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Primary ovarian insufficiency – Why, nearing 2021, are we still debating “to treat or not?”

      Case: A 37-year-old, otherwise healthy woman presented to her primary care provider for evaluation of worsening and bothersome hot flushes over recent months in the setting of secondary amenorrhea of 6 months’ duration. Evaluation yielded a diagnosis of primary ovarian insufficiency (POI) based on biochemical evidence of hypergonadotropic hypogonadism. The patient endorsed that the severity of her symptoms was adversely affecting her quality of life. In counseling this patient, her provider conceded that the spectrum and severity of symptoms were indeed consistent with hypoestrogenism, but proceeded to caution her against consideration of systemic hormone therapy (HT) due to concerns over the increased breast cancer risk. Notable was a lack of any identifiable personal or familial history that would render this 37-year-old woman at a higher than background risk for breast cancer.

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