- Cyclic progesterone (Provera 10 mg or Prometrium 400 mg, for a minimum of 10 days for a minimum of every 2 months) helps protect against the development of endometrial hyperplasia and endometrial carcinoma.
- BCPs are useful when contraception is necessary but also protect against endometrial hyperplasia.
- BCPs improve hirsutism (reducing ovarian androgen production and increasing sex hormone—binding globulin that does reduce free androgen).
- This is a useful and convenient method of estrogen replacement therapy.
- Certain BCPs are not acceptable by athletic organization because of androgenic activity.
- Ovulation induction.
- Clomiphene citrate: There are increased incidence of symptomatic functional cysts, of multiply pregnancies, and a marginally increased risk of ovarian cancer.
- Pulsatile GnRH agonist therapy most closely mimics normal follicular development but is expensive and cumbersome.
- Gonadotrophin therapy is involved and expensive, with a higher risk of hyperstimulation, multiple pregnancy, and possibly ovarian carcinoma.
- Hysteroscope surgery often allows resumption of menses. Pregnancy rates depend on severity of the adhesions.
- Prolactin antagonists are treatment of choice in pituitary microadenomas, idiopathic hyperprolactinemia, and pretherapy for macroadenomas (which usually require surgery or targeted radiation).
- Estrogen therapy should be considered in all cases of hypoestrogenic states.
a.Tamoxifen can be used in patients with breast cancer.
b .Small doses of testosterone may improve quality of life and bone status.
- Egg and zygote donation can be considered if pregnancy is desired in the presence of nonfunctional ovaries.