Hormone Replacement Therapy in Women with Polycystic Ovary Syndrome
Introduction to HRT Regimens
- The American College of Obstetricians and Gynecologists recommends transdermal 17β-estradiol with micronized progesterone as the preferred HRT regimen for women with PCOS due to its favorable cardiovascular and metabolic profile 1, 2
Estrogen Component Selection
- Transdermal 17β-estradiol is the preferred estrogen formulation for women with PCOS, as it mimics physiological serum estradiol concentrations and provides more beneficial effects on lipid profiles, inflammation markers, and blood pressure 1
- The recommended dosage of transdermal 17β-estradiol is 50-100 μg daily for women with PCOS 1
Progestogen Component
- Micronized natural progesterone (100-200 mg/day for 12-14 days per month) is the first-choice progestogen for women with PCOS due to its more favorable cardiovascular risk profile 1, 2
- Progestogen must be given in combination with estrogen therapy to protect the endometrium in women with an intact uterus 4
Administration Regimens
- A sequential regimen (continuous estrogen with cyclic progestogen for 12-14 days every 28 days) is generally recommended for women with PCOS 1, 2
Duration of Therapy and Monitoring
- HRT should be continued at least until the average age of natural menopause (50-51 years) for women with PCOS 1, 3
- Annual clinical review focusing on compliance and cardiovascular risk factors is recommended for women with PCOS on HRT 1, 6