Key Treatment

Common causes of precocity are benign and require no treatment. Careful nontherapeutic observation may be considered (Carel et al., 2004) (SOR: A).

Treatment of precocity with GnRH analogues, which reversibly inhibit gonadotropin secretion, can be used to prevent secondary sexual development and early epiphyseal fusion (Carel et al., 2004) (SOR: A). Hormonal therapy with hCG or GnRH can be used to increase the likelihood of testicular descent (Henna, 2004) (SOR: A). Inguinal orchiopexy is a well-established procedure for palpable undescended testicle and is generally considered the standard of care for cryptorchidism in the United States (Engeler, 2000; Kollin, 2007; Ritzen, 2008) (SOR: A).

Present clinical practice suggests treating menopausal symptoms on an individual basis; predominantly with lifestyle therapies, risk modification, screening strategies, and nonhormonal therapies (Barton and Loprinzi, 2004; Brewer et al., 2003; Krebs et al., 2004; MacGregor et al., 2005) (SOR: C).

SSRIs, clonidine, and gabapentin are recommended for treatment of menopausal symptoms (Barton and Loprinzi, 2004; Brewer et al., 2003; Krebs et al., 2004; MacGregor et al., 2005) (SOR: C). Tibolone is effective in controlling menopausal symptoms and reduces risk of fracture and breast cancer, but with an increased risk of stroke (Cummings et al., 2008) (SOR: A). Patients with polycystic ovary syndrome require cardiovascular risk reduction, psychosocial counseling, management of subfertility and hirsutism, and possible insulin sensitizers and protection of endometrium with hormonal manipulations (Azziz, 2003; Azziz et al., 2009; Ehrmann, 2005; Nestler, 2008) (SOR: A). Newer selective estrogen receptor modulators (SERMs) are being used to treat depressed libido in women, which minimizes risk to the endometrium while preserving benefits to breast and bone (MacGregor et al., 2005) (SOR: A).

Diagnosis of secondary amenorrhea can be facilitated with a progesterone challenge (Sheeler et al., 2007) (SOR: B).



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