What should women do if they have premature ovarian failure?

Premature ovarian failure generally refers to the phenomenon that occurs before the age of 40 due to ovarian failure. Premature ovarian failure has a great impact on a woman's body. So what should women do if they experience premature ovarian failure?

1. Estrogen-progesterone replacement therapy (HRT)

Estrogen-progesterone replacement therapy is very important for young POF patients. It can relieve the symptoms of low estrogen and urogenital tract atrophy (in preparation for donated egg embryo transplantation), prevent long-term complications (osteoporosis, Alzheimer's disease, etc.), and reduce the risk of colon cancer by 37%. However, long-term HRT also has certain risks, such as the occurrence of endometrial cancer and breast cancer. However, studies have shown that estrogen-progesterone replacement therapy with progesterone for more than 10 days per month can reduce the risk of endometrial cancer to almost zero, while slightly increasing the risk of breast cancer, but the mortality rate does not increase. Usually a combination of estrogen and progesterone is used. Before applying HRT, an individualized balance of pros and cons should be made, and necessary monitoring and follow-up should be carried out.

2. Prevent osteoporosis

In addition to HRT, ensure 1200 mg of calcium intake per day. Vitamin D 400-800 IU/day, and engage in necessary physical exercise, such as walking, yoga or Tai Chi.

3. Ovulation induction therapy

There are many reports in the literature about the successful experience of inducing ovulation in POF patients. The conditions for screening patients before treatment are mostly short amenorrhea duration, not too high blood FSH level, and clinical diagnosis of follicular POF. Generally, after HRT or GnRHa is used to suppress endogenous gonadotropin (mainly FSH) to a lower level (<20IU/L), sufficient hMG/hCG is given to induce ovulation while ultrasound monitoring is performed. The hMG dosage is required to be large and the duration is long. The theoretical basis for the success of down-regulation in ovulation induction is that after down-regulation, the endogenous FSH level decreases, the number of FSH receptors on the surface of granulosa cells increases, and the sensitivity of the ovaries is increased.

4. Immunotherapy

Because immune factors are a definite cause of premature ovarian failure, immunosuppressive treatment is effective for patients with premature ovarian failure who have evidence of immune factors. There have been multiple reports of pregnancy occurring during immunosuppressive therapy. So far, there is no clear method to identify the role of immune factors in POF, nor is there a clear indication for immunotherapy and a standardized medication regimen. Immunosuppressive therapy can cause serious side effects, so blindly using immunosuppressants to treat POF is not recommended clinically.

5. DHEA Treatment

50% of DHEA is secreted by the zona reticularis of the adrenal cortex, 20% is secreted by the ovaries, and 30% is converted from peripheral DHEAS. 6 to 8 mg is produced in the body every day, and the blood concentration is 3 to 35 nmol/L. Its level decreases with age. DHEA is an important substance for the synthesis of androstenedione, testosterone and estradiol. The level of DHEA affects the levels of these hormones.

6. Donated egg embryo transfer

In 1984, Lutjen et al. reported the world's first case of a live newborn obtained through donation of oocytes from a woman with premature ovarian failure, providing a way for POF patients to have children. So far, donated oocyte embryo transfer is still the most effective treatment for POF patients to achieve pregnancy.

7. Ovarian transplantation

In October 2004, Donnez J et al. reported for the first time a case in which cryopreserved human ovarian tissue was autotransplanted to restore ovarian function and give birth to a live fetus. In the following years, there were several reports of successful ovarian cryopreservation and transplantation, leading to pregnancy and birth.