All women with early onset oestrogen deficiency have an increased risk of cardiovascular disease regardless of aetiology, be it premature ovarian failure, hypopituitarism or Turner Syndrome. The fact that oestrogen deficiency in young women increases CVD risk appears to be in conflict with the adverse effects of oestrogen replacement on cardiovascular morbidity in postmenopausal women. One explanation for this paradox is that oestrogen may slow atherogenesis in young women while a prothrombotic effect predominates in the older postmenopausal age-group. In support of this notion we see that oestrogen replacement has a much greater beneficial effect on cardiac risk factors such as intima medial thickness in young oestrogen deficient women compared to an older age group.
Following the publication of the risks of HRT in the WHI study, negative advice on the use of oestrogen has been mistakenly extended to young women with oestrogen deficiency. We must recall the WHI study comprised women who were extending their 'oestrogen years' beyond the age of the natural menopause at 50 and therefore none of the conclusions apply to women below this age who are regaining their 'eu-oestrogenaemic' state.
Young women with oestrogen deficiency also differ from an older group by often requiring higher dose of oestrogen and receiving relative greater benefit from androgen replacement and vaginal oestrogen preparations. The management of oestrogen deficiency in young women, therefore, requires familiarity with a wider variety of products than would be common in primary care or in conventional menopause clinics as well as ready access to gynaecology and sex therapy support.