PREMATURE OVARIAN FAILURE (POF)

DESCRIPTION

POF is essentially very early menopause that begins before a woman reaches the age of forty.

Until recently, science has maintained that most women have hundreds of thousands of eggs at the time of their first period and, by the time we hit menopause, that supply of eggs has dwindled down to a handful. More recently, scientists have discovered that mammalian ovaries have specialized stem cells that are capable of making new eggs throughout a woman's life. Nevertheless, the gradual loss of eggs during our fertile years is normal. However, in POF, 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. 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. (Source: "Incidence of Premature Ovarian Failure", Coulam et al., Obstetrics & Gynecology).

SYMPTOMS

Women with POF stop menstruating altogether or 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.

WESTERN MEDICAL TREATMENT

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 their body's own tissues including, in theory, the ovaries. Often a woman diagnosed with POF will have a concurrent diagnosis of a condition like autoimmune thyroiditis or Graves' disease or Addison's disease, which involves the adrenal glands.

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 their body's own tissues including, in theory, the ovaries. Often a woman diagnosed with POF will have a concurrent diagnosis of a condition like autoimmune thyroiditis or Graves' disease or Addison's disease, which involves the adrenal glands.

The treatment of choice for POF is usually estrogen replacement therapy, a version of hormone replacement therapy, but this 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 course 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 would restore their ovaries and hormonal system to full, functional health.

DISCUSSION AND ROOT CAUSES

As ovulation occurs increasingly early in women with POF, the cycle is often accompanied by elevations in FSH, a signal that the ovaries are not responding to clues from the pituitary gland in 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.

According to the traditional Chinese female fertility model, the average age most women go into premature ovarian failure is precisely that at which they should achieve their reproductive prime, but something has halted this process. Sometimes it's physical. Oftentimes there is a deep-seated emotional component. The remedy is always to gently balance and heal all aspects of a woman's body, mind and soul. To treat POF, we 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 free-flowing communication.

EASTERN MEDICINE DIAGNOSES

Although treating POF can 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.

The condition of POF is ultimately a failure of communication: messages from the brain just aren't getting to the ovaries, so 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 deficient 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.

NATURAL TREATMENT

A typical POF treatment will consist of the following recommendations.

1. Dietary modifications from the Spleen Qi-fortifying diet will advise 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 as you want to calm the body down to make it less reactive. Dietary modifications can aggravate autoimmune conditions. 
2. Herbs like Astragalus are prescribed to fortify the Spleen. Multiple-herb formulas including Liu Wei Di Huang Wan or Si Wu Tang and individual herbs such as Rehmannia, Angelica, White Peony and Ophiopogon may be given to nourish Yin and Blood. Herbs like Persica, Moutan and Red Peony help resolve Blood stasis and obstruction. 
3. We stimulate the acupressure points to regulate the Penetrating (Chong) and Conception (Ren) meridians, and to supplement Yin and Blood. We employ physical and emotional therapy techniques to improve blood flow to the pelvic organs, stimulate emotional and energetic release and open up communication to the brain and pituitary gland.