Premature ovarian failure (POF) is defined as the persistent amenorrhea and atrophy of sexual organs due to the decline of ovarian function before the age of 40 in women who have established regular menstruation, often with a rise in gonadotropin levels and a decline in estrogen. The incidence of POF accounts for 1-3% of adult women.
The etiology of premature ovarian failure is unknown in the 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, and 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 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 (e.g., abnormal thyroid function), 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 on the X and Y chromosomes, and structural abnormalities of FSH (inability to bind to the receptor). Infectious factors include mumps, viral infections, etc. In normal women, ovarian function begins to decline only at the age of 45 to 50. 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, and clinical manifestations include varying degrees of hot flashes and sweating, vaginal dryness, decreased libido and other pre- and post-menopausal symptoms.
1.Causes of premature ovarian failure
(1) Physicochemical factors
Physicochemical factors in the development of premature ovarian failure (POF) include: radiation irradiation, chemical drugs and possible infectious factors. Radiation exposure can destroy the ovaries and lead to temporary or permanent amenorrhea. However, Madsen believes that the risk of POF in women undergoing chemotherapy is low. the likelihood of POF is significantly correlated with reversibility and irradiation dose, patient age, and sensitivity, with younger age generally being more resistant to radiation damage. Severely damaged ovaries due to radiation show loss of primordial and developing follicles, interstitial fibrosis and vitellogenic changes, vascular sclerosis, and storage of hilar cells. Chemotherapeutic agents, either alone or in combination, can often lead to ovarian failure. It is uncertain whether chemotherapy-induced ovarian failure is dose-related, but an age-related association has been identified. Younger patients have the potential to retain normal menstruation, but are still at risk of POF after several years. Some authors believe that 65-70% of chemical-induced POF is reversible. the Blumenfeld study showed that the use of gonadotropin-releasing hormone (GnRH-α) in rats and monkeys inhibited chemotherapy-induced follicular destruction and thus prevented the development of POF. The histology showed loss of follicles in the ovaries with a large number of arrested primordial follicles, thickened envelope and interstitial fibrosis. 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 ovarian atrophy and fibrosis with loss of normal follicular structure.
(2) Genetic factors
POF is a group of X-linked genetic disorders that are often associated with chromosomal recombination, translocation or monosomy. 45X Turner syndrome and its variants are the most common hereditary causes of POF. Mo C.F. et al. concluded that 10% of patients with POF have a family history of vertical transmission.
(3) Immune factors
Autoimmune imbalance is not common in women with POF, and roughly 20% of patients will have autoimmune disorders 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; plasma cells, T cells, B cells and NK cells infiltrate in mature follicles, and immune cells release cytokines to damage follicles and accelerate follicular atresia. In the peripheral blood of POF patients, T helper cells (TH or CD4+) are increased and T suppressor cells (TI or CD8+) are few, and the TH/TI ratio is increased, promoting the production of autoimmune antibodies by B cells and causing ovarian damage. Anti-ovarian antibodies can be detected in the blood of 10%-69% of POF patients. Mumps infection in young girls can be combined with viral ovarian infections, while 2% to 8% of patients with ovarian infections tend to develop premature ovarian failure, and the risk of premature ovarian failure increases nearly 10-fold in women with previous mumps, and many cases report that POF occurs when such patients fully recover to normal ovarian function. 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.
(4) Medically induced 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. Alkylating agents are more likely to cause POF . Histological studies of ovarian damage caused by chemotherapy drugs have shown that the ovarian envelope is thickened and the interstitium is fibrotic, but there are a large number of arrested follicles, so that normal ovarian function can be restored in 65% to 70% of patients after discontinuation of chemotherapy drugs. It has been reported that in 92 cases of SLE treated with cyclophosphamide, 55% of patients developed menstrual disorders, mainly amenorrhea, and ovarian failure on sex hormone tests during treatment. The age at the start of treatment and the cumulative dose of cyclophosphamide were associated with this.
(5) Metabolic factors
Galactosemia is associated with the development of POF. The high incidence of POF in women with galactosemia is mainly due to (1) the accumulation of galactose in the body, which directly damages the oocytes; (2) the damage to the ovarian parenchyma by its metabolites; and (3) the premature depletion of oocytes due to the 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, the ovarian pathology was found to be filled with fibrous tissue in the cortex, and follicles were extremely rare or absent.
(6) Autoimmune POF
The most common cause of POF is autoimmune abnormalities. The basis for autoimmune abnormalities is that ① about 20-22% of POF patients have autoimmune diseases of other organs, which constitute multiple endocrine organ failure, the most common being thyroid disease. ② Detection of anti-ovarian antibodies (AOA), the incidence of AOA varies depending on the detection method, and human ovaries are detected by direct immuno- Perspex method. Grasso et al. suggested that the normal process of follicular atresia is triggered by interferon-gamma (IFN-γ), a product of activated T lymphocytes, which is secreted by the remaining macrophages and granulocytes of the ovary. IFN stimulates the major histocompatibility of granulocytes When granulosa cells express MHC II antigens, they may stimulate an autoimmune response, leading to follicular destruction and ovarian failure when all follicles in the ovary are destroyed. He suggests that the pathological changes in this ovary are lymphocyte and plasma cell infiltration in the developing and atretic follicles and in the luteal cysts. Monocytes infiltrate during follicular maturation and the infiltrating cells consist of the multicellular lineage plasma cells, B cells, T cells, macrophages, and NK cells. 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. The severity of the lesion is positively correlated with the titer of anti-ovarian antibodies.
(7) Idiopathic POF
Idiopathic POF is a chromosomally normal, hypergonadotropic, follicle-free POF without a history of mumps, lack of anti-ovarian antibodies, history of physicochemical damage or other metabolic processes, and may be due to a lack of primordial germ cells or to 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. In 52 cases of idiopathic POF, laparoscopic observation showed that 82.6% had bilateral ovarian atrophy or striated changes and 17.4% had unilateral or bilateral small or normal ovaries, and atrophy or striated ovaries may not have follicles.
(8) Ovarian insensitivity syndrome
InsensitiveOvarianSyndrome (IOS) or ovarian antagonistic syndrome (ROS) refers to primary amenorrhea or secondary amenorrhea before the age of 30 years in women with elevated endogenous gonadotropin levels and the presence of normal follicles in the ovaries It is characterized by elevated endogenous gonadotropin levels and the presence of normal follicles in the follicles, but a low response to high doses of exogenous gonadotropin. It is less common than POF and accounts for 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, with some follicles 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 gonadotropin receptor sites on 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, with a decrease in E2 secretion and an increase in endogenous gonadotropins. ROS is relative, not absolute, and some patients can regain ovarian function after treatment.
(9) 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, and the age of menopause is 1 to 2 years earlier in smoking women than in non-smoking people. Environmental pollution such as the use of large amounts of pesticides and cadmium, arsenic and mercury can damage ovarian tissue and cause POF. Receiving high doses or long periods of radiation due to work, illness or accidents can damage the ovaries and cause POF. studies have found that when the ovaries are exposed to direct radiation doses exceeding 8 Gy, irreversible damage to the ovaries will occur in almost all women of all ages. Strong mental stimuli, such as chronic anxiety, depression, sadness, anger, fear and other negative emotions, not only cause dysfunction of the hypothalamic-pituitary-ovarian axis, but can also directly affect ovarian function, which can lead to POF. Risk factors for premature ovarian failure include smoking, history of mumps, poor rest, tight underwear during adolescence, bad moods 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.
2. Types of premature ovarian failure
(1) Plasma ovarian premature failure: accounts for about 25% of premature ovarian failure, commonly seen in patients aged 30 to 40. It is unilateral. The appearance is gray-white, the surface is smooth, mostly unicompartmental, the cyst wall is thin, the cyst contains yellowish clear transparent liquid, some cases can be seen in the inner wall with papillary protrusions, clusters or diffuse scattered, called papillary plasma 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: it accounts for about 15-25% of premature ovarian failure and is 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. Mature ovarian premature failure: also known as cystic ovarian premature failure or skin-like cysts. It accounts for about 10-20% of premature ovarian failure. Most of them occur in the reproductive age.
3. Premature ovarian failure pathology
Premature ovarian failure pathology: microscopically, the surface of the ovary is covered with cuboidal epithelium and there is a thick layer of connective tissue underneath it. Symptoms of Premature Ovarian Failure
4. Symptoms of premature ovarian failure
(1) Primary amenorrhea in undeveloped gonads, delayed menarche or irregular menstruation and dysmenorrhea in underdeveloped gonads.
(2) Infertility secondary to gonadal development, with menstruation becoming sparse until amenorrhea after several years.
(3) In those with ovulation, typical POF has hot flashes, hypogonadism manifestations such as night sweats, constipation, hair loss, vaginal dryness, painful intercourse, decreased libido, hypothyroidism, urinary tract infections, weight gain, anxiety, paranoia, etc.
(4) Breast atrophy and sagging, loose and rough skin, tension, dreaminess, paranoia, palpitations, osteoporosis, joint pain, inflammation of reproductive organs, uterine prolapse, urinary incontinence, constipation, acne, pigmentation.
5.Diagnosis and differential diagnosis of premature ovarian failure
Diagnosis and differential diagnosis of premature ovarian failure: E2 <5g/L, FSH >13/L, LH >301u/L, normal PRL, T <5ng/dl can be distinguished from polycystic ovaries by pituitary excitation test, and the presence of autoimmune problems can be identified by ELIS method to determine antibodies.
6. Complications
For women who love beauty, premature ovarian failure is a serious disease. Premature ovarian failure not only affects the appearance, skin and body of women who love beauty, 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 women’s menstruation gradually decreases, especially when the menstrual cycle is substantially delayed or cannot come, women above the age of 30 should pay great attention to it.
7.Premature Ovarian Failure Treatment
(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. However, in a long-term low estrogen state, young women will experience 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. Ovulation-promoting drugs can also be added for those who are likely to regain ovarian function and expect to have children.
(2) Immunotherapy: Immunotherapy is feasible for those who are found to have antibody factors. Immunization vaccination has become a more reliable treatment.
(3) Surgical treatment: 1) for POF due to ovarian vascular factors leading to ovarian nutritional deficiency should be diagnosed and treated early, and vascular bypass surgery should be performed as soon as possible before ovarian function is lost, such as anastomosis between the ovarian artery and 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 already in the advanced stage of POF or have ovarian deficiency due to various reasons, ovarian transplantation has become very successful. At present, ovarian transplantation has become a very successful treatment, with the help of a small part of another person’s ovary to complete the female physiological function.
(4) Estrogen therapy: premature ovarian failure is mostly due to the lack of estrogen in the body, which can stimulate follicle development; indirectly, the level of estrogen blood concentration can promote or inhibit the release of gonadotropins, thus indirectly affecting ovarian function. At present, it is popular for women in Europe and the United States to use Zhiyuan Chaoshuan to supplement and regulate, and to achieve the effect of supplementing estrogen and nourishing the ovaries.
(5) Chinese medicine treatment with dialectical evidence.
8, premature ovarian failure affects the quality of life of women
When it comes to premature ovarian failure, this is one of the common diseases among women in recent years, especially white-collar ladies. 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.
9, premature ovarian failure prevention.
(1) physical recreation: adhere to exercise, enhance physical fitness, is the most important way to maintain the vitality of middle-aged women. 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 neurological symptoms are heavy, appropriate sedative, antispasmodic and sleeping drugs can be used, such as Valium (Dixieland), Mylicon, Glutathione, etc. Vitamin B6, vitamin E, vitamin A and vitamin B complex can also be added, and if necessary, the help of gynecologists and psychologists should be sought.
(2) Food regimen: Paying attention to dietary regimen and ensuring adequate intake of nutrients can help women obtain the necessary nutrients to maintain a healthy reproductive system function. 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, seaweed, nori, fish, etc. Also keep your diet light, not too greasy, too salty, too sweet. Eat regularly, eat on time and do not overeat. The most effective way to prevent premature failure of ovarian function and anti-aging is through food therapy, and here are a few recommended food products: soybeans 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 other substances, which have special physiological functions that can slow down aging, improve gastrointestinal function, lower blood pressure and lower blood pressure. 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. The distribution of isoflavones in nature is not only in soybeans, but also in plants such as Mexican small white beans, Thai wild kudzu root, alfalfa and mung beans.
10, premature ovarian failure treatment good contraindications are seven.
(1) ovarian premature failure women must avoid sedentary, sedentary posture directly affects the pelvic reproductive organs ovary uterus and other blood microcirculation, hindering the supply of nutrients to the ovary uterus tissue. Over time affect the normal function of the ovaries, thus aggravating the difficulty of premature ovarian failure and treatment of premature ovarian failure.
(2) women with premature ovarian failure must abstain from eating more stimulating foods, women with more pelvic inflammatory lesions, stimulating foods directly aggravate the inflammation, the ripple effect on ovarian uterine function, thus aggravating premature ovarian failure and the difficulty of treatment …….
(3) must learn to maintain a long-term mood, which is a discipline, women long-term emotional depression, directly affecting the breasts and ovaries, Chinese medicine, the liver meridian directly through the breasts and fallopian tubes ovaries, breasts 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 late-night work, long-term late-night direct depletion of female menstrual blood, dark depletion of female essence, damage to the kidney, affecting ovarian function, thus aggravating the condition.
(5) amenorrheic women are deficient, must avoid excessive intercourse, to be moderate intercourse, couples sex is a double-edged sword, frequent sex, direct damage to kidney essence, kidney yin, kidney Yang, etc., resulting in kidney failure, thus directly causing ovarian function decline, aggravating amenorrhea.
(6) Women should not indiscriminately supplement hormonal drugs or health products, improper hormone supplementation and poor health care can lead to over-stimulation of the ovaries, resulting in a large side effect, the result 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 steroid compounds with a wide range of biological activities. It not only has the physiological effect of promoting and maintaining female reproductive organs and secondary sexual characteristics, but also has 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 bi-directional 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” manner, and at the same time exert weak estrogenic effects, thus exhibiting an overall effect of lowering estrogen level in the body.
(7) Women in modern life are very fond of computer chatting or sitting in front of the computer all day to work, not knowing that long-term sitting computer work is a great radiation to the brain, the brain through the pituitary neuromodulation directly affect the reproductive-ovarian-uterine axis, affecting reproductive ovarian function, especially for amenorrheic women, can aggravate amenorrhea, must be drawn attention to.
11, prevention of premature ovarian failure
(1) Adjustment of the mentality: a peaceful attitude towards the problem of premature ovarian failure can be of great help in recovery. It is really hard to gauge the role of women’s self-confidence on their own health. The fact that the ovaries are prematurely failing does not necessarily mean that you cannot have children, although the treatment is relatively difficult, but after treatment can still be recovered. The biggest impact on the human body should be to cause infertility and also make women age faster.
(2) Diet: Prevention of premature ovarian failure should 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 supplements, of 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 be. 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, which can enhance confidence in life, a happy spirit, relieve psychological stress, and improve the body’s immune function.
(3) Improve contraceptive methods and reduce abortion: Some women mistakenly believe that “abortion” is a minor matter. In fact, the physical trauma can be repaired quickly, but the endocrine changes in the human body can not be recovered in a day or two. If repeated abortions, often disturbing the endocrine, will cause invisible damage in the body, gradually make the ovaries lose function, resulting in premature ovarian failure.
(4) Pay attention to menstruation: Premature ovarian failure has a precursor, and before the onset of the disease, there is mostly a change process of reduced menstruation – scanty menstruation – amenorrhea, so it is important to 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 are interconnected and affect each other, so women should learn to grasp a good state of mind and learn to detoxify bad emotions so as not to reduce the body’s resistance to disease, leading to premature ovarian failure. Premature ovarian failure leads to amenorrhea and infertility.
In recent years, more and more women are suffering from “premature ovarian failure”, and the trend is significantly younger. The ovaries are the main reproductive endocrine organs of women, located on both sides of the uterus, one on each side, and are normally about the size of a chestnut. It has two main functions, one is the reproductive function, that is, the generation of mature follicles and ovulation; the second is the secretion of hormones, mainly estrogen, but also secrete a small amount of androgen to maintain the unique female physical characteristics. The normal ovarian function of women starts to decline at the age of 45 to 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 disease 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% to 28%. Premature ovarian failure in women indicates a thin endometrium and low levels of estradiol (E2) and progesterone (P) in the blood. The principle of the menstrual regulatory axis (reproductive gonadal axis) suggests that the ovaries produce less estradiol and progesterone. There are three possible causes of premature ovarian failure: first, high levels of follicular estrogen (FSH) and luteinizing hormone (LH) in the blood, which feedback inhibit ovarian production of estradiol and progesterone, a condition known as premature ovarian failure, which begins with decreased 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 (T) in the blood. Elevated testosterone can neutralize estradiol in the blood, which reduces estradiol and affects follicle development and maturation and normal ovulation. At the same time, excess testosterone can prevent follicles and ovulation, and contribute 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.