Premature Ovarian Failure (POF), also known as Premature Ovarian Insufficiency (POI). POF is characterized by the loss of normal ovarian function before the age of 40, leading to infertility, irregular periods, and menopause-like symptoms.(1,2,3)

it is suggested that genetic disorder, autoimmune origin, toxins, and environmental factors, as well as personal lifestyles, may be risk factors of developing POI. (3)

Symptoms can manifest as estrogen deficiency, with lack of regular menses or shorter menstrual cycles, , hot flushes, night sweats, sleep disturbances, vaginal tissue changes, low libido, and lack of energy. (3)

The symptoms can appear similar to PCOS where there is irregular cycles and hence proper assessment with blood work can help in accurate diagnosis.

Asssesment of POI:

FSH is considered the gold standard test for POI, and will be elevated on day 3, or mid luteal phase.

FSH + Age (+ AMH) is a predictor of ovarian reserve. Young women with elevated FSH can still have a high percentage of quality eggs, but lower total ovarian reserve.AMH levels are a measure of future reproductive capacity. AMH levels are usually low in women with POI.

Women with POI are at an increased risk of in-pregnancy complications including hypertensive disorders of pregnancy (Han 2021) and miscarriage risk. Progesterone supports may be required in those who are pregnant early on.

How naturopathic medicine can help in Premature ovarian insufficiency?

Naturopathic medicine can fill in the gaps in conventional care by looking into the underlying cause for POI and support these areas.

Underlying causes: Lifestyle and environment (4)

Cortisol: POI could be related to HPO axis dysfunction from excessive stress, prolonged fasts and limited diets in atheletes, autoimmune conditions etc and hence investigating and addressing these from a holistic perspective.

Toxins: Toxic exposures such as BPA, Pthalates, PCB’s and heavy metals such as lead, arsenic and cadmium have shown to impair ovarian health leading to premature menopause.

Every patient in my practice who is looking for fertility goals or ovarian health, we provide a complete handout and an extensive list of green products that are ewg certified and available in Singapore.

Other lifestyle factors such as alchol, smoking and unhealthy body weights- obesity or low body weight both have been implicated in ovarian dysfunction and fertility decline.

Air pollution is another factor. Women living in areas of high levels of air pollution have a higher risk of ovarian ageing.

Deficiencies in Vitamin D, folate, B vitamins, zinc, and selenium have been associated with an increased risk of ovarian dysfunction. For example:

Vitamin D deficiency is common in women with POF and may impair the function of the ovaries.

Folic acid, commonly known for its role in fertility, is also crucial for ovarian health and can potentially protect against early ovarian failure.

Antioxidants: Oxidative stress is a known contributor to follicular depletion and ovarian aging. Antioxidants, such as vitamin E, vitamin C, and beta-carotene, help mitigate oxidative damage and protect ovarian cells from apoptosis (cell death), which could prevent premature ovarian failure.

Physical Activity and Exercise

Excessive Physical Activity: The study notes that while regular exercise is essential for overall health, excessive physical activity (particularly in athletes) can lead to amenorrhea (the absence of menstruation) and reduced ovarian function. Overtraining can increase stress hormones like cortisol, which, in turn, affects ovarian function by disrupting hormonal balance.

Moderate Exercise on the other hand, is shown to improve general well-being and hormonal balance. It can help reduce stress and inflammation, both of which are important for maintaining ovarian health.

Cigarette smoking is one of the most significant lifestyle factors that accelerates ovarian aging. Smoking is known to cause oxidative damage and reduce ovarian reserve, potentially leading to earlier menopause and reduced fertility. Smoking is also linked to increased levels of toxins in the body, which can directly harm the ovaries.

Alcohol: Excessive alcohol consumption can disrupt hormone levels and contribute to liver damage, which impacts the metabolism of hormones like estrogen. Chronic heavy drinking has been associated with a higher risk of early menopause and may contribute to POF.

A holistic approach that integrates these lifestyle changes and particularly the combination of certain herbs and nutrients such as melatonin, DHEA, etc along with acupuncture, has shown to be effective in managing POI by improving ovarian function and hormonal balance. These treatments offer a promising alternative or adjunct to conventional hormone therapy, with evidence supporting their efficacy and safety.

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