Woman aged 30 years in 20 days! The culprit of "cliff-like aging" turned out to be premature ovarian failure!

Recently, a 42-year-old woman in Shandong posted a video saying that she had experienced "cliff-like aging" in 20 days and "looked like she was in her 70s", which attracted the attention of netizens. The woman said that she didn't dare to look in the mirror recently and couldn't accept the current situation. She had a full-body examination in the hospital. In the end, the doctor diagnosed her with premature ovarian failure, which was irreversible!

We have all heard of "aging overnight" and "whitening hair overnight", and most of us think it is exaggerated. However, relevant research shows that aging does not occur at a uniform rate, and "cliff-like aging" does exist. Although you will not age overnight, you may age rapidly in a short period of time. Both traditional Chinese medicine and Western medicine have such theories or discoveries.

The "premature ovarian failure" that the client was diagnosed with was one of the main reasons for her "cliff-like aging".

Premature ovarian failure - the "Achilles' heel" of women

Premature ovarian failure refers to the occurrence of amenorrhea for ≥4-6 months before the age of 40 in women, with two follicle-stimulating hormone (FSH) levels >40 U/L more than 4 weeks apart, accompanied by decreased estrogen and menopausal symptoms. It is the terminal stage of premature ovarian insufficiency. The global incidence rate is about 3.7%, and the domestic reported incidence rate is 1%-3.8%. The current incidence rate of premature ovarian failure is gradually increasing, and it is showing a trend of younger age.

1. Aging is a major manifestation of premature ovarian failure

(1) Menstrual changes

Amenorrhea, shortened or irregular menstrual cycles, reduced menstrual flow, and oligomenorrhea may occur. It may take several years for ovarian reserve function to decline and fail, and the clinical heterogeneity is high. A small number of patients may experience sudden cessation of menstruation without warning.

(2) Reduced fertility or infertility

In the early stage of ovarian reserve decline, there is still a 5% to 10% chance of natural pregnancy due to occasional ovulation, but the risk of miscarriage and fetal chromosomal abnormalities is significantly increased. Even if assisted reproductive technology is used for fertility treatment, the number of eggs obtained is small, the cycle cancellation rate is high, and the clinical pregnancy rate is low.

(3) Symptoms of decreased estrogen levels

Symptoms of low estrogen include hot flashes, heavy sweating at night, insomnia, memory loss, decreased libido, etc. Gynecological examinations can reveal breast atrophy (breast sagging and atrophy) and vulvar and vaginal atrophy. Hair loss and pigmentation can also be seen, and may be accompanied by osteoporosis, resulting in rapid aging of the face.

2. Causes of ovarian aging

Ovarian aging is a complex biological process that is influenced by multiple factors and gradually accumulates.

Age factor: Age is one of the main factors affecting ovarian reserve/function, but age-related ovarian damage is only a concomitant phenomenon, not the root cause of ovarian aging.

Genetic factors: Current results reveal about 20% of the genetic causes of the disease.

Environmental factors: pesticides, heavy metals, mobile phone electromagnetic radiation and noise, etc.

Social and psychological factors: stress states such as anxiety, depression, occupational burnout, malnutrition, and long-term fatigue.

Behavioral factors: smoking, drinking, staying up late, lack of exercise, unreasonable diet, etc.

Iatrogenic factors: injuries caused by surgery and radiotherapy and chemotherapy.

Other factors include infectious factors and immune factors . Premature ovarian failure is irreversible and can only be detected and prevented in advance.

If the age is less than 40 years old, but the ovarian function has begun to decline, it may be clinically classified as "premature ovarian insufficiency". At this time, if it is not discovered in time or simply left alone, it may develop into premature ovarian failure.

Premature ovarian failure is irreversible, and only early detection can lead to early control. Currently, there is no way to restore the "aging" ovaries to youth. We can only detect the signs of premature ovarian failure as early as possible, improve the symptoms through active treatment, and maintain it until menopause.

Moreover, premature ovarian failure is equal to "aging prematurely", and this "early menopause" is extremely harmful to women. Normal women's menopause age is basically around 50 years old, but if they have premature menopause, for example, they start to age prematurely at the age of 35, they will "endure" the "package" of perimenopausal syndrome for 15 years in advance.

1.What are the diagnostic criteria for premature ovarian failure?

The definition of premature ovarian failure varies in each guideline. The currently recognized diagnostic criteria for premature ovarian failure are: ① Age < 40 years old; ② Amenorrhea duration ≥ 6 months; ③ Two blood FSH levels (more than 1 month apart) > 40 U/L.

The woman mentioned above is 42 years old, which is over 40 years old. Although she does not meet the strict diagnosis requirements for premature ovarian failure, she does have rapid facial aging caused by ovarian dysfunction.

2. Treatment methods recommended by the Guidelines for the Diagnosis and Treatment of Premature Ovarian Insufficiency with Integrated Traditional Chinese and Western Medicine

(1) Traditional Chinese Medicine Treatment

① 100% consensus solution: nourishing the liver and kidneys, nourishing blood and regulating menstruation

Recommended prescription: Zuogui Pills (Jingyue Complete Book) (Level B evidence, strong recommendation).

Ingredients of the prescription: Rehmannia root, yam, cornus officinalis, dodder seed, antler glue, wolfberry, and Cyathula.

Recommended Chinese patent medicine: Kunbao Pills (Level III evidence, strong recommendation).

② 87.5% consensus: tonifying the kidney and improving essence

Recommended prescription: Erxian Decoction combined with Erzhi Pills plus Polygonum multiflorum, Dragon Bone, and Oyster (Level III evidence, strong recommendation).

Ingredients of the prescription: Curculigo, Epimedium, Angelica, Morinda officinalis, Phellodendron chinense, Anemarrhena asphodeloides, Eclipta prostrata, Ligustrum lucidum, Polygonum multiflorum, Dragon bone, and Oyster.

Recommended Chinese patent medicine: Qilin Pills (Level B evidence, strong recommendation).

③ Consensus rate 85.71% plan: warming the kidney and supporting yang, nourishing blood and regulating menstruation

Recommended prescription: Yougui Pills (Jingyue Complete Book) (Level B evidence, strong recommendation).

Ingredients of the prescription: Rehmannia root, aconite root, cinnamon bark, yam, cornus officinalis (made with wine), dodder seed, antler glue, wolfberry, angelica root, and Eucommia ulmoides (fried with salt).

Recommended Chinese patent medicine: Yougui Pills (Level III evidence, strong recommendation).

④ Consensus rate 85.71% plan: nourishing yin and blood, connecting the heart and kidneys

Recommended prescription: Tianwang Buxin Dan (Secret Anatomy of Shesheng) (Level III evidence, strong recommendation).

Ingredients of the prescription: ginseng, Scrophularia, Angelica, Asparagus, Ophiopogon, Salvia, Poria, Schisandra, Polygala, Platycodon, Ziziphus jujuba seed, Rehmannia root, cinnabar, and Platycladus seed.

Recommended Chinese patent medicines: Tianwang Buxin Pills (Level III evidence, strong recommendation), Kuntai Capsules (Level B evidence, weak recommendation).

(2) Western medicine hormone replacement therapy (HRT)

Western medicine treatment is also level III evidence, strongly recommended, and the consensus rate has reached 100%. Those who want to have children should use natural estrogen and progesterone supplementation therapy. The following plan is recommended.

①Continuous Sequential

Use Fentaton for sequential treatment, 1 tablet per day, and start the next box directly after finishing the first box without stopping the medication.

② Cycle Sequential

Sequential treatment with Clemen was performed, 1 tablet per day. After finishing 1 box, the drug was stopped for 7 days and the next box was started.

③Continuous combination

Tibolone (2.5 mg) can be used once a day. Local vaginal estrogen is used to improve symptoms of urogenital atrophy. Vaginal medication, once a day, after 2 weeks of continuous use, symptoms are relieved, change to 2 to 3 times a week. Long-term single use should regularly monitor the endometrium.

3. Long-term management of premature ovarian failure

(1) Adjust lifestyle (Level III evidence, strong recommendation)

Eat a balanced diet, get enough vitamin D and calcium, do weight-bearing exercises, maintain an appropriate amount of body fat, quit smoking, and avoid exposure to reproductive toxic substances.

(2) Psychological intervention (Level III evidence, strong recommendation)

It is very important for the family to provide psychological support and the patients to do self-psychological counseling to improve the disease. They should relax and relieve psychological pressure.

(3) Long-term health and complication management

Bone health (Level III evidence, strong recommendation): Bone density examination is recommended. If diagnosed with osteoporosis, estrogen therapy should be actively supplemented, and other osteoporosis treatment drugs should be added if necessary to prevent bone loss.

Cardiovascular health (Level III evidence, strong recommendation): Reduce the adverse effects of risk factors through a healthy lifestyle. It is recommended to start HRT treatment as early as possible and continue to use it until the average age of natural menopause.

References

[1] Obstetrics and Gynecology Committee of the Chinese Association of Integrated Traditional Chinese and Western Medicine, Feng Xiaoling, Li Li, et al. Guidelines for the diagnosis and treatment of premature ovarian insufficiency with integrated traditional Chinese and Western medicine [J]. Journal of Traditional Chinese Medicine, 2022, 63(12): 1193-1198.

[2] Expert consensus group on clinical diagnosis and treatment of diminished ovarian reserve function, Reproductive Endocrinology and Fertility Protection Group, Fertility Protection Branch, Chinese Association of Preventive Medicine. Expert consensus on clinical diagnosis and treatment of diminished ovarian reserve function [J]. Journal of Reproductive Medicine, 2022, 31(4): 425-434.