Patients with primary ovarian insufficiency (POI) prior to spontaneous onset of puberty require appropriately timed exogenous estrogen replacement therapy (ERT) to initiate appropriate pubertal development. The optimal ERT regimen for puberty induction has not been established. This study aimed to assess patterns of puberty induction by analyzing final adult height, time to maintenance estrogen dose, and time to menarche. The secondary aims were to compare outcomes based on age of initiation, as well as underlying POI diagnosis

IRB approval was obtained. A retrospective chart review was performed for pre-pubertal female patients who received care from 2012-2022 with diagnosis codes of POI, gonadal failure, and premature menopause. Patients were excluded due to lack of documented follow-up, Tanner breast stage >2 at initial encounter, and diagnoses of hypogonadotropic hypogonadism or gonadal dysgenesis. Data were collected on etiology of POI, managing specialty, visit heights, estrogen dose, and gonadotropin and estradiol lab work. Time from hormone initiation to maintenance dosing and menarche was calculated and age cohorts of patients 10-12 years and older than 12.1 years were compared. Analysis was performed using T-tests and Fisher's exact tests

The cohort included 26 patients with a mean age of 13 years old. The most common causes for POI were a history of gonadotoxic chemotherapy or bone marrow transplant (44%, n=12) and Turner Syndrome (30%, n=8). There were varied starting doses of ERT in pill and patch form used for induction (Table 1). Patients < 12yo had significantly higher rates of gonadotropin testing at their first follow up visit (55% vs 13%, P<.02). There was no significant difference in the proportion of patients who underwent medication increases during first visit (45% vs 44% P=0.95) and second visit (73% vs 69%, P=0.98). The final height of both cohorts was not significantly different, nor was the time to maintenance dosing or time to menarche (Table 2)

All patients were initiated on low doses of estrogen for puberty induction via a pill or patch, but there was wide variation in initial dose, timing of dose increases, repeat gonadotropin levels, and time to maintenance dosing. Repeat gonadotropin testing was collected more in the younger cohort but this did not appear to affect practice management. Age at pubertal induction was not associated with a significant difference in outcomes of final adult height, time to menarche, or time to reach maintenance dosing