Early Menopause (Premature Ovarian Failure)
Premature Ovarian Failure (POF) is essentially very early menopause, before a woman reaches the age of forty. Most women have hundreds of thousands of eggs at the time of their first period. By the time we hit menopause that supply of eggs has dwindled down to a handful.
This gradual loss of eggs during our fertile years is normal. However, in premature ovarian failure for some reason either the loss of eggs is accelerated or the follicles themselves become less responsive to hormonal stimulation (of course, these conditions contribute to each other). Unfortunately, POF is one of the more common conditions affecting a woman's fertility, occurring in one in every thousand women (0.10%) between the ages of fifteen and twenty-nine, and in one in every hundred women (1.0%) between the ages of thirty and thirty-nine.
Symptoms and Signs
Women with POF will have stopped menstruating altogether, or will have short cycles characterized by early (or no) ovulation. Sometimes periods do not occur at all, and menopausal symptoms-hot flashes, amenorrhea, and vaginal dryness-may appear suddenly over one to two months, or gradually over several years.
What is Happening?
As ovulation occurs increasingly early in women with POF, the cycle is often accompanied by elevations in FSH, a signal indicating that the ovaries are not responding to clues from the brain. This lack of communication causes hormonal "confusion." The hypothalamus gives the pituitary gland messages to try harder to stimulate the ovaries to respond. More FSH is produced to stimulate the ovaries, but the ovaries, whose receptors are down, have become less responsive to this message.
Western Medicine Diagnosis of POF
POF is an extremely frustrating diagnosis, as Western medicine cannot pinpoint its cause with any degree of accuracy. Some theories include chromosomal defects, damage from pelvic surgery, chemotherapy, radiation therapy, or pelvic inflammatory disease (PID). One promising avenue of investigation has to do with autoimmune disorders, where a person's immune system attacks the body's own tissues, including (in theory) the ovaries. Often a woman diagnosed with POF will have a concurrent diagnosis of conditions like autoimmune thyroiditis or Graves' disease, or Addison's disease (involving the adrenal glands).
Unfortunately, no matter what the cause of POF, Western medicine can do little to help it. Sometimes treating the associated autoimmune disorder (hypothyroidism, for example) will restore function to the ovaries, but this doesn't always work. If there is evidence of ovarian antibodies indicating an autoimmune disorder, high doses of steroids may be given in an attempt to restore ovarian function. However, the side effects of this treatment are severe. The treatment of choice for POF is usually estrogen replacement therapy (a version of HRT), which is not an option for women who are attempting to conceive because administration of estrogen feeds back to the hypothalamus that it doesn't need to prompt the pituitary to stimulate the ovaries to produce estrogen. The whole hormonal system then goes to sleep.
Women with POF who consult reproductive endocrinologists are usually given one option: IVF with donor eggs. While this might give a woman a baby, it does nothing to address the underlying failure of the ovaries and all of the menopausal symptoms that occur as a result. And since the average age of POF onset is 27-28, most women with POF would prefer a treatment that will restore their ovaries and hormonal system to full, functional health.
According to the traditional Chinese female fertility model, the average age most women go into premature ovarian failure is precisely when they should achieve their reproductive prime. Something has halted this process. Sometimes it's physical. Often there is a deep seated emotional component. Yet, the remedy is, always, to gently restore all aspects of her body, mind, and soul. We must open up the communication between the hypothalamus, pituitary gland, and ovaries. This is not only a physical process, but one that evaluates all aspects of a woman's life that may be preventing this open communication.
Although treatment of POF may be challenging for the TCM practitioner, the results are extremely rewarding, because Chinese medicine is one of the most effective ways to address POF. TCM views most cases of POF as a combination of excess and deficiency patterns that cause the Penetrating and Conception meridians to become "empty." The lack of menstrual bleeding tells us that there is also a deficiency in Blood. Blood deficiency may be due to an obstruction, but in most POF cases it is due to deficient Blood production, usually from faltering Spleen energies or insufficient Kidney Yin. If a woman is experiencing short cycles, early ovulation, and heat signs like night sweats and hot flashes, there is also concurrent heat.
We view the condition of POF as a failure of communication: messages from the brain just aren't getting to the ovaries, and they cease their performance. As a result, the whole system increases its (Yang) energy to try to evoke a response from the ovaries, producing a frenetic cycle of stimulation with no effect. The result is depletion of Yin and deficiency Heat. Most POF cases we have treated have presented with a severe Kidney Yin deficiency, usually accompanied by (Liver or Heart) Blood deficiency, and Spleen Qi deficiency accompanied by deficient heat. It also is not unusual to see concurrent Kidney Yang deficiency.
A typical treatment will consist of the following recommendations.
Dietary modifications from the Spleen-fortifying diet, avoiding wheat, refined carbohydrates, sugars, dairy, and most animal products. It's also wise to avoid hot, spicy foods if signs of internal heat are present. We want to calm the body down to make it less reactive. Dietary insults can set off aggravations in autoimmune conditions.
Take herbs to fortify the spleen like Astragalus; herbs to nourish Yin and Blood like the formulas Liu Wei Di Huang Wan or Si Wu Tang, or the individual herbs Rehmannia, Angelica, White Peony, and Ophiopogon; and herbs to resolve Blood stasis and obstruction, like Persica, Moutan, and Red Peony.
We stimulate the acupressure points to regulate the Penetrating (Chong) and Conception (Ren) meridians, and to supplement Yin and Blood. We employ techniques to improve blood flow to the pelvic organs and open up communication to the brain and pituitary gland.