Ovarian hormone treatment in adults with Turner syndrome

Most women with Turner syndrome (TS) require life-long replacement therapy with oestrogen and progesterone, and we therefore have to consider the optimal strategy for this treatment for 35 years of continuous use. The forms of oestrogen replacement therapy use in young women with TS are usually borrowed from estrogen replacement therapy (ERT) preparations designed for use in postmenopausal women. There have been few attempts at finding an age-appropriate dose of oestrogen for use in young women. There are many end organ responses for exogenous oestrogen that might be used to guide treatment strategies in young women including those in bone, uterus, arterial walls and liver. In this era of caution with ERT brought about by the women's health initiative (WHI) trials in older women, many young women with TS have been advised to reduce the dose of oestrogen replacement or to terminate oestrogen early. This advice may run counter to the concern over quality of life which is already reduced in this group of women. This paper we will consider a selection of target organs for oestrogen for which data are available in women with TS with particular reference to the starting age of oestrogen and possible effects of dose reduction in adult life. Lastly, ovarian androgen secretion is also lost in women with gonadal dysgenesis and some consideration will need to be given to testosterone replacement in the future.