A 34-year-old woman has 7 months of amenorrhoea. Two FSH measurements taken six weeks apart are both above 40 IU/L with low estradiol. She wants relief from vasomotor symptoms and protection of bone density. What is the appropriate long-term plan?
- A No treatment; expect spontaneous recovery within a year
- B Bilateral salpingo-oophorectomy to prevent malignancy
- C Combined oestrogen-progestogen therapy continued until the average age of natural menopause, around 51 years ✓
- D Clomiphene citrate induction of ovulation
Correct answer: C. Combined oestrogen-progestogen therapy continued until the average age of natural menopause, around 51 years
Explanation
Premature ovarian insufficiency requires hormone replacement with combined oestrogen and progestogen (or a combined oral contraceptive) until approximately the average age of natural menopause, about 51 years, to protect bone and cardiovascular health. Clomiphene is futile against follicle depletion, and spontaneous recovery occurs in only a minority. Oophorectomy is inappropriate since the ovaries are already non-functional.
Reference: Williams Gynecology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.