Premature ovarian failure definition.
The phenomenon of ovarian hypofunction in women before the age of 40 is called premature ovarian failure. the incidence of POF accounts for 1-3% of adult women. Premature ovarian failure refers to women who have established regular menstruation, but before the age of 40, they develop persistent amenorrhea and sexual organ atrophy due to the decline of ovarian function, often with rising gonadotropin levels and declining estrogen, with clinical manifestations accompanied by varying degrees of hot flashes and sweating, vaginal dryness, decreased libido and other pre- and post-menopausal symptoms, causing the patient to decline before her age, bringing great pain to her physical and mental health and married life. Premature ovarian failure affects women’s quality of life.
The etiology of premature ovarian failure is unknown in the vast majority of patients. It is thought to be related to genetics, autoimmune processes, infections, etc. The most research has been done on premature ovarian failure and autoimmunity. The abnormalities that have been identified include antibodies to FSH, antibodies to FSH receptors, antibodies to parathyroid, thyroid and adrenal glands, and some patients have had a recovery of ovarian function after immunosuppressive therapy. Tests for autoimmune diseases include blood calcium, phosphorus, fasting glucose, early morning cortisol, free T4, TSH, thyroid antibodies, complete blood count, sedimentation, total protein, albumin/globulin ratio, rheumatoid factor, and antinuclear antibodies. Genetic abnormalities are also heterogeneous and multifactorial, including FSH receptor abnormalities, translocations of homologous sequences of X and Y chromosomes, and structural abnormalities of FSH. Infectious factors include mumps, viral infections, etc. In normal women, ovarian function begins to decline only at the age of 45-50 years. If signs of decline appear before the age of 40, it is medically called premature ovarian failure. Such women often have amenorrhea or oligomenorrhea, increased gonadotropin levels and decreased estrogen levels. Clinical manifestations include varying degrees of hot flashes and sweating, vaginal dryness, decreased libido and other pre- and post-menopausal symptoms.
Causes of premature ovarian failure
1.Physical and chemical factors
Physicochemical factors in the development of premature ovarian failure include: radiation irradiation, chemical drugs and possible infection factors. Radiation exposure can destroy the ovaries and lead to temporary or permanent amenorrhea. Some pelvic infections such as severe tuberculosis, gonorrhea or septic pelvic inflammatory disease can also cause POF. histological examination of cured patients with mumps ovarianitis shows atrophy and fibrosis of the ovaries and loss of the normal structure of the follicles.
2. Genetic factors
The most common cause of POF is the presence of two structurally normal X chromosomes, each of which has a specific locus for ovarian function, and abnormalities in the number and structure of X chromosomes can cause congenital ovarian insufficiency and POF, a group of X-linked genetic disorders that are often accompanied by chromosomal recombination, translocation or monosomy.
3.Immune factors
Autoimmune imbalance in ovarian location is not common in women with POF, and roughly 20% of patients will have accompanying autoimmune diseases that may occur before symptoms of ovarian insufficiency become apparent, including autoimmune thyroiditis, hypoparathyroidism, SLE, rheumatoid arthritis, and type I diabetes. Premature ovarian failure is often considered to be part of a systemic polyglandular syndrome. Immune ovarianitis has been reported to account for approximately 4% of the etiology of POF. It has been found that lymphocytes and plasma cells infiltrate in developing follicles, atretic follicles and luteal cysts; in mature follicles, plasma cells, T cells, B cells and NK cells infiltrate, and immune cells release cytokines to damage follicles and accelerate follicular atresia. in peripheral blood of POF patients, T helper cells increase and T suppressor cells are few, and the TH/TI ratio increases, promoting B cells to produce auto The increase in TH/TI ratio promotes B-cell production of autoimmune antibodies, causing ovarian damage. Anti-ovarian antibodies can be detected in the blood of 10-69% of POF patients.
Infections
Mumps in young girls can be combined with viral ovarian infections, and 2-8% of patients with ovarian infections tend to have premature ovarian failure secondary to mumps. Other infections that can cause POF include tuberculosis, malaria, chickenpox, and Shigella spp. The pathogenic bacteria invade the ovaries and cause fibrosis due to ovarian inflammation, resulting in a decrease in the number of follicles, which can eventually develop into premature ovarian failure.
Medical factors
Any surgery on the tissues surrounding the ovaries may damage the blood supply to the ovaries or cause inflammation in the area, leading to the development of POF. Surgeries that may cause POF include hysterectomy, tubal ligation or removal, conservative or semi-radical treatment of endometriosis, ovarian wedging or perforation, ovarian cyst debridement, or removal of one ovary. It is believed that too little normal ovarian tissue remains after surgery or large blood vessels are damaged during surgery, which may destroy the cortical structure or blood supply of the ovary and cause irreversible damage to ovarian function leading to the development of POF. Radiotherapy and chemotherapy can cause serious damage to the ovaries, leading to acute ovarian failure. Histological studies of ovarian damage caused by chemotherapeutic agents have revealed thickening of the ovarian envelope and interstitial fibrosis, but a large number of arrested follicles exist, so that normal ovarian function can be restored in 65-70% of patients after discontinuation of chemotherapeutic agents. It has been reported that in 92 cases of SLE treated with cyclophosphamide, 55% of the patients developed menstrual disorders, mainly amenorrhea, during treatment, and ovarian failure was present on sex hormone tests. Age at the start of treatment and the cumulative dose of cyclophosphamide were associated.
Metabolic factors
Galactosemia is associated with the development of POF. The high incidence of POF in women suffering from galactosemia is mainly due to the accumulation of galactose in the body galactosemia, which directly damages the oocytes; damage to the ovarian parenchyma by its metabolites; premature depletion of oocytes due to altered biological activity of galactose-containing gonadotropin molecules. Fraser et al. reported two sisters with galactosemia and POF in whom ovarian biopsy revealed ovarian antagonistic syndrome in the sister and follicular deficiency in the sister, a report that suggests that the follicular resistance stage precedes follicular deficiency. In these patients, ovarian pathological studies revealed a cortical area filled with fibrous tissue and extremely rare or absent follicles.
Autoimmune POF
The most common cause of POF is an autoimmune abnormality. The basis for autoimmune abnormalities is that about 20-22% of patients with POF have autoimmune diseases of other organs, which constitute multiple endocrine organ failures, most commonly thyroid disease. Detection of anti-ovarian antibodies, the incidence of AOA varies depending on the method of detection, and human ovaries are detected by direct immuno- Perspex method. Ovarian biopsy reveals lymphocytic infiltration around primitive or primary follicles. The pathological changes in early autoimmune ovarianitis occur mainly in and around the growing follicles, and under light microscopy, monocyte-macrophage and plasma cell infiltration predominate. The longer the disease progresses, the more severe the cellular infiltration becomes, with a decrease in the number of growing follicles and corpus luteum, an increase in atretic follicles, granulosa cell thinning with vasodilation and congestion, and interstitial edema, and a positive correlation between the severity of the lesions and the titer of anti-ovarian antibodies.
Idiopathic POF
Idiopathic POF is a chromosomally normal, hypergonadotropic, follicle-free POF without a history of mumps, lack of anti-ovarian antibodies, history of physico-chemical damage or other metabolic processes, and may result from a lack of primordial germ cells or from accelerated depletion of normal ovarian germ cells. In idiopathic POF, the ovaries are usually small and histological examination reveals an excess of interstitial cells in the ovarian cortex and the absence of follicular structures, atretic follicles and white bodies may be present. Laparoscopic observation of 52 cases of idiopathic POF showed that 82.6% had bilateral ovarian atrophy or striated changes, while 17.4% had unilateral or bilateral small or normal ovaries, and atrophy or striated ovaries may not have follicles.
Ovarian insensitivity syndrome
Premature ovarian failure refers to women with primary amenorrhea or secondary amenorrhea before the age of 30 years. It presents with elevated endogenous gonadotropin levels and the presence of normal follicles in the follicles, but a low response to high doses of exogenous gonadotropin stimulation. This condition is less common than POF and accounts for approximately 11-20% of patients with hypergonadotropic amenorrhea. One of its most characteristic features is the presence of a large number of primordial follicles in the ovary, mostly showing rudimentary and immature, without lymphocytic and plasma cell infiltration, some showing focal or diffuse vitellogenic changes. The oocytes, zona pellucida and follicular membrane cells were observed to have normal ultrastructure under electron microscopy. Ovulatory scarring is present in some cases of secondary amenorrhea. These are the main points of differentiation from POF. The possible pathogenesis of POF is due to the development of antibodies against the gonadotropin receptor sites on the autologous ovarian granulosa cells for some reason, or a deficiency of FSH receptor protein in the ovary that may cause changes in the biological activity of the receptor, resulting in a decrease in the sensitivity of the ovary to gonadotropins, thus leaving the follicle in a resting state and unable to develop and mature, and a decrease in E2 secretion and an increase in endogenous gonadotropins. is relative, not absolute, and some patients can regain ovarian function with treatment.
Environmental and psychological factors
Smoking, alcohol consumption and insomnia are risk factors for premature ovarian failure. A large number of epidemiological surveys have shown that smoking affects the natural age of menopause in different populations, with smoking women experiencing menopause 1-2 years earlier than non-smokers. The use of pesticides, cadmium, arsenic and mercury can damage ovarian tissues and cause POF, and receiving high doses or long periods of radiation due to work, illness or accidents can damage the ovaries and cause POF, and studies have found that irreversible ovarian damage occurs in almost all women of all ages when the ovaries are exposed to direct radiation doses exceeding 8 Gy. The risk factors for premature ovarian failure include smoking, history of mumps, poor rest, tight underwear during adolescence, bad mood, history of toxic exposure, menstruation, and the risk of ovarian failure. The risk factors for premature ovarian failure include smoking, history of mumps, poor rest, tight underwear during puberty, bad mood, history of toxic exposure, early menarche, etc.; protective and beneficial factors include regular exercise, regular consumption of soy products and vegetables, breastfeeding, etc.
Types of premature ovarian failure
1, plasma ovarian premature failure: about 25% of premature ovarian failure, common in patients aged 30-40. Unilateral is more common. The appearance is grayish white, the surface is light
In some cases, papillary protrusions can be seen on the inner wall, clustered in groups or diffusely scattered, called papillary plasmacytoid cystic glands. The papillae may protrude from the cyst wall, spread and grow on the surface of the cyst, and even invade the adjacent organs. If accompanied by ascites, malignancy has mostly occurred.
2, mucinous premature ovarian failure: about 15-25% of premature ovarian failure, most common in 30-50 years old. Most of them are unilateral. The surface of the tumor is smooth, orchid-white and multi-housed. The cyst contains coumarin-like mucus and occasionally there are papillary protrusions in the cyst wall, which is called papillary mucinous cystic gland.
3, Premature ovarian failure: also known as cystic ovarian premature failure or skin-like cyst. It accounts for about 10-20% of premature ovarian failure. Most of them occur in the reproductive age.
Premature ovarian failure pathology
Premature ovarian failure pathology: Microscopically, the ovarian surface is covered with cuboidal epithelium with a thick layer of connective tissue underneath.
Symptoms of premature ovarian failure
1. primary amenorrhea in undeveloped gonads, delayed menarche or irregular menstruation in underdeveloped gonads, dysmenorrhea
2. Infertility secondary to gonadal development, with menstruation becoming sparse until amenorrhea after several years.
3.For those who have ovulation, typical POF has hot flashes, hypogonadism, such as night sweats, constipation, hair loss, vaginal dryness, painful intercourse, decreased libido, hypothyroidism, urinary tract infection, weight gain, anxiety, paranoia, etc.
4.Atrophy and sagging of breast, loose and rough skin, tension, dreaminess, paranoia, palpitations, osteoporosis, joint pain, inflammation of reproductive organs, prolapse of uterus, urinary incontinence, constipation, acne, pigmentation
Complications
Premature ovarian failure is a serious disease for women who love beauty. Premature ovarian failure not only adversely affects the appearance, skin and body of women, but also leads to infertility, decreased sexual function and some of the same complications as menopause, making people fear the premature onset of aging. How to treat premature ovarian failure, early detection is very important. When a woman’s menstruation gradually decreases, especially when her menstrual cycle is significantly delayed or fails to come, women over the age of 30 should pay great attention to it.
Treatment of premature ovarian failure
1. HRT: In addition to amenorrhea, only a few people with POF have menopause-like symptoms, so they are often not taken seriously and do not receive treatment, but in a long-term low estrogen state, young women will experience uterine atrophy, vaginal
However, in a long-term low estrogen state, young women may suffer from uterine atrophy, reduced vaginal secretions, painful intercourse, and even long-term calcium deficiency resulting in osteoporosis. Therefore, estrogen supplementation is needed in a timely manner. For those who have the possibility to restore ovarian function and expect to have children, ovulation-promoting drugs can be added.
2. Immunotherapy: Immunotherapy is feasible for those who are found to have antibody factors. Immunization vaccination has become a more reliable treatment method.
3.Surgical treatment.
(1) For POF due to ovarian vascular factors leading to ovarian nutritional deficiency, early diagnosis and treatment should be carried out, and vascular bypass surgery should be performed as early as possible before the loss of ovarian function, such as anastomosis of the ovarian artery with the inferior mesenteric artery or renal artery to restore the ovarian vascular supply and bring the ovaries back to life.
(2) For those who are in the late stage of POF or have ovarian defects due to various reasons, ovarian transplantation has become a very successful treatment.
Premature ovarian failure affects a woman’s quality of life
Premature ovarian failure refers to the persistent amenorrhea and sexual organ atrophy due to the decline of ovarian function in women who have established regular menstruation before the age of 40, often accompanied by an increase in gonadotropin levels and a decrease in estrogen.
When it comes to premature ovarian failure, this is one of the common diseases among women in recent years, especially white-collar women. According to the Chinese Women’s Sex Survey, 57% of women over 40 years old often feel vaginal dryness and insufficient lubrication. In Western medicine, this is due to premature decline of ovarian function and the decrease or disappearance of estrogen secretion. In Chinese medicine, it is related to the kidney, liver and spleen, and the kidney plays a pivotal role in this. If kidney yin is insufficient, the liver will lose its nourishment, which will lead to loss of drainage; kidney yang is insufficient, which will lead to deficiency of essence, blood and qi, and loss of nourishment of the uterus, leading to premature ovarian failure.
The decline of ovarian function can cause different degrees of hot flashes and sweating, anxiety and depression, irritability and other menopausal symptoms; vaginal dryness and insufficient lubrication will not only greatly affect the sexual life of couples, but also cause damage to the vaginal mucosa, which can easily cause viral and bacterial infections and induce vaginitis or aggravate the original condition, bringing great impact on the quality of life and mental and physical health.
Premature ovarian failure prevention.
1, physical fitness and recreation
The most important way to maintain the vitality of middle-aged women is to keep exercising and strengthening their physique. The most important thing is to keep your body healthy and coordinated with the function of all organs and systems, so that the neurological and endocrine system can naturally slow down the decline of ovarian function.
It is also important for middle-aged women to remember to keep their spirits up and keep their mood as comfortable as possible. Currently, it is not uncommon for white-collar women to suffer from premature ovarian failure due to excessive stress and pressure at work. Women should take a positive attitude towards menopause and old age, eliminate unnecessary worries and fears, and take positive and effective ways to deal with certain maladjustments once they occur, and also be good at getting sympathy, comfort and encouragement from family members. If the mental or nervous system symptoms are heavy, appropriate use of sedative, antispasmodic, sleeping drugs, such as Valium (Dixieland), sleep, sleep, vitamin B6, vitamin E, vitamin A and vitamin B complex can be added, if necessary, should seek the help of gynecologists and psychologists.
2.Food conditioning
Soybean attention to dietary conditioning, to ensure the intake of sufficient nutrients, can help women to obtain the necessary nutrients to maintain the healthy function of the reproductive system. Women can eat more high-quality protein, B vitamins, folic acid, iron, calcium and other nutrients, such as eggs, pig liver, milk, beans and their products, fresh vegetables, mushrooms, fungus, kelp, nori, fish and so on. Also keep your diet light, not too greasy, too salty, too sweet. Eat regularly, eat on time, and do not overeat.
Recommended several food nutrition products.
Soybeans are not only rich in high-quality protein, but also soy isoflavones, soy phospholipids, soy saponins, soy oligosaccharides, soy dietary fiber, vitamin E and hydrolyzed soy peptides and many other substances, which have special physiological functions that can delay aging, improve gastrointestinal function, lower blood pressure and lower blood lipids. Among them, soy isoflavones have phytoestrogenic effects and can prevent the occurrence of conditions related to low estrogen, such as menopausal syndrome, osteoporosis and elevated blood lipids; for people with high estrogen levels, soy isoflavones exhibit anti-estrogenic activity and can prevent breast cancer and endometrial cancer. Isoflavones are found in nature in plants such as Mexican small white beans, Thai wild kudzu, alfalfa and green beans, in addition to soybeans.
There are seven contraindications to good ovarian failure treatment
Isoflavone tablets
1, ovarian premature failure of women must avoid sedentary, sedentary position directly affect the pelvic reproductive organs ovary uterus and other blood microcirculation, impede the ovary uterus tissue nutrient supply.
2, ovarian premature failure women must abstain from eating more stimulating food, women more pelvic inflammatory lesions, stimulating food directly aggravate the inflammation, the ripple effect ovarian uterine function, thus aggravating ovarian premature failure and the difficulty of treatment ……
3, must learn to keep a long-term mood happy, this is a discipline, women’s long-term emotional depression, directly affecting the breast and ovaries, Chinese medicine, the liver meridian directly through the breast and fallopian tube ovaries, breast and ovaries are connected, long-term liver qi depression is bound to directly affect ovarian function, aggravating amenorrhea.
4, amenorrheic women must avoid long-term stay up late at work, long-term stay up late directly depleted female menstrual blood, dark depletion of female essence, damage to the kidney, affecting ovarian function, thus aggravating the condition.
5, amenorrheic women more deficiency, must avoid excessive intercourse, to intercourse, couple sex is a double-edged sword, frequent sex, direct damage to the kidney essence, kidney yin, kidney Yang, etc., resulting in kidney failure, thus directly causing ovarian function decline, aggravating amenorrhea.
6, women should not supplement hormonal drugs or health care products, improper hormone supplementation and poor health care, will lead to ovarian over-stimulation, resulting in a great side effect, the results will be contrary to expectations, counterproductive, aggravating amenorrhea. Appropriate non-synthetic estrogens can be supplemented, such as: forest frog oil and soy isoflavones. Forest frog oil contains estrogens such as estradiol, estriol and estradiol, which are estrogens secreted by the ovaries. Estrogen is a class of
steroidal compounds with a wide range of biological activities in forest frog oil, which not only have physiological effects on promoting and maintaining female reproductive organs and secondary sexual characteristics, but also have obvious effects on the endocrine system, cardiovascular system, metabolism of muscles, growth and maturation of bones, skin and other aspects. Soy isoflavones are chemically related to estrogenic activity as structural analogues, showing inhibitory and synergistic bidirectional regulatory effects: when estrogen levels in the body are low, isoflavones occupy estrogen receptors, exerting a weak estrogenic effect and exhibiting a role in raising estrogen levels; when estrogen levels in the body are too high, isoflavones compete in a “competition When the estrogen level in human body is too high, isoflavones occupy the receptor position in a “competitive” way, and at the same time play a weak estrogenic effect, thus showing an overall effect of lowering the estrogen level in the body.
7, modern life of women like computer chat or sit all day in front of the computer work, do not know long-term sitting computer work on the brain radiation is very large, the brain through the pituitary neuromodulation directly affect reproductive – ovarian – uterine axis, affecting reproductive ovarian function, especially for amenorrheic women, can aggravate amenorrhea, must be drawn to attention.
The four most common causes of premature ovarian failure
The four main causes of premature ovarian failure: cytogenetic factors. Low congenital germ cell count, accelerated follicular atresia, X chromosome abnormalities, and a family history in 10% of patients. Immune factors. About 20% of patients have ovarian antibodies detected in the blood.
One of the etiological factors: cytogenetic factors. Congenital low germ cell count, accelerated follicular atresia, X chromosome abnormalities, family history in 10% of patients.
Etiology No. 2: Immune factors. Ovarian antibodies can be detected in the blood in about 20% of patients. These patients are often combined with other autoimmune diseases such as lupus erythematosus, rheumatoid arthritis, and congenital lack of an enzyme in the body.
Etiology No. 3: Physical factors. Such as surgery, chemotherapy, infection, etc. resulting in defective gonadotropin secretion or post-gonadotropin receptor or receptor defects.
Etiology No. 4: Idiopathic premature ovarian failure. The patient has no clear cause, normal chromosomes, elevated blood FSH (follicle stimulating hormone) and LH (luteinizing hormone), low E2 (estrogen), and normal PRL (prolactin) as measured by sex hormones. Patients have not only estrogen deficiency, but also an underlying ovarian androgen deficiency, or a mild defect in the ability of the adrenal glands to produce steroid hormones, and small or atrophic ovaries are most often seen on laparoscopy.
Prevention of premature ovarian failure
1, adjust the mentality: with a calm mind look at the problem of premature ovarian failure, which will help a lot to recover. It is really difficult to gauge the role of women’s self-confidence on their own health. The actual fact is that you can’t get a lot of money from the company. The biggest impact on the human body should be to cause infertility, but also make women aging faster.
2, diet: prevention of premature ovarian failure to pay attention to nutritional balance, in addition to adequate intake of protein, fat and sugar should be moderate, while paying special attention to vitamin E, D and minerals such as iron and calcium supplementation, which appropriate supplementation of vitamin E can remove free radicals, improve skin elasticity, delay the process of gonadal atrophy, play a role in anti-aging, and can regulate immune function, 150-300 mg daily can . To properly strengthen exercise, exercise is conducive to promote metabolism and blood circulation, delaying organ aging. Ensure sufficient sleep, dinner should not be too full, and do not do strenuous exercise at night. Maintain a harmonious sex life, can enhance confidence in life, happy spirit, relieve psychological stress, and can improve the body’s immune function.
3, improve contraceptive methods, reduce abortion: some women wrongly believe that “abortion” is a small matter. In fact, the physical trauma can be repaired quickly, but the endocrine changes in the human body can not be restored in a day or two. If you repeatedly have multiple abortions, often disrupting the endocrine, it will cause invisible damage in the body, gradually causing the ovaries to lose their function, resulting in premature ovarian failure.
4, attention to menstruation: ovarian premature failure is a harbinger, before the onset of more menstrual reduction – menstrual sparing – amenorrhea change process, so pay attention to menstrual changes. Some women are careless, or do not pay attention to it, or even think it does not matter if it comes or not, until it causes serious consequences, then they get anxious.
5, emotional regulation: the human central nervous system and endocrine interlinked, mutual influence, so women should learn to grasp a good state of mind, learn to relieve bad emotions, so as not to reduce the body’s ability to resist disease, leading to premature ovarian failure.
Premature ovarian failure leads to amenorrhea and infertility.
The ovaries are the main reproductive endocrine organs of women, located on both sides of the uterus, one on each side, and normally about the size of a chestnut. It has two main functions, one is the reproductive function, i.e. to produce mature follicles and ovulate; the other is to secrete hormones, mainly estrogen, but also a small amount of androgen to maintain the unique female body characteristics. The normal ovarian function of women starts to decline at the age of 45-50 years, but in recent years, there has been a significant increase in the number of patients with premature ovarian failure, and even adolescent women can be seen in outpatient clinics. Premature ovarian failure is a condition characterized by a lack of estrogen and elevated gonadotropin levels in women with amenorrhea and infertility caused by some reason before the age of 40. The prevalence in patients with primary amenorrhea is 10-28%.
Premature ovarian failure in women indicates a thin endometrium and low levels of estradiol and progesterone in the blood. The principle of menstrual regulation axis indicates that the ovaries produce less estradiol and progesterone. There are three possible causes of premature ovarian failure: first, high follicular estrogen and luteinizing hormone in the blood, which feedback inhibits the ovaries from producing estradiol and progesterone, a condition known as premature ovarian failure, which begins with a decrease in menstrual flow, a 1-2 month postponement of the menstrual cycle, and finally amenorrhea. Because of irregular menstruation or amenorrhea, it will naturally lead to infertility. Secondly, some of them are accompanied by elevated testosterone in the blood, which can neutralize estradiol in the blood and reduce estradiol, affecting follicle development and maturation and normal ovulation. At the same time, excess testosterone can prevent follicles and ovulation, while contributing to their atrophy and atresia. As there is no normal ovulation, it leads to infertility. Third, the normal function of the ovaries is inhibited, resulting in low ovarian function, which can manifest as scanty menstruation, reduced menstrual flow, anovulation and insufficient luteal function, and finally amenorrhea. This can also lead to infertility.