Abstract
Girls with either hypo- or hypergonadotropic hypogonadism need treatment with estrogens
to initiate puberty and maintain a normal hormonal milieu. The focus of this review
is hormone replacement treatment in girls with hypogonadism, to initiate and progress
through puberty, and to maintain a healthy hormonal milieu in women. It also addresses
what is known in the literature regarding estrogen levels in girls and women, instructive
cases, practical tables for reference and application, and thoughts on future directions
in this area. It represents a thorough literature review with author opinions and
recommendations. Girls with normal ovarian function begin puberty on average at 10.5 years
old, although there is variation according to ethnicity and degree of excess weight
gain. The aim of estrogen therapy to initiate puberty is to mimic normal onset and
rate of progression. On the basis of the currently available literature, when a diagnosis
of hypogonadism is established, we recommend initiating treatment between age 11 and
12 years of age, with dose increases approximately every 6 months until adult levels
are reached. In some situations, treatment may be delayed to allow time for diagnosis
or permit more time for linear growth, or address unique risks found in girls treated
for various cancers or blood disorders. When adult dosing is reached, progestins are
also used to protect uterine health. This can be combined sequentially, allowing regular
menstruation, or combined continuously when menstrual bleeding is not preferred. Treatment
is continued until the average age of menopause, again with various considerations
for longer or shorter duration on the basis of risk-benefit ratios. Transdermal estrogens
are considered the most physiologic replacement and theoretically might have fewer
associated risks. We review what is known about risks and outcomes and areas for future
research.
Key Words
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Article info
Publication history
Published online: May 03, 2019
Footnotes
The authors indicate no conflicts of interest.
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© 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
