How old are your ovaries?

This is the 4726th article of Da Yi Xiao Hu

I believe everyone is familiar with ovaries. We women have a pair of ovaries, located on both sides of the uterus deep in the pelvic cavity below the abdomen, and are usually difficult to touch.

Someone asked: Shouldn’t the age of the ovaries be the same as your own age?

In fact, it is not so. We all know a person's physiological age very well, that is, "how old is he". In daily life, we have all heard similar descriptions, "So-and-so is in his 40s, smokes and drinks, and doesn't exercise. After examination, his heart is like that of a 60-year-old..." Or "So-and-so is in his 70s, but his thinking is flexible and his brain is like that of a 30-year-old young man..." Since organs such as the heart and brain have their own "age", the ovaries certainly have their own "age"! Usually, as age increases, the function of the ovaries declines. But age does not represent the true state of ovarian function. Some women in their twenties who look as beautiful as flowers actually have ovaries that are nearly half a century old. This is premature ovarian failure.

The ovaries have two main functions. One is the reproductive function of producing eggs and ovulating. In normal women of childbearing age, one follicle will mature and ovulate in each menstrual cycle, which is one of the basic prerequisites for female conception; the second is the endocrine function of synthesizing and secreting sex hormones to maintain female endocrine balance. When a woman is born, there are about one million primordial follicles in her ovaries, which decrease to more than 300,000 by puberty, and there will be no "replenishment" in her life; after a woman reaches sexual maturity, a batch of follicles will be consumed in each menstrual cycle, that is, the reserves are getting fewer and fewer. When the available follicles are exhausted, the woman enters menopause. So in simple terms, the number of available follicles stored in the ovaries determines the age of the ovaries, so the age of the ovaries is the reserve function of the ovaries.

How old are my ovaries?

The age of the ovaries can be estimated from the following aspects:

Biological age

That is, the actual age. The number of eggs in the ovaries decreases every month, and age is the simplest and most intuitive indicator for evaluating ovarian reserve function. With age, the number of follicles gradually decreases, and the ovarian reserve function gradually declines. Especially after the age of 35, women's ovarian function begins to decline. Of course, some people's ovaries "age" faster and some slower, but for most people, the aging of the ovaries is roughly in line with the increase in age, and physiological age largely determines the age of the ovaries.

Antral follicle count (AFC)

That is, count the "inventory" (number) of antral follicles in both ovaries under gynecological ultrasound. In each cycle, a group of primordial follicles in the ovarian "warehouse" will be recruited and develop into antral follicles, of which only one can eventually mature and ovulate. The number of antral follicles is one of the best indicators for predicting ovarian reserve function. The inspection time should be paid attention to, which is on the 2nd to 4th day of menstruation. Generally, the number of basal follicles on one side is no more than 10. The more the number, the better the ovarian reserve function. If the number of antral follicles on both sides is less than 5-7, it indicates that the ovarian reserve is decreased.

Serum anti-Mullerian hormone (AMH)

When evaluating ovarian reserve function, AMH is sensitive and relatively stable and is not affected by the menstrual cycle, which means that it can be checked at any time during the menstrual cycle. When serum AMH is ≤1.1ng/mL, it indicates that the ovarian reserve function is reduced. When serum AMH is <0.5ng/mL, it indicates that the ovarian reserve function is significantly reduced, which may lead to infertility.

Basal follicle stimulating hormone (bFSH)

Fasting blood test on the morning of the 2nd to 4th day of menstruation. bFSH ≤ 10 IU/L indicates normal ovarian function, bFSH between 10-15 IU/L indicates decreased ovarian reserve function; bFSH> 25 IU/L indicates premature ovarian insufficiency; bFSH> 40 IU/L indicates that the ovaries are about to "retire".

Basal estrogen (bE2)

Fasting blood draw on the morning of the 2nd to 4th day of menstruation, when bE2>80pg/ml, regardless of age and bFSH, indicates that the follicles are developing too fast and the reserve function is reduced. So the higher the estrogen level, the better!

What signs indicate the need to measure ovarian age?

Menstrual cycle changes

Early menstrual cycle and decreased menstrual volume: Normal women have a relatively fixed menstrual cycle, most of which are about 28 days on average. If the menstrual cycle becomes shorter and shorter, for example, from 28 days to 23-24 days, and lasts for more than 3 cycles in a row, then you should be alert, especially when accompanied by a decrease in menstrual volume, which may indicate a decrease in ovarian function.

Irregular or delayed menstruation, or even amenorrhea: If the regular menstrual cycle becomes irregular, or frequent, or infrequent, lacks regularity, or even amenorrhea occurs, or irregular vaginal bleeding occurs repeatedly, excluding organic lesions, it may indicate ovarian hypofunction.

In addition, you should also be vigilant if you experience symptoms such as hot flashes, night sweats, poor sleep, fatigue, irritability, vaginal dryness, and low libido!

Author: Shanghai First Maternity and Infant Health Care Hospital

Wu Shengnan Attending Physician