How to Treat Premature Ovarian Failure? | PYHP 138

In this episode, we talk about Mary’s hormone concerns after ovarian failure. She is only
34, and in the last 7 years since her ovarian failure has tried many hormone
replacement options, all without the success she was looking for.

Let’s Read Mary’s Question:
When I was 27 years old I was diagnosed with iatrogenic primary ovarian insufficiency
due to chemotherapy treatments for a gestational trophoblastic disease (molar
pregnancy). I am now 34 years old, and I am currently struggling most notably, with
fatigue, low libido, dry skin/eyes/hair, low mood, annxiety, and brain fog. I began HRT
about 3 years ago, but I was not consistent.
In the beginning I tried estradiol 1mg and medroxyprogesterone 2.5mg with no symptom
relief or rise in serum levels. For 9 months I faithfully took esterified
estrogens/methyltestosterone 1.25/2.5mg and 100 mg of micronized progesterone at
nighttime. My estradiol levels only rose to 16.9pg/mL (estrogens, total 56pg/mL), and
free testosterone only rose to 0.2pg/mL (testosterone, total undetectable). The T
actually decreased.
My doctor was baffled by how stunningly this application failed. 3 months ago I began
estradiol patches (0.1mg/twice week), testosterone 1% gel (12.5mg/1.25gm) pump (1/2
pump/day), micronized progesterone (100 mg/bedtime), and Intrarosa (vaginal DHEA)
at nighttime. I do not have any current bloodwork for this new regimen. I have noticed a
decrease in my symptoms, but I am no where near where I would like to be regarding
symptom relief.
Is it possible to increase my estrogen dosing? I’ve read POI dosing will often be
signicantly higher. Fertility isn’t my primary concern (we have been blessed with two
children), but I’ve heard mixed opinions that cyclic HRT for someone my age may have
benefits outside of fertility such as the lining of the uterus becoming unresponsive to
estrogen and the ability of cyclic HRT may stimulating the uterus to reestablish this
responsiveness.
I’ve never had a DEXA scan, nor discussed bone health with my provider, who is a
university physician. I am also traveling to MN this summer to see a reproductive
endocrinologist with the Mayo Clinic in hopes of finding further solutions. Thank you for
your time.
In this episode, we break Mary’s question into:
● What is ovarian failure?
● How hormone replacement is helpful for sleep, mood, libido, energy, and brain
fog.
● Consider the long-term consequences of low to no hormones in women.
● Estrogen and bone density.
● Cyclic/rhythmic HRT vs static hormone dosing.
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