Premature ovarian failure (POF)

Premature ovarian failure, also known as primary ovarian insufficiency, premature menopause, and hypergonadotropic hypogonadism, affects approximately 1% to 4% of the female population, and is defined as the loss of ovarian function before the age of 40. Women with POF typically experience amenorrhea (absence of menstruation), low levels of estrogen, and elevated levels of gonadatropins (FSH and LH). Ovarian failure can be permanent in some cases, but is often intermittent, with up to a 60% rate of subsequent ovarian function.

Treatment for premature ovarian failure with Chinese medicine

While POF is a complicated and emotionally difficult disorder, natural therapies have much to offer patients with POF who wish to conceive:

Acupuncture helps to improve signaling within the hypothalamus-pituitary-ovarian axis, which can induce ovulation and normal menstruation over time. Underlying causes of POF such as autoimmune conditions and stress are also treated.

Chinese herbs enhance the hormonal balance within the body, and can encourage the body’s own endogenous production of estrogen and progesterone and lower FSH levels.

Reproductive organ massage brings more blood flow to the ovarian tissue, helping to restore reproductive response.
Diet and nutritional therapies reduce inflammation in the system, as well as help to regulate hormonal functioning.

Stress management techniques such as yoga, meditation, and qigong are often useful for women with POF. Once lifestyle stressors are lessened, the body is able to heal the ovarian tissue.

Symptoms of premature ovarian failure

Symptoms of POF include:

  • Absence of menstrual periods
  • Irregular menstrual periods
  • Infertility
  • Decreased bone density
  • Hot flashes
  • Night sweats
  • Sleep disturbance
  • Low sex drive
  • Painful intercourse
  • Mood swings
  • Vaginal dryness
  • Low energy
  • Bladder control problems

Causes of premature ovarian failure

The cause of POF is usually unknown. In cases in which the cause is known, autoimmune or genetic disorders are often involved. Family history, or ovarian or pelvic surgery early in life increases the chance of developing POF. Premature ovarian failure can also be the result of chemotherapy and radiation treatments for cancer. When an abundant number of primordial follicles are seen on ultrasound, the cause is often autoimmune ovarian disease, which causes damage to the maturing follicles. When few or no primordial follicles are found, the cause is more likely to be due to genetic disorders, surgery, endometriosis, infection, or the aftermath of chemotherapy and radiation. Some causative factors and associated disorders are:

  • Turner syndrome
  • Swyer syndrome
  • Androgen insensitivity syndrome
  • Fragile X syndrome
  • Galactosemia
  • Thalassemia major, treated with multiple blood transfusions
  • Hemochromatosis
  • Chemotherapy/radiation therapy–related
  • Surgical removal of the ovaries
  • Viral infection
  • Abnormal gonadotropin (FSH and LH) secretion or action
  • Thyroid dysfunction
  • Polyglandular failure I and II
  • Hypoparathyroidism
  • Rheumatoid arthritis
  • Idiopathic thrombocytopenia purpura (ITP)
  • Diabetes
  • Pernicious anemia
  • Adrenal insufficiency
  • Vitiligo
  • Systemic lupus erythematosus; also called SLE or lupus

Western treatment for premature ovarian failure

POF is generally treated with high-dose hormone therapy, typically estrogen and progesterone, occasionally including testosterone. Oral contraceptive pills are sometimes used as an alternative to hormone replacement. Estrogen therapy helps to prevent bone loss in women with POF, and also helps to control many of its associated symptoms. While there is currently no treatment able to restore fertility in patients with POF, 5% to 10% of women diagnosed with the disorder are able to become pregnant. In vitro fertilization (IVF), as well as donor eggs and adoption, are options for women with POF who wish to become parents.