What is Premature Ovarian Failure?
Premature ovarian failure is a condition in which menopause occurs before the age of 40 due to ovarian failure. It is characterized by primary or secondary amenorrhea, accompanied by elevated blood gonadotropin levels, decreased estrogen levels, and a range of low estrogen symptoms such as hot flashes and sweating, facial flushing, and low sex drive.
Premature ovarian failure is a syndrome with multiple etiologies, and in most cases the cause is unknown, while various etiologies can reduce the follicular reserve in the ovary or cause follicular dysfunction leading to the onset of premature ovarian failure. It is thought that the etiology of premature ovarian failure may cover genetic factors, immune factors, surgery/chemotherapy/radiotherapy/environmental toxins, and enzyme defects.
What are the clinical manifestations of premature ovarian failure?
Amenorrhea: There are primary amenorrhea and secondary amenorrhea, with secondary amenorrhea occurring before the age of 40. Some patients have sudden amenorrhea after regular menstruation, some patients have amenorrhea after stopping birth control pills or after childbirth, while some patients show disturbance of menstrual cycle and period before amenorrhea.
Infertility: Some patients present for infertility and are found to have premature ovarian failure.
Low estrogen symptoms: This is the most obvious group of symptoms that patients with premature ovarian failure experience, and is basically similar to the symptoms of perimenopausal syndrome. Patients may experience hot flashes and sweating, indifference to sexual desire, low volume of hypogonadism, heartburn, chest tightness, hair loss, insomnia, depression, palpitations, dizziness, headache, fatigue, irritability, dry stools, urinary urgency, urinary frequency and many other symptoms before and after menopause.
Autoimmune diseases: Patients with long-term premature ovarian failure or see Hashimoto’s thyroiditis, Addison’s disease, Crohn’s disease, insulin-dependent diabetes mellitus, chronic active hepatitis, glomerulonephritis, systemic lupus erythematosus, rheumatoid arthritis and many other diseases.
Hormone levels: Hormone levels in patients with premature ovarian failure are measured with FSH consistently above 40 IU/L, E2 often below 100 pmol/ L, and P below 2 nmol/L.
Gynecologic examination: changes of senile atrophic vaginitis such as vulvar atrophy, vaginal atrophy, pale/thinning mucosa, and punctate congestion and bleeding are seen.
Ultrasound examination: transvaginal or rectal ultrasound examination may reveal a shrinking uterus, thinning endometrium and shrinking ovarian measurements. About 40% of patients may have follicles present in the ovaries, but the diameter is below 10mm.
Laparoscopy: the ovaries are reduced in size, it is difficult to see the developing follicles and ovulation holes, there is no corpus luteum formation, and the uterus is reduced in size.
Diagnostic criteria for premature ovarian failure?
According to the definition of premature ovarian failure, the diagnosis of the disease is not difficult: (1) age <40 years; (2) amenorrhea ≥6 months; (3) fsh >40mIU/ml on two occasions (more than 1 month apart).
What is the prognosis of premature ovarian failure?
If not diagnosed in time and treated early with estrogen and progestin replacement therapy, premature ovarian failure will lead to the following long term effects.
Osteoporosis: both estrogen and progestin can inhibit bone resorption, prevent bone loss and prevent osteoporosis. After ovarian function declines, blood estrogen and progesterone levels decrease, bone loss is accelerated, and patients are prone to osteoporosis and even fractures.
Cardiovascular diseases: the incidence is higher than that of women of the same age. Studies have shown that differences in serum estrogen levels are the main factor causing a lower incidence of cardiovascular disease in premenopausal women than in men of the same age, and that estrogen supplementation can reduce the incidence of cardiovascular disease in postmenopausal women at all ages.
Alzheimer’s disease: The decline in estrogen levels in patients with premature ovarian failure may lead to earlier onset of Alzheimer’s disease.
When did the disease of premature ovarian failure come to people’s attention?
Compared to other diseases, premature ovarian failure is relatively new to the medical community, and research on the mechanisms and treatments for this disease is relatively recent. Objectively speaking, the current understanding of this disease is still in the research and exploration stage.
Before the 1960s, there was no definition of premature ovarian failure in modern medicine. However, this does not mean that the disease does not exist. It is logical to assume that, throughout the history of human diseases, premature ovarian failure has always existed in the female population, but the medical technology at that time was limited to treat this disease as amenorrhea and infertility.
In 1967, Moraes-Ruehsen and Jones first proposed the definition of premature ovarian failure as a non-physiological cessation of menstruation in women occurring after puberty and before the age of 40, accompanied by hot flashes, primary or secondary infertility, and general and reproductive organ atrophy.
In 1994, the World Health Organization proposed an ideal definition of early menopause, i.e., the onset of menopause at an age less than 2 standard deviations from the mean age of menopause estimated from a reference population, and referred to menopause before age 40 as early menopause.
Today, with the increasing prevalence of premature ovarian failure in modern society, premature ovarian failure has become a difficult disease that seriously disturbs the physical and mental health of affected women, and medical research and studies on this disease have been active year by year. This phenomenon may be related to the rapid improvement of human material living standards and health levels, the rapid development of human health care technology, and the rapid changes in the living environment and pace of life faced by human beings in the last half century, while modern research results show that the occurrence of premature ovarian failure is intrinsically linked to these modern factors.
What is the understanding of premature ovarian failure in ancient Chinese medical literature?
The same is true for the understanding of premature ovarian failure in traditional medicine.
A review of the ancient Chinese medical literature shows that there is no name for premature ovarian failure in Chinese medicine to date. However, the symptoms and treatment of the disease have been discussed in the literature for a long time. From the point of view of pathogenesis, modern premature ovarian failure is consistent with the ancient descriptions of “first closure of menstrual water” and “early breakage of menstrual water”, and should be classified as amenorrhea, blood depletion, blood isolation, symptoms before and after menstrual breakage, and infertility.
In the Spring and Autumn Period and the Warring States period, the “Women’s lack of menstruation” and “absence of menstruation” in the “Su Wen – Yin and Yang Particular Discourse” are the earliest descriptions of amenorrhea.
Jin, “The Secret Collection of the Orchid Room, Women’s Gate, Menorrhagia, and Failure of Menstruation,” says: “Women with long-standing deficiency of the spleen and stomach, or the shape of the wonky both extinct, for heat scintillation, muscle wasting, sometimes thirsty and dry, the sea of blood is depleted, the disease is called blood withering menstruation extinction;
Ming Fu Qingzheng has “the year before the old menstrual water broken” said, his book “Fu Qingzheng female science” said: “the scriptures: the woman seven seven and the days of the sperm extinct. There are those who have not yet reached seventy-seven years and the menstrual water is broken first”;
Ming – “Jing Yue Quan Shu” said: “is because of the exhaustion of Yin, so the blood withered, withered as the meaning, no blood and natural, so or to weakness, or to sleepy, or to cough, or to night fever, or to food and drink to reduce, or to the loss of blood, and all without swelling and pain, no obstruction and no partition, and the menstruation has a long time does not come, that is, is not the blood withered menstruation of the closed;
Qing Shen also Peng has “years before not confused and first extinct”, his book “Shen’s Women’s Section Series Paper” said: “two seven menstrual line, seven seven menstrual stop, said its normal, but the endowment is not uniform, the line is not a certain wait, soft, years before not confused and first extinct, the strong, years after the big and still line, this varies with their physique varies according to the physique of the person.”
And so on. The above descriptions of ancient texts either point to pathological phenomena similar to modern premature ovarian failure or elaborate on the pathogenesis of diseases similar to premature ovarian failure, all of which can be interpreted as vague concepts of premature ovarian failure in ancient traditional medicine.