Premature Ovarian Failure (POF)

Understanding Premature Ovarian Failure (POF) and How It Affects Fertility

POF is defined as the cessation of the menstrual cycle associated with low levels of estrogen and high levels of follicle stimulating hormone (FSH) before the age of 40. FSH levels above 30mIU/ml are considered high. POF affects between one and four percent of women, and between 250,000 and one million American women. POF was initially believed to be an irreversible condition, but it is now known that ovarian failure is often intermittent, especially in chromosomally normal women. Case studies have reported up to a 60% rate of subsequent ovarian function. Thus, this is a relatively common condition.

The most common causes are a past history of chemotherapy or radiation, genetic (10-20% of all cases), chromosomal abnormalities, damage to the pelvic organs from a surgery, Hypothalamus-Pituitary-Ovarian axis issues, or a history of autoimmune problems. Typically a patient will experience a cessation of menses (amenorrhea), hot flashes, night sweats, insomnia, irritability, low libido, infertility, and vaginal dryness.

POF can increase a woman’s risk of osteoporosis (due to low levels of estrogen since estrogen is needed to make bone), heart disease (estrogen is needed to protect the heart), thyroid problems (65% of all POF cases are autoimmune), diabetes, and adrenal problems.

How Chinese Medicine and Acupuncture Treat Premature Ovarian Failure

In Chinese medicine the condition of POF is due to a decline in the kidney energy (hormonal production and reproductive organs), spleen dampness (autoimmune connection), heart disconnection (pituitary function and emotions), and to a liver pathway disconnect (liver is responsible for an aspect of hormonal control and menstrual cycle regulation).

A number of studies have confirmed that acupuncture and Chinese herbal therapy can positively affect both the Pituitary and the Hypothalamus, thus restoring ovulation, reducing elevations in FSH, promoting estrogen production, and regulating the LH. Also, acupuncture and Chinese herbs have shown success in regulating and preventing the symptoms that are associated with POF, like night sweats, vaginal dryness, insomnia, and a deficient uterine lining. When all of these symptoms are improved, the overall fertility of the patient is improved due to a higher estrogen production. As estrogen levels increase, the menstrual cycle will become more regular and ovulation can resume.

In a study of women with secondary ovarian failure published in 1999, the group receiving acupuncture and herbal treatments responded better and experienced longer-lasting results without side effects than those receiving the standard Western fertility drug clomiphene (Clomid). Both groups responded to treatment, with returning menstruation and normalizing of FSH and LH levels, but patients taking clomiphene (Clomid) complained of several undesirable side effects.

Acupuncture increases blood flow to the pelvic cavity to nourish the ovaries, improve egg quality, and regulate the Hypothalamus-Pituitary-Ovarian axis. Acupuncture can also relax the body and reduce stress levels. There are many studies that show the effectiveness of acupuncture in regulating ovulation, reducing elevated FSH, and restoring embryo quality.

Chinese herbs are used to increase blood flow to the pelvic cavity, increase estrogen levels and decrease FSH levels, moderate stress, encourage proper ovulation, modulate the immune system, regulate the endocrine system, and stop hot flashes and irritability.

Reproductive organ massage is a highly specialized form of therapeutic massage that manipulates the fascia of the pelvic cavity to improve blood circulation to ovaries and to establish a better connection between the pituitary and the ovary. Once this connection is established, elevated FSH numbers will start to decline and hormonal balance will be achieved.

Nutritional guidance is customized for each patient based on the health of her kidney, liver, and spleen functions, which control our reproductive health and underlie our metabolic processes. For POF, maintaining a healthy diet of organic fruits, vegetables, and protein sources is recommended to encourage proper hormonal support. It is also advisable to eat wild caught fish (not farmed fish), seaweeds, and wheat grass, and to avoid trans-fats and limit refined carbohydrates.

How Western Medicine Treats POF

Western doctors diagnose POF by measuring the levels of FSH in your blood over the course of a few months time. A diagnosis of POF is likely if your tests show your FSH levels to be above 30 mlU/ml. Also, one of the best indictors of premature ovarian failure is poor ovarian response to gonadotropin (hMG) stimulation. Common gonadotropin stimulating drugs include: Gonal F, Follistim, Repronex, and Menopur. These stimulants are usually prescribed by your physician or infertility center.

Unfortunately, the use of Clomid (Clomiphene citrate), gonadotropins (hMG), GnRH, estradiol and corticosteroids (such as prednisone) have shown to have little to no effect in stimulating follicles to ovulate. It is likely your body is already producing large quantities of FSH and LH in an effort to get your ovaries to respond. Adding more hMG is unlikely to produce a reaction, since that is not where the problem lies.

Once diagnosed with POF, the standard Western protocol would include hormone replacement therapy. For women wishing to have a baby, in vitro fertilization (IVF) with donor eggs or adoption is the recommended course of action.

Research and Related Articles on Premature Ovarian Failure

Experimental study on preventive and therapeutic effect of bushen huoxue recipe on autoimmune premature ovarian failure model
Institute of Obstetrics/Gynecology, Shanghai Medical University, Shanghai (200011)
PMID: 12577397 [PubMed – indexed for MEDLINE]

Pregnancy in premature ovarian failure after therapy using Chinese herbal medicine
Department of Gynecology and Pediatrics, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
PMID: 12956293 [PubMed – indexed for MEDLINE]