Sugianto Stella Rizalina Sasha, Webber Lisa, Safdar Husain Farah, Viardot-Foucault Veronique, Nadarajah Sadhana, Lim Jiin Ying, Tan Ee Shien, Yong Tze Tein, Puvanendran Rukshini
Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore.
Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2025 Mar 25;54(3):178-191. doi: 10.47102/annals-acadmedsg.2024227.
Premature ovarian insufficiency (POI) refers to loss of ovarian activity before the age 40 years. POI has significant detrimental effects on health (infertility, cardiovascular diseases, type 2 diabetes, reduced bone density, dementia), well-being and longevity. This summary is a practical toolkit for health-care professionals (HCPs) looking after women with POI.
A workgroup comprising specialists in gynaecology, reproductive medicine, endocrinology, genetics and family medicine reviewed relevant guidelines and literature on POI to establish recom-mendations for the diagnosis and management of POI in Singapore.
A summary to assist HCPs manage POI was produced, outlining: (1) the aetiology and conse-quences of POI; (2) making the diagnosis; (3) hormone therapy (HT) prescribing options including for those with additional medical conditions; (4) counselling women with POI about HT; and (5) long-term management of POI.
Timely diagnosis and management of POI is vital to prevent long-term adverse consequences, except infertility. HT is the mainstay of treatment and there are no alternatives as effective. Contraindications are very few; estrogen-sensitive cancer is the main contraindication, and caution in prescribing may be needed with established coexisting cardiovascular disease. Estrogen dosage is higher than when treating normal menopause, and as a result, the patient might require more progestogen for endometrial protection. Minimising cardiovascular risk factors by following a healthy lifestyle is important. POI is a significant public health issue and it is imperative that women have affordable access to appropriate HT. Large-scale research on POI in Asian women is needed.
卵巢早衰（POI）是指40岁之前卵巢功能丧失。卵巢早衰对健康（不孕、心血管疾病、2型糖尿病、骨密度降低、痴呆）、幸福感和寿命有重大不利影响。本综述是为照顾卵巢早衰女性的医护人员提供的实用工具包。
一个由妇科、生殖医学、内分泌学、遗传学和家庭医学专家组成的工作组，回顾了有关卵巢早衰的相关指南和文献，以制定新加坡卵巢早衰诊断和管理的建议。
形成了一份协助医护人员管理卵巢早衰的综述，概述了：（1）卵巢早衰的病因和后果；（2）进行诊断；（3）激素治疗（HT）的处方选择，包括针对有其他疾病的患者；（4）为卵巢早衰女性提供关于激素治疗的咨询；以及（5）卵巢早衰的长期管理。
除不孕外，及时诊断和管理卵巢早衰对于预防长期不良后果至关重要。激素治疗是主要治疗方法，且没有其他同样有效的替代方法。禁忌症很少；雌激素敏感型癌症是主要禁忌症，对于已确诊的并存心血管疾病患者，开处方时可能需要谨慎。雌激素剂量高于治疗正常绝经时的剂量，因此，患者可能需要更多的孕激素来保护子宫内膜。通过健康的生活方式将心血管危险因素降至最低很重要。卵巢早衰是一个重大的公共卫生问题，女性必须能够负担得起并获得适当的激素治疗。需要对亚洲女性的卵巢早衰进行大规模研究。
