A 42-year-old woman with a cliff-like aging was diagnosed with premature ovarian failure? Will menopausal women age rapidly?

Author: Doctor Flying Knife Cutting Rain

Reviewer: Lan Yibing, deputy chief physician, Department of Obstetrics and Gynecology, Zhejiang University School of Medicine

gossip

Recently, a 42-year-old woman in Shandong said that she had experienced "cliff-like aging" and posted before-and-after photos. Later, some media reported that the woman was diagnosed with "premature ovarian failure."

Whether it is the concept of "cliff-like aging" or the photo of this woman with obvious changes before and after, it is enough to cause a lot of shock. In fact, many people originally believed that women in menopause will age rapidly. Now there is such a significant "case", which has aroused the long-buried health anxiety in the heart. So, is it really true that "women in menopause will age rapidly" as rumored on the Internet?

analyze

This topic is a long one, so it is worth discussing in detail. If you are also worried about "precipitous aging after premature ovarian failure" or your health after menopause, please see if this article can help you solve your doubts!

Function of the ovaries

The ovaries have two main functions: ovulation and hormone secretion. A healthy woman's ovaries develop 3 to 11 follicles every month, and the best-developed follicle (also called the dominant follicle) eventually releases an egg, while the other follicles degenerate on their own. At the same time, the ovaries also secrete sex hormones (including estrogen, progesterone, and some androgens) and some polypeptide hormones, cytokines, growth factors, etc. These hormones are responsible for or assist in regulating physiological activities such as follicle development, menstruation, water and sodium excretion, and bone matrix metabolism.

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Menopause and premature ovarian failure

As age increases, the number of oocytes gradually decreases, and their quality also gradually deteriorates[1]. When the ovaries can no longer ovulate and secrete sex hormones normally, menstruation gradually decreases, becomes irregular, and eventually stops completely. This process is called menopause.

Menopause means that the ovaries are completely "retired" and their two major functions also stop working: no more periodic ovulation and no longer regular hormone secretion. Therefore, postmenopausal women are generally unable to conceive naturally and may also have some health problems due to lack of estrogen, which requires doctors to treat according to the specific situation.

The average age of menopause for Chinese women is 49.5 years old, and 80% of women go through menopause between the ages of 44 and 54 [2]. Medically, menopause before the age of 40 is called premature ovarian failure (because it cannot accurately summarize the characteristics of the disease, the official name has now been changed to "primary ovarian insufficiency"), while menopause before the age of 45 is called early menopause.

The woman in the news was 42 years old. Although she had menopause earlier than most people, it was early menopause at best and could not be diagnosed as premature ovarian failure. In this case, if there are menopausal-related discomfort symptoms, symptomatic treatment should be given, but it is inappropriate to diagnose "premature ovarian failure".

Why do ovaries fail prematurely?

The specific cause of most cases of premature ovarian failure is still unclear[3]. Current research has found that genetic factors are one of the important causes[4]. In other words, many people with premature ovarian failure actually have "congenital ovarian deficiency."

Some autoimmune diseases, which are diseases caused by the immune system attacking itself without distinguishing friend from foe, such as Hashimoto’s thyroiditis, autoimmune adrenalitis, autoimmune polyglandular syndrome, etc., are also closely related to premature ovarian failure[5].

In addition, some external ovarian toxic factors, such as radiotherapy and chemotherapy, certain drugs, environmental toxins, and infection with certain viruses, can also directly or indirectly lead to the occurrence of premature ovarian failure.

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What are the consequences of premature ovarian failure?

Premature ovarian failure means that the ovulation and hormone secretion functions of the ovaries have problems too early, so the consequences of premature ovarian failure can be divided into two aspects: one is the impact of abnormal ovulation on fertility, and the other is the impact of estrogen deficiency on physical health.

Patients with premature ovarian failure face the problem of premature follicle exhaustion and are unable to ovulate normally. If the patient still has plans to have children, even with the help of assisted reproductive technology, it is often difficult to successfully conceive. If the follicles are exhausted, the only way to have a baby is to accept egg donation or adoption. However, premature ovarian failure cannot be completely regarded as premature menopause. The ovaries of many patients with premature ovarian failure can still intermittently ovulate and secrete estrogen. A few patients can also intermittently restore regular menstruation. About 5%-10% of patients can conceive and have a normal pregnancy[6].

Estrogen deficiency can lead to a series of health problems. Due to the decline in estrogen levels, patients will experience "menopausal" symptoms such as hot flashes, night sweats, depression, and sleep problems in the early stages of the disease, just like other normal menopausal women.

Estrogen plays an important role in maintaining the health of the urogenital system. Without the support of estrogen, the uterus will shrink, the vagina will narrow, and secretions will decrease. Many people will experience dryness and pain in the vulva and vagina, and have persistent and obvious discomfort. Estrogen also plays an important auxiliary role in maintaining vaginal flora and establishing vaginal self-defense mechanisms. Women who lack estrogen for a long time have reduced vaginal defense capabilities and are more susceptible to vaginal inflammation. At the same time, the urinary system next door will also be affected, resulting in urination discomfort, repeated urinary tract infections, etc. Under the combined influence of estrogen deficiency and other symptoms, sexual desire and quality of sex life will also be affected.

In addition to the health of the urogenital system, estrogen also plays an important protective role in maintaining bone mass and cardiovascular health. Women who have long-term estrogen deficiency, including patients with premature ovarian failure and normal postmenopausal women, need to pay attention to osteoporosis and the risk of cardiovascular complications [7,8].

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However, although estrogen deficiency has so many harmful effects, it is not difficult to solve. In clinical practice, for patients with premature ovarian failure who do not have contraindications, estrogen and progesterone preparations with structures similar to natural hormones are generally used to mimic normal ovarian function and are administered until the age of 50 to 51, which is the expected normal menopausal age.[9] Of course, if there are no contraindications, the medication period can be extended or even lifelong. In this way, all health problems related to estrogen deficiency can be solved or improved.

Will menopause lead to “cliff-like aging”?

After reading this article, I believe you already have the answer to this question.

There are various hormones in the human body that are involved in various physiological functions. The hormones secreted by the ovaries are only responsible for part of the work and are not the ones that take care of everything.

When the ovaries "retire", only the parts they are originally responsible for will be affected. As mentioned above, fertility will decline or disappear, and the health of the urogenital system, cardiovascular system and bones will be affected due to long-term estrogen deficiency. Other tissues and organs that are not closely related to ovarian hormones will still function normally according to their own aging rhythm.

Therefore, even those young women who have to have their ovaries removed due to illness will not age overnight after the operation. As long as they receive standardized hormone replacement therapy, their health conditions are no different from those of other women who go through menopause at a normal age.

As for the ovaries themselves, "premature aging" or "aging" is also a gradual process. Unless there are significant ovarian toxic factors, such as certain drugs, surgery, radiotherapy and chemotherapy, the ovaries generally will not fail rapidly in a short period of time.

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So, what do you think about the woman in the news who experienced rapid "cliff-like aging" in 20 days?

Our estrogen levels fluctuate during each menstrual cycle (see figure). The estrogen levels are at their lowest before and during each menstrual cycle. Estrogen levels can also drop precipitously after childbirth and during lactation. Some breastfeeding mothers may even experience atrophic vaginitis and other menopausal-like symptoms due to low estrogen levels. Therefore, even without discussing medical theories, based on common sense, you can feel that estrogen changes will not have such a significant impact on your appearance.

(Image source: Reference [2])

In fact, skin aging means a decrease in collagen and elastic fibers and a loss of skin moisture. This process generally requires a long period of accumulation, such as photoaging, the influence of gravity, muscle squeezing, and natural aging caused by aging.

If you suddenly become very haggard in a short period of time, it is more likely due to internal factors such as fatigue and mental trauma. In addition, when the climate is dry, excessive cleaning, and insufficient moisturizing, the skin is also prone to dry lines or pseudo-lines due to dryness, which is not real sudden aging. After a good rest, adjusting your mood, and moisturizing well, the skin can return to its previous state.

in conclusion

Aging is a normal physiological phenomenon. It is also normal for women to show signs of aging after menopause. However, it is a bit exaggerated to say that women will experience "cliff-like" aging when they enter menopause.

Menopause is an important node in every woman's life. Physiological changes and changes in mood will have a real impact on life. No matter how much and how thoroughly you explain the truth, it is still inevitable to have a huge impact when you really face it. If menopause comes early, it will greatly increase women's health anxiety, so it is necessary to seek help from a doctor in time. I hope this article can help female friends who are or will soon face menopause to relieve their anxiety. I also hope that female elders know that the discomfort symptoms after menopause are actually very common, and many of them have solutions. Don't be ashamed to speak up, and don't endure it alone.

References:

[1]KleinNA,BattagliaDE,MillerPB,BraniganEF,GiudiceLC,SoulesMR.Ovarianfolliculardevelopmentandthefollicularfluidhormonesand growthfactorsinnormalwomenofadvancedreproductiveage.JClinEndocrinolMetab.1996;81(5):1946-1951.doi:10.1210/jcem.81.5.8626862

[2] Xie Xing, Kong Beihua, Duan Tao (eds.); Lin Zhongqiu, Di Wen, Martin, Cao Yunxia, ​​Qi Hongbo (co-eds.). Obstetrics and Gynecology, 9th edition [M]. Beijing: People's Medical Publishing House, 2018

[3]NelsonLM.Clinicalpractice.Primaryovarianinsufficiency.NEnglJMed.2009;360(6):606-614.doi:10.1056/NEJMcp0808697

[4]RossettiR,FerrariI,BonomiM,PersaniL.Geneticsofprimaryovarianinsufficiency.ClinGenet.2017;91(2):183-198.doi:10.1111/cge.12921

[5]SzeligaA,Calik-KsepkaA,Maciejewska-JeskeM,etal.AutoimmuneDiseasesinPatientswithPrematureOvarianInsuff iciency-OurCurrentStateofKnowledge.IntJMolSci.2021;22(5):2594.Published2021Mar5.doi:10.3390/ijms22052594

[6]vanKasterenYM,SchoemakerJ.Prematureovarianfailure:asystematicreviewontherapeuticinterventionstorestoreovarianfunctionandachievepregnancy.HumReprodUpdate.1999;5(5):483-492.doi:10.1093/humupd/5.5.483

[7]IkiM,MoritaA,IkedaY,etal.Biochemicalmarkersofboneturnoverpredictbonelossinperimenopausalwomenbutnotinpostmenopausalwome n-theJapanesePopulation-basedOsteoporosis(JPOS)CohortStudy.OsteoporosInt.2006;17(7):1086-1095.doi:10.1007/s00198-005-0052-3

[8]DerbyCA,CrawfordSL,PasternakRC,SowersM,SternfeldB,MatthewsKA.Lipidchangesduringthemenopausetransitioninrelatio ntoageandweight:theStudyofWomen'sHealthAcrosstheNation.AmJEpidemiol.2009;169(11):1352-1361.doi:10.1093/aje/kwp043

[9]Committeeopinionno.605:primaryovarianinsufficiencyinadolescentsandyoungwomen.ObstetGynecol.2014;124(1):193-197.doi:10.1097/01.AOG.0000451757.51964.98

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