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Acupuncture is effective for premature ovarian insufficiency (POI)

Premature ovarian insufficiency (POI) is a condition where a woman experiences a decline in ovarian function before the age of 40, leading to infertility. This condition is characterized by elevated levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and low levels of estradiol (E2). POI can cause menstrual disturbances, menopausal symptoms such as hot flashes, night sweats, and insomnia, and also increase the risk of decreased bone mineral density and cardiovascular disease. The incidence of POI is approximately 1%–5%.

The European Society of Human Reproduction and Embryology (ESHRE) has developed guidelines for diagnosing POI. The diagnostic criteria include age under 40 years, oligo/amenorrhea for at least 4 months, and elevated FSH levels of over 25 mIU/ml on two occasions over 4 weeks apart. While the exact causes of POI are not yet clear, they could be related to gene factors, iatrogenic causes, autoimmunity, unhealthy lifestyle, and psychological stress.

Currently, hormone replacement therapy (HRT) is the primary way to treat POI in Western medicine. However, in China, acupuncture is suggested as a good candidate for improving ovarian function for women with POI who want to have children. Clinical research has shown the effectiveness of acupuncture in treating POI. Acupuncture treatment can improve clinical symptoms, slow down female genital atrophy, regulate hormone levels, and improve pregnancy rates.

For example, a study analyzed eight randomized controlled trials before 2014. The results showed that acupuncture significantly lowered serum FSH levels, and more women who received acupuncture reported the resumption of menses. Another study focused on the effect of acupuncture on POI. A total of 66 patients with POI were randomly divided into an observation group and a control group and treated for three menstrual cycles. After treatment, the serum levels of FSH and LH were decreased, and the levels of E2 were increased. The serum level of anti-Mullerian hormone (AMH) and antral follicle count (AFC) in the observation group were higher than those in the control group, suggesting that acupuncture treatment was effective in improving ovarian function in POI patients.

A more recent study found that after 12 weeks of acupuncture treatment, there was a significant improvement in patients with POI. Their anxiety levels were reduced, and FSH and LH levels decreased, while the AFC increased. The endometrium became thicker, and menstrual symptoms were improved, indicating that acupuncture therapy was effective in improving ovarian function and low estrogen symptoms in POI patients.

In conclusion, POI is a condition that affects a woman's fertility and has various symptoms and potential health risks. While HRT is the primary treatment in Western medicine, acupuncture has shown promising results in improving ovarian function and reducing symptoms and improve conception rates in POI patients.

References

Yang Fu et al Evid Based Complement Alternat Med. 2022; 2022: 9053930.

Junyoung Jo  et al Evid Based Complement Alternat Med. 2015; 2015: 842180.

Lin-Lin Wang et al  Zhongguo Zhen Jiu 2021 Jul 12;41(7):742-6.

Ting-ting Zhao et al Zhen Ci Yan Jiu 2022 Jul 25;47(7):617-24.

Acupuncture provides hope for conceiving in women with premature ovarian failure

Menopause is a natural biological process that occurs in women as they age, typically beginning in their 40s or 50s. During menopause, a woman's ovaries stop functioning, resulting in no egg supply and no ovulation. Hormone levels also change during this time. The signal for menopause is typically a stopped period, which indicates the end of fertile life for a woman.

However, for some women, their ovaries may stop functioning before the age of 40. This condition is known as premature ovarian failure (POF), premature menopause, or hypergonadotropic hypogonadism. POF occurs due to premature exhaustion of the follicle pool or follicular dysfunction, such as mutations in the follicle-stimulating hormone (FSH) receptor. This condition is relatively common, affecting 1-2% of women younger than 40 and 0.1% of women younger than 30. The cause of POF can be genetic, with a family history present in 10-20% of women with POF. It can also be due to poor ovarian blood supply or autoimmune damage. Additionally, cancer therapies can damage the ovaries.

The main symptoms of POF include irregular periods, low blood estrogen levels, and high FSH levels in women under the age of 40. The Anti-Mullerian hormone (AMH) level is also low in these cases. Oestrogen is produced by follicles, and if the follicles are short in supply or dysfunctional, the blood level of oestrogen will be low. FSH, produced in the pituitary gland at the base of the brain, stimulates follicle growth. If a woman is running out of eggs in her ovaries due to POF, resulting in low levels of estrogen, the pituitary gland will work hard to produce more FSH to stimulate the ovaries to make more good eggs. AMH is produced only in small ovarian follicles and its level is quite constant, strongly correlating with the number of growing follicles. Since this hormone is not dependent on hypothalamic-pituitary-gonadal axis function and decreases to an undetectable level at menopause, it could potentially help assess remaining ovarian function and egg supply.

Women with POF may experience menopause symptoms, such as hot flushes, night sweats, and vaginal dryness, similar to those going through a natural menopause. POF can result in many health problems, such as osteoporosis and heart disease. The loss of fertility is associated with the development of POF, which is often due to the absence of follicles or the inability of remaining follicles to respond to stimulation. For most women, there are no obvious signs before the cessation of periods. Most women have a normal period history and fertility before the onset of POF symptoms. A common presentation is for women to fail to resume their periods after a pregnancy or after stopping oral contraceptive pills. For most women, the diagnosis of POF is deeply upsetting, not only due to the unpleasant symptoms but also due to infertility. It can have a significant psychological impact on those diagnosed with this condition. While many women with POF may ovulate at some points, it cannot be reliably predicted.

While there are treatments available to manage symptoms, no proven medication exists to improve a woman's ability to conceive. However, traditional Chinese medicine (TCM) offers an alternative approach to treating POF that could help women conceive naturally.

According to TCM theory, POF is caused by kidney qi deficiency, with liver and spleen qi deficiency also contributing. This qi deficiency leads to blood stagnation and blockage of meridians, resulting in the ovaries losing function. Acupuncture can help unblock meridians, restore qi flow and blood supply to the ovaries. From a Western medicine perspective, acupuncture can improve the function of the hypothalamic-pituitary-ovarian axis, regulate blood hormone levels, increase ovarian blood flow and regulate nervous system function.

In a case report on a Chinese acupuncture website, 76 POF patients aged 26-40, diagnosed for 1-9 years and treated from 1990-1996, were given acupuncture treatment for six months. Sixty-eight percent of patients restored normal period, ovulation or pregnancy, while FSH level decreased to normal and oestrogen level increased significantly.

Recent research has also provided evidence of the effectiveness of acupuncture on POF. Kehua Zhou et al investigated the effects of acupuncture on FSH, oestrogen (E2) and LH in 11 women with diagnosed POF for 4 months to 10 years, aged 25-39, who had no menstrual period for at least four months or longer. Before acupuncture treatment, they stopped all medications that could affect hormones. After treatment, E2 increased while FSH and LH decreased, which persisted at the end of three-month follow-up. Ten out of 11 patients resumed menstruation, with nine still menstruating at the end of follow-up. Symptoms such as night sweats, hot flashes and mood swings were reduced during acupuncture treatments and at the end of follow-up.

One significant advantage of acupuncture treatment for women with POF is that it not only improves symptoms caused by POF but also increases fertility. Unlike Western medicine, which typically relies on donor eggs, acupuncture treatment offers women with POF the potential to conceive naturally using their own eggs. While more research is needed to validate these findings, acupuncture may offer a promising alternative or complementary treatment for women with POF.

References

http://www.wfas.org.cn/lunwen/wfas10/200709/1055.html

Kehua Zhou et al Evid Based Complement Alternat Med (2013) 2013: 657234 Published on line 2013 Feb 28 

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