Aged more than 30 years in 20 days, can premature ovarian failure really lead to "cliff-like aging"?

Recently, the topic of "42-year-old woman experienced 20 days of 'cliff-like aging' and was diagnosed with premature ovarian failure" has aroused widespread attention and discussion.

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Regardless of whether the diagnosis in this news is true or not, as the news has attracted more and more attention, more and more netizens have raised questions: Can premature ovarian failure really cause cliff-like aging? Can premature ovarian failure really cause obvious skin aging? Let's talk about it in detail today.

What is premature ovarian failure?

Menopause is the natural cessation of menstruation, when the ovaries no longer release eggs and stop producing estrogen and progesterone, or earlier in some women.

The age of menopause in women is affected by many factors, including genetics, ethnicity, smoking, and reproductive history. Most women go into menopause between the ages of 48 and 50, with the median age of natural menopause in the United States being 51.4 years old and in China being 48.5 years old. However, not everyone fits into this time period, and a slight advance or delay is not necessarily a problem.

If menopause occurs between the ages of 40 and 45, we call it "early menopause." If ovarian failure occurs before the age of 40 due to natural exhaustion of ovarian follicles or iatrogenic damage, we will consider the diagnosis as "premature ovarian failure."

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Previous studies have shown that the incidence of premature ovarian failure is about 1/250 before the age of 35, and about 1/100 before the age of 40[1]. In recent years, the incidence of premature ovarian failure has been increasing year by year, which may be related to multiple factors such as environmental changes, irregular work and rest, unhealthy diet, reduced exercise, and increased stress.

Premature ovarian failure may cause many problems for women's bodies, including infrequent menstruation, amenorrhea, hot flashes caused by estrogen deficiency, vaginal dryness, osteoporosis, increased cardiovascular disease, dementia and decreased cognitive function, increased mental illness, and other negative effects.

Does premature ovarian failure really lead to cliff-like aging?

The woman in the news experienced "20-day cliff-like aging". We should not jump to conclusions and cannot simply attribute it to "premature ovarian failure".

First, estrogen deficiency does reduce the collagen content in the skin and bones, and reduced skin collagen may cause skin aging and aggravate wrinkles. However, this change is often not a straight-line drop, but a gradual change.

One study found that there was no significant difference in skin changes (wrinkles and skin stiffness) between women in the estrogen supplement group and those in the placebo control group [2], suggesting that the rapid skin aging process may not be entirely related to this.

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Secondly, the typical clinical manifestations of premature ovarian failure do not include the symptom of skin aging. It is more related to hot flashes, vaginal dryness, osteoporosis and other problems caused by reduced estrogen levels. We have seen many patients with premature ovarian failure and have not found similar rapid aging phenomena.

From the perspective of the mechanism of skin aging, aging may lead to skin atrophy, reduced elasticity, impaired metabolism and repair response, and the amount of dermal collagen may decrease by 75% with age. After the age of 40, the biosynthesis of elastin decreases significantly and the elastic fiber network degenerates. The loss of hydration in the dermis and the reduction of skin elasticity will lead to skin deterioration, loss of subcutaneous fat, and the formation of skin wrinkles and sagging.

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However, estrogen is not directly involved in this process, so it is unlikely that "premature ovarian failure" will directly progress to "cliff-like aging." It is speculated that she may have caused and accelerated skin aging due to some stressful events, anxiety, difficulty sleeping, unhealthy diet, environmental factors, etc.

Moreover, she is already 42 years old. Theoretically, she cannot be diagnosed with premature ovarian failure. At most, it can only be considered as early menopause (if confirmed).

What are the signs of premature ovarian failure?

The first symptom for most women is missing menstruation or a marked decrease in menstrual flow. Other symptoms include:

a. Hot flashes: Feeling as if there is a wave of heat in the chest and face and spreading throughout the body;

b. Excessive sweating at night;

c. Sleep disorders;

d. Mood changes, irritability;

e. Vaginal dryness and pain during sexual intercourse.

If a woman is younger than 40 years and has irregular menstruation for at least three months, she should see a doctor.[3]

How to prevent premature ovarian failure?

Premature ovarian failure is not easy to prevent, mainly because the cause is unknown in 75% to 90% of cases [4]. However, a number of possible causes of premature ovarian failure have been identified, including genetic factors, autoimmune diseases, and ovarian toxins (chemotherapy and radiotherapy, as well as certain viruses such as mumps), which can lead to accelerated follicle depletion.

If premature ovarian failure is diagnosed, we certainly can’t just ignore it. Many people find it hard to accept at first – the most common words used by patients to describe their emotional state in the first few hours after receiving the diagnosis are “devastated”, “shocked” and “confused”.

A diagnosis of premature ovarian failure may lead to related depression and anxiety disorders in patients [5], so the most important initial treatment step for doctors is to inform patients of the diagnosis in a more emotional and caring manner, provide accurate information, give adequate psychological comfort, and arrange follow-up treatment.

Premature ovarian failure is indeed irreversible. Unless there are absolute contraindications, all patients with premature ovarian failure should receive hormone replacement therapy to improve the negative feedback caused by reduced estrogen levels and reduce the risk of osteoporosis and cardiovascular disease. We recommend that women with premature menopause use hormones until at least 50 years old.

To protect the ovaries, we can prevent from the following 4 aspects:

1. Improve bad living habits, environmental factors and mental factors to avoid affecting gonadal output and causing menstrual disorders, and reduce the impact on ovarian function. Pay attention to a balanced and diversified diet.

2. Reduce stress in work and life, and relax your mood. Abnormal fluctuations in emotions will inevitably interfere with the normal functioning of the central nervous system, thereby affecting the regulation of ovarian function that determines menstrual changes and causing menstrual disorders.

3. Do not abuse drugs, do not smoke, and do not lose weight blindly. Avoid adverse external factors that increase the accumulation of ovarian toxins.

4. Do appropriate exercise, such as swimming, jogging, brisk walking, aerobics, etc., because exercise can enhance physical fitness, maintain body shape, and relieve mental stress.

References

[1] CoulamCB,AdamsonSC,AnnegersJF.Incidenceofprematureovarianfailure.ObstetGynecol.1986Apr;67(4):604-6.PMID:3960433.

[2]OwenCM,PalL,MumfordSL,FreemanR,IsaacB,McDonaldL,SantoroN,TaylorHS,WolffEF.Effectsofhormonesonskinwrinklesandrigidityvarybyrace/ethnicity:four-yearfollow-upfromth eancillaryskinstudyoftheKronosEarlyEstrogenPreventionStudy.FertilSteril.2016Oct;106(5):1170-1175.e3.doi:10.1016/j.fertnstert.2016.06.023.Epub2016Jul5.PMID:27393520.

[3]Uptodate, Topic15606Version9.0: "Patienteducation:Primaryovarianinsufficiency(TheBasics)"

[4]NelsonLM.Clinicalpractice.Primaryovarianinsufficiency.NEnglJMed.2009Feb5;360(6):606-14.doi:10.1056/NEJMcp0808697.PMID:19196677;PMCID:PMC2762081.

[5]GroffAA,CovingtonSN,HalversonLR,FitzgeraldOR,VanderhoofV,CalisK,NelsonLM.Assessingtheemotionalneedsofwomenwithspon taneousprematureovarianfailure.FertilSteril.2005Jun;83(6):1734-41.doi:10.1016/j.fertnstert.2004.11.067.PMID:15950644.

This article is a work of Science Popularization China-Starry Sky Project

Produced by: Science Popularization Department of China Association for Science and Technology

Producer｜China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.

Author: Weng Ruopeng, attending physician, Zhejiang University Affiliated Obstetrics and Gynecology Hospital

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