Thyroid disease and ovarian failure

193 who have normal ovarian function. HRT is therefore required to control vasomotor symptoms, minimize risks of cardiovascular disease, osteoporosis and possibly Alzheimer’s disease, and to maintain sexual function. There is no evidence that the results of the Women’s Health Initiative study (of much older women) apply to this younger group. HRT in POF patients is simply replacing ovarian hormones that would normally be produced at this age. It is of paramount importance that the patients understand this, in view of the recent press on HRT. The aim is to replace hormones as near to physiological levels as possible. HRT should generally continue at least until the estimated age of natural menopause (on average 51 years in the UK). Since spontaneous ovarian activity can occasionally resume, consideration should be given to appropriate contraception in women not wishing to fall pregnant. Although standard oral contraceptive pills are sometimes prescribed, they contain synthetic steroid hormones at a greater dose than is required for physiological replacement and so may not be ideal. Low-dose combined pills may be used to provide estrogen replacement and contraception, although they are less effective in the prevention of osteoporosis. The progestogen intrauterine system may also be offered in those who choose HRT and require contraception. In our experience, the choice of HRT regimen and the route of administration vary widely among patients. In the absence of better data, treatment should therefore be individualized according to choice and risk factors. Where libido is a problem, testosterone replacement should also be considered, especially in surgically menopaused women. To complement the role of HRT for the long-term prevention of osteoporosis, supplementary intake of calcium (1000–1500 mg per day) and multivitamins should be encouraged, as should weight-bearing exercises. The use of complementary therapies and non-estrogen-based treatments, such as bisphosphonates, strontium ranelate or raloxifene, for the prevention of osteoporosis in women with POF has not been studied.