Recently, a 42-year-old woman in Shandong posted ** 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 was afraid to look in the mirror recently, and it was difficult to accept the current situation, and she had already done a full body examination in the hospital. In the end, the doctor diagnosed premature ovarian failure, and it cannot be reversed!
We've all heard of "growing old overnight" and "turning white overnight", and most of the time we think it's an exaggeration. However, relevant studies have shown that aging does not occur at a uniform rate, and "cliff aging" does exist, although it does not age overnight, but it is possible to age rapidly in a short period of time. Whether it is the research of traditional Chinese medicine or Western medicine, there are such theories or discoveries.
The client's diagnosed "premature ovarian failure" is one of the main reasons for her "cliff-like aging".
Premature ovarian failure – the "Achilles' heel" for women
Premature ovarian failure refers to the onset of amenorrhea for 4 to 6 months before the age of 40, with an interval of more than 4 weeks between two episodes of follicle-stimulating hormone (FSH) of 40 ul, accompanied by estrogen reduction and menopausal symptoms, which belongs to the terminal stage of early-onset ovarian insufficiency. The global incidence is approximately 37%, with a reported incidence rate of 1% in China 38%。At present, the incidence of premature ovarian failure is gradually increasing, and it is showing a younger trend.
1.Aging is a major manifestation of premature ovarian failure
(1) Menstrual changes
Amenorrhea, shortened or irregular menstrual cycles, decreased menstrual flow, and oligomenorrhea may occur. The decline from ovarian reserve to failure can take several years, and clinical heterogeneity is high, with a small number of patients experiencing abrupt termination of menstruation without warning.
(2) Reduced fertility or infertility
In the early stages of declining ovarian reserve, there is still a 5% 10% chance of a 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**, the number of eggs retrieved is smaller, the cycle cancellation rate is higher, and the clinical pregnancy rate is low.
(3) Manifestations of decreased estrogen levels
Hypoestrogen manifestations include hot flashes, profuse sweating at night, insomnia, memory loss, decreased libido, etc. **Examination may show breast atrophy (breast sagging atrophy), *atrophy. At the same time, hair loss, pigmentation, osteoporosis can be accompanied by osteoporosis, and the phenomenon of rapid aging of the face can appear.
2.Causes of ovarian aging
Ovarian aging is a multifactorial, cumulative and complex biological process.
Age factor:Age is one of the main factors affecting ovarian reserve, but age-related ovarian injury is only a concomitant phenomenon, not the root cause of ovarian aging.
Genetic factors:The current results reveal about 20% of heredity**.
Environmental factors:pesticides, heavy metals, electromagnetic radiation and noise from mobile phones, etc.
Psychosocial factors:Stress states such as anxiety, depression, burnout, malnutrition, and long-term exertion.
Behavioral factors:Smoking, drinking, staying up late, lack of exercise, unreasonable diet, etc.
Iatrogenic factors:Surgery-induced injuries and chemoradiotherapy.
Others include:Infectious factors, immune factors
Premature ovarian failure is irreversible and can only be detected and prevented in advance
If you are under the age of 40 but your ovarian function has begun to decline, you may be clinically classified as "early-onset ovarian insufficiency". At this time, if it is not detected in time, or simply left unchecked, it may develop into premature ovarian failure.
Premature ovarian failure is irreversible and can only be controlled early if it is detected early. At present, there is no way to regain the youth of the "aging" ovaries, we can only detect the signs of premature ovarian failure as early as possible, and improve the symptoms through active **, and maintain them until menopause.
Moreover, premature ovarian failure "prematurely ages", and this "early menopause" is extremely harmful to women. The age of menopause in normal women is basically around 50 years old, but if you go through menopause early, such as premature aging from the age of 35, you are "suffering" perimenopausal syndrome for 15 years in advance"**
1.What are the diagnostic criteria for premature ovarian failure?
The definition of premature ovarian failure varies from guideline to guideline, and the currently accepted diagnostic criteria for premature ovarian failure are:Age 40 years; Amenorrhea 6 months; Two times (more than 1 month apart) blood FSH 40 u l.
The woman above is 42 years old and over 40 years old, although she does not meet the strict requirements for the diagnosis of premature ovarian failure, but it is indeed a rapid appearance aging caused by ovarian hypofunction.
2.The best method recommended by the "Guidelines for the Diagnosis and Treatment of Early-onset Ovarian Insufficiency with Integrated Traditional Chinese and Western Medicine".
(1) Traditional Chinese Medicine**
100% consensus program: nourish the liver and kidneys, nourish blood and regulate menstruation
Recommended formula: Zuogui Pill (Jingyue Quanshu) (Level B evidence, strong recommendation).
Prescription composition: Rehmannia rehmannia, yam, dogwood, dodder seed, deer horn gum, wolfberry seed, Sichuan hyssop.
Recommended Chinese patent medicine: Kun Bao Pill (level of evidence, strong recommendation).
Consensus 875% plan: tonify the kidney and improve the essence
Recommended formula: Erxian Tang Heerzhi Pill plus Polygonum multiflori, keel, oyster (level of evidence, strong recommendation).
Composition of the prescription: Xianmao, Epimedium officinalis, Angelica sinensis, Morinda officinalis, Phellodendron chinensis, Zhimu, Lotus motiflora, Ligustrum ligustrum, Polygonum multiflori, keel, oyster.
Recommended proprietary Chinese medicine: Qilin pills (level B evidence, strong recommendation).
Consensus 8571% plan: warm the kidneys and help yang, nourish blood and regulate menstruation
Recommended formula: Yougui Pill (Jingyue Quanshu) (Level B evidence, strongly recommended).
Composition of the prescription: Rehmannia rehmannia, aconite, cinnamon, yam, cornus (wine), dodder seeds, deer horn gum, wolfberry seeds, angelica, eucommia (salt fried).
Recommended Chinese patent medicine: Yougui pill (level of evidence, strong recommendation).
Consensus 8571% plan: nourish yin and nourish blood, communicate heart and kidney
Recommended Formula: Tianwang Buxin Pill ("The Secret Anatomy of Regency") (level evidence, strong recommendation).
Prescription composition: Panax ginseng, Radix radix, Angelica sinensis, Asparagus, Ophiopogon vulgaris, Salvia, Poria cocos, Schisandra chinensis, Yuanzhi, Platycodon, Jujube Kernel, Rehmannia Radix, Cinnabar, Cypress Kernel.
Recommended Chinese patent medicines: Tianwang Buxin Pill (level evidence, strong recommendation), Kuntai Capsule (level B evidence, weak recommendation).
(2) Western medicine hormone supplementation** (HRT).
Western medicine** is also a level of evidence, strongly recommended, and the consensus has reached 100%. People who want to have children should be supplemented with natural estrogen and progestogen**. The following plan is recommended.
Continuous sequential
Use Fenmorphon for sequential**, 1 tablet d in sequence, and start the next 1 box directly after using up 1 box, and do not stop the drug in the middle.
Cycle sequential
Clementon was used for sequential **, 1 tablet in sequence, after using 1 box, the drug was stopped for 7 days, and the next 1 box was started.
Continuous union
Tibolone (2.)5 mg once a day. **Topical estrogen application to improve symptoms of genitourinary atrophy. **Medication, 1 time a day, after 2 weeks of continuous use and symptom relief, change to 2 3 times a week. Long-term solitary use should be monitored regularly for endometrial conditions.
3.Long-term management of premature ovarian failure
(1) Lifestyle modification (level of evidence, strong recommendation).
Eat a balanced diet, adequate intake of vitamin D and calcium, exercise with weights, maintain proper body fat, quit smoking, and avoid exposure to toxic reproductive substances.
(2) psychological interventions (level of evidence, strongly recommended).
Psychological support from the family and self-psychological counseling are important for the improvement of the disease, and the mood should be relaxed and the psychological pressure should be relieved.
(3) Long-term health and complication management
Bone health (level of evidence, strongly recommended): bone density testing is recommended. If osteoporosis is diagnosed, estrogen** should be actively supplemented, and other osteoporosis** medications should be added if necessary to prevent bone loss.
Cardiovascular health (level of evidence, strong recommendation): reduce the adverse effects of risk factors through a healthy lifestyle. Early HRT** is recommended and continued until the average natural menopause age.
References
1] Obstetrics and Gynecology Professional Committee of Chinese Association of Integrative Medicine, Feng Xiaoling, Li Li, et al. Guidelines for the diagnosis and treatment of early-onset ovarian insufficiency with integrated traditional Chinese and Western medicine[J].Journal of Traditional Chinese Medicine,2022,63(12):1193-1198
2] Expert Consensus Expert Group on Clinical Diagnosis and Treatment of Hypoactive Ovarian Reserve, Reproductive Endocrinology and Fertility Protection Group of the Fertility Protection Branch of the Chinese Preventive Medicine Association. Expert consensus on the clinical diagnosis and treatment of ovarian reserve hypofunction[J].Journal of Reproductive Medicine, 2022, 31(4): 425-434