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A 21-year-old girl was diagnosed with premature ovarian failure! These are the few things that will make women "precipitously aging", so don't do it again
Text: Genkei
Expert support: Liu Yi (Deputy Director of the Reproductive Center of Wuhan Union Medical College Hospital, Doctoral Supervisor)
Source: Marriage & Family Magazine
Tag: 99
"Premature ovarian failure at the age of 21, is there anyone more unlucky than me?"
"I haven't moved for a year and a half when I'm trying to get pregnant, it turns out that my ovaries are premature......
"I haven't had a period for 3 months, am I having premature ovarian failure?"
"I was diagnosed with premature ovarian failure, my husband was going to divorce me, and my life was completely ruined. ”
On social media, more and more young girls, most of whom are in their 30s, share stories about their diagnosis of premature ovarian failure and how to treat it, with the youngest being a freshman.
At a time when their peers are enjoying youth and love wantonly, and expanding their life possibilities to the fullest, where should they go because of premature ovarian failure and accelerated aging?
What exactly is premature ovarian failure?
How to diagnose and prevent it scientifically?
What happens once premature ovarian failure is diagnosed?
Let's take a look at what the experts have to say.
01
"Old" at a young age
"The ovaries are one year old, and the women are ten years old. "A normal woman has menopause around the age of 50, and after menopause, ovarian function declines and estrogen levels in the body decline. If you go through menopause before the age of 40, you have premature ovarian failure, which is medically known as early-onset ovarian insufficiency.
Yanhui, 31 years old this year, doesn't seem to have regular menstruation. Ten and a half days ahead or thirty or forty days in advance is a common thing for her, and it is often the case that it ends in seven or eight days or less than two days. "It's not normal, isn't it? Maybe the baby will be fine after pregnancy and childbirth." Despite her irregular menstruation for many years, Yanhui has never been to the hospital for treatment.
In 2021, Yanhui and her boyfriend who have been in love for many years will get married, and childbirth will naturally be on the agenda. But a year has passed in a blink of an eye, but Yanhui is not pregnant, and she has not had a period for more than 6 months. Yanhui secretly went to Wuhan Union Hospital for an examination.
"The number of antral follicles (basal follicles) on both sides of you adds up to only 3, which is basically premature ovarian failure. Professor Liu Yi, deputy director of the reproductive center of the hospital, suggested that she get pregnant as soon as possible, and try to do IVF if she can't get pregnant naturally, otherwise after a while, the ovarian function will be completely struck, and it will be impossible to have a child at that time.
It has been 8 years since Yanhui and her husband fell in love in college to get married. Yanhui and her husband are both only children, and they plan to have at least two children. "He loves me very much, and he has long said that children's affairs will be natural, but I always have a thorn in my heart. Yanhui felt that the reason why her ovaries were about to strike at such a young age was that nine times out of ten she did it herself, and her menstruation had always been abnormal, and she never took it seriously.
Yanhui felt extremely desperate: "Not only may I not be able to have children, but I will also grow old quickly, why am I so unlucky?" She regretted it very much, because after entering junior high school, she stayed up until midnight almost every day before going to bed, and in her three years of high school, she slept less than 5 hours a day. After going to work, she also worked very hard, often working overtime and staying up late, and her spirit was always in a tense state.
Yanhui mentioned this to her mother anxiously, but she didn't expect her mother to say that she had not had her menstruation since she was 31 years old. Because the marriage was tied and the child was born, the mother did not go to the hospital for examination, let alone treatment. "I often work overtime, travel on business trips, and my menstruation doesn't come, and I think it's very convenient, but I didn't expect to pass on this disease to you......"
Is premature ovarian failure really hereditary? Liu Yi said that Yanhui's premature ovarian failure may be caused by irregular work and rest, emotional stress, or genetic factors. There are many causes of premature ovarian failure, including: congenital inheritance, acquired emotions, psychiatry, diseases, living environment and surgery.
Young women in their twenties and thirties are diagnosed with premature ovarian failure, which may also be the result of certain chromosomal abnormalities. In addition, those who have undergone surgery for endometriosis, ovarian cyst, or chocolate cyst are prone to pelvic inflammation leading to ovarian adhesions (adhesions between the ovaries and surrounding tissues may be caused by pelvic inflammatory disease, ovarian cysts, pelvic peritonitis, etc.), which will affect the blood supply of the ovaries and lead to premature ovarian failure.
Liu Yi said ectopic pregnancy surgery can also lead to premature ovarian failure, because the surgery can cut out the fallopian tubes, affecting the blood supply to the ovaries. Emotional and mental factors, long hours of overwork, accelerated pace of life, emotional stress, bad lifestyle habits, smoking, alcoholism, and staying up late can also lead to premature ovarian failure.
In many patients with premature ovarian failure, the cause of which cannot be identified. However, cancer treatment is highly susceptible to premature ovarian failure, and there is a large number of clinical data to prove it. Exogenous drugs, bone marrow transplantation, or chemoradiotherapy can also cause significant damage to ovarian function. If the radiation therapy exceeds 5 Gy, it will cause damage to the ovarian function. In fact, the unit of measurement of radiotherapy in clinical practice is far greater than 5Gy, and the minimum gradient reaches 44~54Gy, which is self-evident in the damage to ovarian function, and the ultra-large chemotherapy dose of bone marrow transplantation will lead to a complete decline in 70%~100% of ovarian function.
Premature ovarian failure is clinically referred to as early-onset ovarian insufficiency. There is currently a lack of authoritative statistics on the number of women with premature ovarian failure in the mainland. However, Ruan Xiangyan, director of the endocrinology department of Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University, the world's largest gynecological endocrine clinic, believes that premature ovarian failure accounts for at least 1% of women of childbearing age, and the incidence of premature ovarian failure is likely to be as high as 20.1% according to the random sample survey data of the outpatient clinic for one day.
02
Irreversible, but preventable
In women, the number of oocytes peaks at 20 weeks (5 months) of pregnancy. After that, as we age, apoptosis occurs in large numbers. The expulsion of each mature follicle means that 1,000 follicles will die with apoptosis. In general, a woman's ovarian function begins to decline after the age of 31, and it declines significantly after the age of 35, and when there are less than 1,000 egg cells, it reaches menopause.
Premature ovarian failure is irreversible once diagnosed. At present, there is no drug or effective treatment in the world that can revitalize a failing ovary. However, there are many ways to prevent or delay until the diagnosis or symptoms are present.
"Many young women are used to regular screening for 'two cancers', and I think that when I do these two tests, I can check the ovarian function by the way. Liu Yi said that this examination includes two things: one is to go to the hospital on an empty stomach to do six tests of gynecological endocrine on the second and third days of menstruation, and the other is to check the anti-Mullerian hormone (AMH), and draw blood to test the ovarian reserve function and how many antral follicles there are, so as to determine the reserve function status of the ovary. Both of these tests are not complicated and inexpensive.
"I recommend that reproductive function, i.e., ovarian function, be included in the annual routine physical examination to make a scientific assessment of ovarian function in young women. Liu Yi said that if you are diagnosed with low ovarian function, you should get married and have children in advance, and do not go to IVF after you reach the age, which will be financially, physically and psychologically stressful and tested. In particular, if there are relatives suffering from premature ovarian failure, they should go to the hospital for regular check-ups. Among the genetic factors, "having a relative with abnormal menstruation" has a greater effect, which increases the risk of premature ovarian failure by 28 times. Relatives here include the patient's mother, sister, or mother's sister.
So, how to protect the function of the ovaries and make them work healthily for a longer time? Liu Yi said that some girls over-dieting to lose weight, do not eat staple foods for a long time, and finally lose weight to the point of amenorrhea, which can easily lead to premature ovarian failure. Therefore, instead of worrying about which foods are "good" for ovarian function, it is better to ensure a balanced intake of nutrients such as protein, fat, carbohydrates and vitamins as much as possible.
In addition, studies have shown that smoking can make ovarian function decline 1-2 years earlier, stress, staying up late, and irregular life can also lead to ovarian function decline. Therefore, developing healthy lifestyle habits, trying not to stay up late, ensuring six or seven hours of quality sleep every day and exercising moderately will definitely be beneficial to the protection of ovarian function.
According to the statistics of the World Health Organization (WHO) in 2021, there are more than 4.57 million new cases of malignant tumors in China every year, and at least 1 million girls and women of childbearing age lose their fertility due to premature ovarian failure due to radiotherapy and chemotherapy of the disease. In this case, cryopreservation and transplantation of ovarian tissue is the only way to preserve and preserve fertility. However, many people do not consult about it until after chemotherapy and radiotherapy.
Liu Yi once received six young patients with premature ovarian failure in one day. One of the most heartbreaking was a 15-year-old girl who underwent a bone marrow transplant due to aplastic anemia, which led to premature ovarian failure. The mother brought the girl to the hospital in the hope that her daughter would have her period again. Liu Yi said it was too late. If you come to the hospital for bone marrow transplantation and cryopreservation of ovarian tissue, then after chemotherapy and radiotherapy, you can have an ovarian tissue transplant, and this 15-year-old girl will have the opportunity to be a mother in the future, let alone enter menopause early due to premature ovarian failure.
In fact, the cryopreservation technology of ovarian tissue in mainland China has reached the international advanced level. It is understood that Beijing Obstetrics and Gynecology Hospital has frozen nearly 500 cases of ovarian tissue, most of them from cervical cancer, breast cancer and children with benign and malignant diseases in need of bone marrow transplantation, the oldest cryopold is 46 years old, and the youngest is only 1 year and 3 months. So far, 10 cases of ovarian tissue transplantation have been completed, and all of them have been successful.
"Before the ovaries are treated with gonadal toxicity, part of the ovarian tissue is removed from the body for cryopreservation, which can avoid the destruction of ovarian function by radiotherapy, chemotherapy and other factors. After the primary disease of the patient is completely relieved in the future, the cryopreserved ovarian tissue will be resuscitated and transplanted back into the body, so as to preserve the fertility and endocrine function of women and delay the occurrence and aging of various chronic diseases in women. ”
Liu Yi said that ovarian tissue cryopreservation technology is the only way to protect and delay the fertility of prepubertal girls and women undergoing radiotherapy and chemotherapy. If doctors warn patients before surgery, iatrogenic premature ovarian failure will be greatly reduced.
03
Accept the natural aging of life
There is a scientifically rigorous procedure for diagnosing premature ovarian failure, but some of the similar symptoms are likely to be just premature ovarian aging or low ovarian response.
Premature ovarian aging refers to the phenomenon of overload and stress leading to endocrine changes in the human body, resulting in temporary menstrual irregularities, such as shortening and prolonging the cycle, and the menstrual flow is more and less time; Decreased menstrual flow is the main symptom.
Unlike premature ovarian failure, which causes amenorrhea and is irreversible, premature ovarian aging and ovarian hyporesponsiveness can be improved or treated. The former can achieve good results by adjusting the work and rest time, reducing work and mental stress, while the latter can be treated with medication, such as taking a combination of estrogen and progesterone to regulate the ovarian endocrine function, so that menstruation can return to normal. Therefore, once menstruation is abnormal, it is best to go to the hospital to determine whether it is premature ovarian failure, premature ovarian aging or low ovarian response.
Premature ovarian senescence and ovarian hyporesponsiveness are temporary and reversible, but the incidence of these two conditions is 10 times higher than that of premature ovarian failure. Because of the similar symptoms, some people mistakenly interpret "premature aging" and "low response" as "premature aging", which also leads to a 10-fold expansion of the base number of people with premature ovarian failure. Some non-medical institutions take the opportunity to fish in troubled waters, in order to create anxiety, stimulate consumption, and even exaggerate menstrual irregularities as premature ovarian failure. Health products for the "treatment" of premature ovarian failure have appeared, and beauty salons and massage parlors have launched expensive ovarian maintenance packages.
26-year-old Cheng Yan went to a beauty medical institution for consultation because of irregular menstruation, accompanied by insomnia, night sweats and other symptoms, and the staff said conclusively that she suffered from premature ovarian failure, and Cheng Yan's hair loss and acne on her face were also caused by premature ovarian failure.
In order to improve ovarian function, Cheng Yan spent nearly 50,000 yuan to buy an ovarian maintenance package. According to the organization, massaging the abdomen with Thai essential oils can play a role in maintaining the ovaries and improving aging, and the expensive magnetic therapy device can nourish the ovaries by promoting blood circulation. However, after nearly two years of treatment in the beauty salon, Cheng Yan's symptoms not only did not get any relief, but her menstruation became more and more abnormal, and the longest one did not come for 3 consecutive months.
Cheng Yan went to the hospital for medical treatment and was diagnosed with premature ovarian aging, which can be relieved by drug treatment. "It turns out that I am not premature ovarian failure!" she cried with joy, and the huge psychological pressure she had borne in the past two years because of premature ovarian failure was also released in an instant.
Cheng Yan's story is not an isolated case, many premature ovarian failure identified by beauty institutions or self-examination is actually just premature ovarian aging or low ovarian reaction.
Therefore, we must not only attach great importance to premature ovarian failure, but also not put everything into this basket.
If it is premature ovarian failure, you must go to a regular hospital for examination. Because there are strict diagnostic criteria for premature ovarian failure, women under the age of 40 who have not stopped menstruation for 6 months (or more) cannot be considered to have premature ovarian failure, but only premature ovarian aging and low ovarian function.
In fact, at some point in life, the ovaries stop working, and this is a process that every woman goes through. For most women, it is acceptable to have abnormal ovarian function around the age of 50 and thus enter menopause.
If an adult woman's ovaries are examined under a microscope, each ovary is in a state of "gradual aging", regardless of whether menstruation is normal or not. For women, the ovaries are the first organ to age. Normally, around the age of 50, the ovarian function completes its mission, but other organs continue to function normally until the end of life.
The ovaries are important organs that maintain a woman's sexual characteristics and produce eggs, but their decline is also a manifestation of human evolution. Otherwise, women will always take on the mission of reproduction and procreation, which is obviously unfair to them, and will not only become a heavy burden, but may even bring life risks.
Therefore, we strive to prevent premature ovarian failure, and at the same time accept the natural aging of the ovaries and bloom with beauty at every stage of life.
(Except for Ruan Xiangyan and Liu Yi, the other characters are pseudonyms)
Original title: "Why did you have premature ovarian failure at a young age?"
(Excerpted from Marriage & Family Magazine January 2024)