THERAPEUTIC APPROACH AND TREATMENT STRATEGIES FOR PREMATURE OVARIAN INSUFFICIENCY

Abstract

Premature Ovarian Insufficiency (POI) is a heterogeneous condition characterized by a decline in ovarian activity before the age of 40, associated with menstrual irregularities, hypoestrogenism, reduced fertility, and long-term systemic consequences. This study aimed to analyze the main therapeutic strategies available and emerging approaches for the management of POI. A narrative literature review was conducted using the PubMed database, employing keywords related to premature ovarian insufficiency and its treatment. Recently published articles in Portuguese or English addressing hormone therapy, fertility preservation, regenerative medicine, cell-based therapies, and lifestyle interventions were considered. Hormone replacement therapy remains the primary approach for managing hypoestrogenism and preventing bone, cardiovascular, and genitourinary complications. Fertility preservation should be discussed early, particularly for patients undergoing potentially gonadotoxic treatments. Strategies based on mesenchymal stem cells, secretomes, exosomes, *in vitro* follicular activation, ferroptosis modulation, and artificial ovary development show promising results, although they remain predominantly experimental. It is concluded that POI management must be individualized and multidisciplinary, based on an assessment of systemic risks, etiology, age, residual follicular activity, and the patient's reproductive goals. High-quality clinical studies are needed to establish the safety and efficacy of emerging therapies.