Heavy: How to deal with premature ovarian failure, the latest guidelines for four major breakthroughs in diagnosis and treatment

Premature ovarian failure is the most painful scar in the hearts of many sisters, and many guidelines and consensus on the treatment plan for premature ovarian failure are often difficult to solve the fundamental pain point
.

In July 2022, the Obstetrics and Gynecology Professional Committee of the Chinese Society of Integrative Medicine organized national experts in Chinese medicine, Western medicine, obstetrics and gynecology of integrated Chinese and Western medicine, evidence-based medicine experts and pharmaceutical experts to formulate guidelines for the diagnosis and treatment of early-onset ovarian insufficiency with traditional Chinese and Western medicine
.

Today, I will take you to learn this latest guide to see what diagnosis and treatment solutions
are worth learning for the sisters of Progeria.

01The diagnosis and treatment population targeted by this guideline

The definition of premature ovarian failure varies from
guideline to guide.

The target of this guideline is mainly to prolong menstrual cycles, irregular cycles, decreased menstrual flow, and oligomenorrhea to amenorrhea for at least 4 months before
the age of 40.

All four of the above points are indispensable
.

The incidence of this premature ovarian failure is 1% globally and about 2.
8%
in China.

These sisters are often associated with low fertility or even infertility, and can increase the risk of osteoporosis and cardiovascular disease, seriously affecting the physical and mental health, family happiness and social stability
of patients.
Common causes involve genetic abnormalities, autoimmunity, infection, metabolic/enzyme dysfunction, iatrogenic factors, psychosocial, living environment and physiological factors
.

From the perspective of traditional Chinese medicine, the premature decline of ovarian function in women with premature ovarian failure is related to
their kidney deficiency, insufficient decency and gradual failure.
Depending on the etiology, manifestations such as developmental defects of the cardiovascular system, intellectual disability, abnormal development of sexual characteristics, adrenal and thyroid hypofunction, and recurrent miscarriage
may occur.

02TCM treatment methods recommended by this guideline

(1) 100% consensus plan: nourish the liver and kidneys, nourish blood and regulate menstruation

Recommended Medications:

Zuo Gui Pill ("Jingyue Quanshu") (B-level evidence, strong recommendation, consensus 100%)

Composition of prescription medicine:

Ripe rehmannia, yam, dogwood, dodder seed, deer antler gum, goji berry, Sichuan hyssop

Recommended proprietary Chinese medicines:

Kun Baomaru (Level III evidence, strong recommendation, consensus 95.
24%)

(2) 87.
5% consensus plan: tonify the kidney and benefit the sperm

Recommended Medications:

Erxian soup combined with two to pills plus He Shou Wu, keel, oysters (level III evidence, strong recommendation, consensus 75.
00%)

Composition of prescription medicine:

Fairy Mao, Epimedium, Angelica, Bayantian, Huangbai, Zhimu, Ink Lotus, Female Privet, He Shou Wu, Keel, Oyster

Recommended proprietary Chinese medicines:

Kirin Pill (B-level evidence, strong recommendation, consensus 87.
50%)

(3) Consensus 85.
71% program: warm kidneys and help yang, nourish blood and regulate menstruation

Recommended Medications:

Yougui Pill ("Jingyue Quanshu") (B-level evidence, strong recommendation, consensus 100%)

Composition of prescription medicine:

Cooked rehmannia, aconite, cinnamon, yam, dogwood (made from wine), dodder seeds, deer antler gum, goji berries, angelica, eucommia (stir-fried with salt)

Recommended proprietary Chinese medicines:

Right return pill (level III evidence, strong recommendation, consensus 100%)

(4) Consensus 85.
71% program: nourish yin and nourish blood, traffic heart and kidney

Recommended Medications:

Heavenly King Tonic Heart Pill ("Rebirth Secret Anatomy") (Level III evidence, strong recommendation, consensus 88.
88%)

Composition of prescription medicine:

Ginseng, ginseng, angelica, asparagus, wheat dong, salvia, poria, schisandra, yuanzhi, bellflower, jujube kernel, rehmannia, cinnabar, cypress kernel

Recommended proprietary Chinese medicines:

Tianwang Tonic Pill (Level III evidence, strong recommendation, consensus 83.
33%)

Kuntai capsules (B-level evidence, weak recommendation, consensus 77.
77%）

03 Western medicine HRT treatment

Western medicine treatment is also a third-level evidence, strongly recommended, and the consensus degree has reached 100%.

It mainly refers to the Expert Consensus on Hormone Replacement Therapy for Early-onset Ovarian Insufficiency and the Clinical Application Guidelines for Menopausal Management and Hormone Replacement Therapy (2012 Edition).

Western medicine recommends the following regimens:

(1) Continuous sequentiality

Sequential treatment with fenmorphon, 1 tablet per day in order, and start the next box directly after using 1 box, without stopping the drug
in between.

(2) Cycle sequentiality

Sequential treatment with Kelimon is followed by 1 tablet per day in order, discontinue the drug for 7 days after using 1 box, and start taking the next box
.

(3) Continuous union

Tibolone (2.
5 mg) may be used once
daily.
Topical vaginal estrogen application to improve symptoms of
urogenital atrophy.
Vaginal medication, once a day, after 2 weeks of continuous use of symptoms relief, change to 2~3 times
a week.
Long-term solitary users should regularly monitor the endometrium
.

04Long-term management of premature ovarian failure

We must be clear that the management of premature ovarian failure should not stop at holding the baby, lifelong health management is especially important, holding the baby is only a stage of life, if you want a happy family and a thriving baby, a healthy mother is particularly important
.
Therefore, please pay attention to the full life cycle management of premature ovarian failure, this is absolutely not necessary, do not let down your vigilance, the following discussion please take it seriously!

(1) Lifestyle adjustments (level III evidence, strong recommendation, consensus 100%):

Eat a balanced diet, get adequate intake of vitamin D and calcium, exercise with weights, maintain proper body fat mass, quit smoking, and avoid exposure to reproductive toxins
.

(2) Psychological intervention (level III evidence, strong recommendation, consensus 95.
24%):

What is more meaningful to us in the consensus is that families give psychological support and patients self-psychological counseling, which is very important for disease improvement, and psychological factors are getting more and more attention
.

(3) Long-term health and complication management

Bone densitosis is
recommended.
If osteoporosis is diagnosed, estrogen therapy should be actively supplemented, and other osteoporosis treatment drugs should be added if necessary to prevent bone loss
.

Reduce the adverse effects
of risk factors through a healthy lifestyle.
Early HRT treatment is recommended and continued until mean natural menopausal age
.

From the perspective of premature ovarian failure alone, it may be more effective
to treat it with traditional Chinese medicine or a combination of traditional Chinese medicine and western medicine.
TCM is better at considering premature ovarian failure from a holistic perspective rather than just using hormone replacement
.

All the recommendations of Chinese medicine prescriptions in the guide must be systematically treated under the guidance of professional doctors, Chinese medicine emphasizes individuals, the same two premature ovarian failure, may have completely different
treatment ideas.
Therefore, sisters, do not be afraid of trouble, please be sure to register for medication under the guidance of a professional doctor
.

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