Premature ovarian failure
Introduction
Introduction to premature ovarian failure Definition of premature ovarian failure: The phenomenon of ovarian dysfunction in women before the age of 40, known as premature ovarian failure (Prematureovarianfailure). The incidence of POF accounts for 1-3% of adult women. The clinical manifestations are accompanied by different degrees of pre-menopausal symptoms such as hot flashes, sweating, vaginal dryness and decreased libido, which make the patients premature, causing great pain to their physical and mental health and husband and wife life. Premature ovarian failure affects the quality of life of women. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for middle-aged women Mode of infection: non-infectious Complications: infertility, amenorrhea
Cause
Causes of premature ovarian failure
Immunity factor (20%):
Immune diseases, women with autoimmune diseases, immune mechanisms in the body such as rheumatoid arthritis, thyroid disease, etc., so that the body's immune system often mistakenly kills germ cells in ovarian tissue as foreign objects. ,damage.
Cytogenetic factors (15%):
The number of congenital germ cells is small, the follicle atresia is accelerated, the X chromosome is abnormal, and 10% of patients have a family history. POF is a group of X-linked hereditary diseases that are often accompanied by chromosome recombination, translocation or monomeric changes. X-chromosome abnormalities, such as 45X Turner syndrome and its variants, are the most common cause of hereditary POF.
Iatrogenic factors (10%):
Surgery that may cause POF may be hysterectomy, tubal ligation or resection, conservative or semi-radical surgery for endometriosis, ovarian wedge or perforation, ovarian cystectomy or one-sided oophorectomy. Histological study of ovarian damage caused by chemotherapy drugs, found that ovarian capsule thickening, interstitial fibrosis, but there are a large number of follicles that stop development, so after the chemotherapy drug is stopped, 65% to 70% of patients can recover the ovaries The normal function of the.
Viral infection (20%):
Causes ovarian virus infection. Some women are infected with mumps virus and ovarian inflammation at an early age, which destroys the function of the ovary, makes the ovary insensitive to the stimulation of the pituitary gonadotropin, does not produce the proper response, and presents with viremia. If the gonads are damaged, the primordial follicles can also be quickly depleted after entering puberty.
Environmental and psychological factors (15%):
1. Environmental factors: Environmental pollution such as the use of a large number of pesticides and cadmium, arsenic, mercury, etc. can damage ovarian tissue, causing POF. Oxygen-induced POF can be destroyed by receiving large doses or long-term radiation due to work, illness or accident. 2. Psychological factors: Strong mental stimulation, such as long-term anxiety, depression, sadness, anger, fear and other negative emotions, not only cause hypothalamic-pituitary-ovarian axis dysfunction, but also directly affect ovarian function, which can cause POF.
Prevention
Premature ovarian failure prevention
In terms of spirit
Invigorate the spirit, try to keep your mood comfortable, don't give too much pressure to yourself, women should treat the menopause and old age with a positive attitude, eliminate unnecessary worries and fears, and in the event of some incompatibility Take active and effective treatment, and be good at getting sympathy, comfort and encouragement from family members.
2. Physical exercise
Insist on exercise and enhance physical fitness, which is the most important way for middle-aged women to maintain vigorous vitality. A strong body can maintain the functional health and coordination of various organ systems throughout the body, thereby disrupting the function of the nervous and endocrine systems, naturally delaying the decline of ovarian function.
3. Diet
Pay attention to dietary conditioning and ensure that adequate intake of nutrients can help women gain the necessary nutrients to maintain healthy reproductive function. Women can eat more high-quality protein, B vitamins, folic acid, iron, calcium and other nutrients, such as eggs, pig liver, beans and their products, fresh vegetables, mushrooms, fungus, kelp, seaweed, fish and so on. At the same time, keep the diet light, not too greasy, too salty, too sweet. Eat regularly, eat on time, and not overeating.
4. Sexual love
A happy and happy couples sexual life is quite beneficial to womens health. Sex promotes female hormone secretion, promotes breast development, and relieves dysmenorrhea.
Sexuality helps to eliminate the bactericidal effect of semen cytokines contained in semen, and has an inhibitory effect on vaginitis, cervicitis, endometritis, salpingitis and other diseases.
5. Focus on menstruation
Premature ovarian failure has aura, and there are many changes in menstruation before menstruation - menstrual thinning - amenorrhea changes, so pay attention to menstrual changes.
6. Women should not supplement hormone drugs or health products
Improper hormone supplementation and poor health care can lead to excessive stimulation of the ovaries and a large side effect. The result will be counterproductive and counterproductive, aggravating amenorrhea.
Complication
Premature ovarian failure Complications, infertility, amenorrhea
For women who love beauty, premature ovarian failure is a serious disease.
1. The impact on the body. Premature ovarian failure not only affects the beauty, skin and body of Amy, but also causes infertility and decreased sexual function.
2. Menopausal complications. Some of the same complications as menopause make people's fear of aging come prematurely.
Symptom
Premature ovarian failure symptoms Common symptoms Female secondary sexual characteristics disappeared amenorrhea anti-ovarian antibody positive constipation Menopausal red ovarian atrophy hair loss night sweats thyroid function low urinary tract infection
Clinical manifestations are accompanied by different degrees of pre-menopausal symptoms such as hot flashes, sweating, vaginal dryness, decreased libido, etc. In addition to amenorrhea, only a few people with ovarian premature aging have symptoms similar to menopausal syndrome.
symptom
1. Amenorrhea.
1. Primary amenorrhea, gonadal dysplasia, delayed menarche or irregular menstruation, dysmenorrhea.
2. Gonadal development is secondary to infertility. After a few years, menstruation is gradually rare until amenorrhea.
3. Ovulation, typical POF has hot flashes, hypogonadal performance, such as night sweats, constipation, hair loss, vaginal dryness, sexual pain, decreased libido, hypothyroidism, urinary tract infection, weight gain, anxiety, suspicious and so on.
4. Breast atrophy, sagging skin, rough, nervous, dreamy, suspicious, palpitations, osteoporosis, joint pain, uterine ptosis, urinary incontinence, constipation, acne, pigmentation, genital inflammation (including genital, vagina, Cervicitis, pelvic inflammatory disease, genital tuberculosis, etc.
Examine
Examination of premature ovarian failure
Laboratory inspection:
1. Electro-immunoluminescence assay: E2 < 5g / L, FSH > 13 / L, LH > 301u / L, PRL is normal.
2. Pituitary stimulation test can identify polycystic ovary, T <5ng / dl.
3. The ELIS method measures antibodies to identify the presence of autoimmune problems.
4. Estrogen withdrawal test is often positive. Blood estrogen levels are low (usually below 20 pg/ml), blood FSH and LH increase, and FSH rises earlier than LH.
5. Ovarian biopsy: If there are still follicles present, it may be that the ovary lacks FSH receptor and lacks response to gonadotropin, a condition known as ovarian insensitivity syndrome. Ovarian biopsy is generally not recommended because ovarian insensitivity syndrome is less common and there is less chance of pregnancy.
6. B-ultrasound: shows that the ovary is small, no follicles are premature ovarian failure; the ovary is normal size, and many small follicles are seen as non-responsive ovarian syndrome.
7. Laparoscopy: ovarian premature aging can be seen small ovarian, atrophy, follicles are not obvious, no primordial follicles, ovarian interstitial fibrosis.
Diagnosis
Diagnosis and diagnosis of premature ovarian failure
In 1967, Moraes-Reuhsen proposed that amenorrhea, perimenopausal syndrome or menopausal symptoms, low estrogenemia and hypergonadotropinemia can be diagnosed as premature ovarian failure before the age of 40. In 1973, Goldenberg proposed that blood FSH340IU/L is hypergonadotropinemia. However, several studies have subsequently confirmed that a single FSH > 40 IU / L as evidence of follicular failure is wrong. Therefore, the current worldwide diagnostic criteria for premature ovarian failure are: (1) Age <40 years. (2) Amenorrhea time 6 months. (3) Two times (over 1 month interval) blood FSH> 40mIU/ml. Therefore, the diagnosis of premature ovarian failure is not difficult, more importantly, to identify the cause of premature ovarian failure as much as possible to guide clinical treatment.
In addition to the above clinical manifestations, medical history, auxiliary examination can indicate possible causes, all patients should be examined as follows:
1. Chromosome examination: ovarian failure caused by abnormal chromosomal abnormalities.
2. Screening of autoimmune diseases and related diseases: thyroid function: T3, T4, TSH; adrenal function: cortisol, ACTH; diabetes: fasting blood glucose; autoantibodies: anti-nuclear antibodies, anti-thyroid microsomal antibodies, anti-thyroid Globulin antibodies, anticardiolipin antibodies, rheumatoid factors, and the like. Screening for blood routine, erythrocyte sedimentation, and urine routine should also be performed.
3. POF combined with central nervous system symptoms should be performed by nuclear magnetic resonance imaging of the pituitary to exclude pituitary tumors.
4. Determination of bone density: Common methods include single photon absorption, dual energy X-ray absorption, quantitative CT and ultrasonography, etc. Reference to normal bone density values can be used to diagnose osteoporosis.
Identification with polycystic ovary
With menstrual disorders, amenorrhea, no ovulation, hairy, obesity, infertility and bilateral ovarian enlargement cystic changes, known as polycystic ovary syndrome. Patients may have the above typical symptoms, but also some symptoms, but infertility due to ovulation disorders is the main clinical manifestations of polycystic ovary syndrome. Polycystic ovaries can be identified by pituitary stimulation tests.
