A 37-year-old woman has 14 months of amenorrhea, vasomotor flushes, and vaginal dryness. Two FSH values taken 5 weeks apart are 38 and 42 IU/L with estradiol below 20 pg/mL. Karyotype is 46,XX and autoimmune screening is negative. What is the correct long-term management plan?

• A Low-dose combined oral contraceptive pills stopped once symptoms settle
• B Combined estrogen-progestogen hormone therapy continued until approximately the average age of natural menopause ✓
• C Calcium and vitamin D supplementation alone, avoiding hormones given her age
• D Ovarian suppression with a GnRH agonist until age 50

Explanation

Premature ovarian insufficiency is diagnosed when menopausal-range FSH with low estradiol occurs before age 40, ideally confirmed on two occasions weeks apart. Because these women face years of estrogen deficiency with accelerated bone loss and cardiovascular risk, systemic hormone replacement is recommended and should continue until roughly age 51, the mean age of natural menopause. Short-course pills or calcium alone leave the deficit untreated, and GnRH agonist would worsen hypoestrogenism.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.