Beware of amenorrhea caused by premature ovarian failure before the age of 40

Ovarian dysfunction, unable to respond to gonadotropins and synthesize sex hormones, resulting in low ovarian sex hormone levels and no cyclical changes in the endometrium, leading to amenorrhea. This situation often occurs before the age of 40, and is caused by high gonadotropin-induced amenorrhea due to ovarian failure, also known as premature ovarian failure.

Premature ovarian failure is a condition in which the ovaries have low function or cannot synthesize sex hormones, which reduces the negative feedback on the hypothalamus-pituitary axis, resulting in increased gonadotropins and decreased estrogen levels. A survey of 1,850 women born between 1930 and 1950 found that the incidence of this disease was 0.09%, accounting for 20%-28% of primary amenorrhea and 4%-20% of secondary amenorrhea.

So far, the exact cause of premature ovarian failure is still unclear, and it may be a syndrome caused by multiple factors, including cellular and molecular genetic factors, immune factors, hypogonadism caused by enzyme deficiency, iatrogenic premature ovarian failure, and infectious factors.

Infectious factors are often seen in childhood and adolescence when a woman has mumps, which can be complicated by viral oophoritis, leading to partial or complete loss of ovarian function and premature ovarian failure. Severe suppurative, tuberculous, and gonococcal pelvic inflammatory diseases can also cause ovarian dysfunction.

Premature ovarian failure is not irreversible. There are still many cases of natural remission and successful drug-induced ovulation. The traditional concept is that patients with premature ovarian failure have ovarian failure and very few follicles grow. In recent years, many scholars have found that premature ovarian failure is not irreversible. About 25% of patients may recover follicle growth within 1-5 years. The clinical application of assisted reproductive egg donation technology brings new hope to patients who have failed drug-induced ovulation. Therefore, patients who want to have children should not give up treatment.