2026 Post-Doctoral Fellowship Awardee Antoinette Farrell, MD

Fellowship Awardee
Antoinette Farrell, MD, Pediatric Endocrinology Fellow at the University of California – San Diego at Rady Children's Hospital

Project Title
A Study of Continuous Progesterone in Adolescents and Young Adults with Turner Syndrome Compared to Traditional Cyclical Hormone Replacement

Summary
Hormone replacement therapy (HRT) is an essential part of care for most adolescents and young adults with Turner syndrome (45,X), helping to support healthy puberty, bone health, and protection of the uterus. Current treatment typically includes estrogen along with cyclic (sequential) progesterone, which produces a monthly menstrual bleed. While this approach effectively protects the uterine lining, some individuals find the predictable monthly bleeding inconvenient or distressing, and it may negatively affect quality of life, emotional well-being, and daily activities. In other populations, continuous progesterone therapy, in which a lower dose of progesterone is taken every day, has been shown to provide similar protection of the uterus while reducing or eliminating menstrual bleeding. However, this approach has not been systematically studied in adolescents and young adults with Turner syndrome.

This pilot clinical trial will compare the standard sequential progesterone regimen with a continuous daily progesterone regimen in participants with Turner syndrome receiving hormone replacement therapy. During the 12-month crossover study, participants will receive both treatment approaches, allowing each individual to serve as their own comparison. Researchers will monitor uterine health using pelvic ultrasound to measure endometrial thickness and will evaluate hormone levels, menstrual bleeding patterns, medication side effects, mental well-being, and participants' experiences with treatment. Monthly check-ins and participant journals will provide additional information about bleeding, symptoms, and overall satisfaction with each regimen.

The primary goal of this study is to determine whether continuous progesterone is a safe and effective alternative to the current standard of care while continuing to protect the uterus from endometrial overgrowth. Researchers will also evaluate whether continuous progesterone offers meaningful improvements in quality of life, including fewer bleeding days, improved menstrual hygiene, and greater treatment satisfaction. Results from this pilot study will provide the first evidence specific to Turner syndrome to guide progesterone replacement therapy and may help inform future clinical practice guidelines, offering individuals and families additional treatment options that better align with their preferences and daily lives.