormones for years beyond what nature intended. Also, the hormone regimen in the report was completely differenct from what we recommend to our patients. The estrogen used in the study was horse estrogen and we recommend using the natural human estrogen called estradiol. Also, the estrogen in the study was given by mouth, which might have contributed to the increased cardiovascular risk. For years we have been recommending use of the estradiol patch. We have recommended this because the estradiol patch avoids the first pass effect on the liver and provides estradiol in a more natural manner similar to how the ovary works. The patch provides estradiol a little bit at a time in a constant manner into the veins rather than one big dose in a pill once a day (when taken by mouth it has to get past the liver before entering the blood, which can cause problems). Also, the postmenopausal women who participated in the recently reported study took the progestin every day. We recommend taking it only 12 days each month.

We need to work extra hard to generate the scientific evidence that is needed to help these young women. It is important to point out that we are trying to help them and learn things for their benefit at the same time. In my view the research system that the NIH has in place does a good job of protecting patients who work with us. There is an independent group of doctors and scientists who are charged to review our study progress on a regular basis (data safety monitoring committee).

submitted by Vien Vanderhoof, NICHD/NIH with permission from Dr. Nelson

Read the entire study as reported in JAMA July 17, 2002. This file is a PDF file. You must have the free Adobe Acrobat Reader in order to view it.