Beneficial Effects of Traditional Chinese Medicine in the Treatment of Premature Ovarian Failure

Premature ovarian failure (POF) or premature ovarian insufficiency (POI) can diminish female fertility potential prematurely. Symptoms of POF include cessation of menstruation, follicular dysplasia, and disruption of elevated follicle-stimulating hormone (FSH), estradiol (E2), anti-Müllerian hormone (AMH), and luteinizing hormone (LH) levels in women before forty. Likewise, it is also accompanied by hot flashes, night sweats, insomnia, psychological distress, sexual dysfunction, and other symptoms similar to menopause. Chemotherapy, autoimmunity, and genetic defects could contribute to POF's etiology.

POF is difficult to prevent and cure. Estrogen therapy and progesterone therapy are used for clinical treatment. Estrogen has been reported to avoid the adverse effects of clomiphene citrate and apoptosis in the ovarian follicles of the mammalian ovary. Melatonin is helpful in the treatment of chemotherapy-induced ovarian dysfunction by reducing oxidative stress levels and preventing apoptosis in the ovarian follicles and oocytes. However, hormone therapy may cause side effects such as obesity, headaches, and even malignant tumors. Therefore, it is necessary to look for alternative forms of treatment.

Traditional Chinese Medicine (TCM) has long been used in China for the treatment of a wide variety of illnesses. Herbal medicine resources in China are abundant, easy to grow, and affordable. Different therapeutic effects could be achieved by mastering different drug combinations. TCM could improve the body's resistance. Menstruation and ovulation could be improved with TCM, as well as perimenopausal symptoms such as hot flashes, sweating, insomnia, anxiety, and osteoporosis. TCM is effective in the treatment of several gynecological disorders such as polycystic ovary syndrome and infertility.

POF was described based on its symptoms as “amenorrhea,” “infertility,” or “menstrual water loss at a young age” among ancient Chinese medical texts. Kidney deficiency (Shen Xu) was one of the primary causes of POF in TCM. Qu et al. asserted that kidney deficiency was the origin, followed by liver stagnation and spleen deficiency based on the etiology and pathogenesis of POF. In addition to strengthening the kidneys and feeding the essence, it was also necessary to maintain the spleen and soothe the liver to treat POF. Several studies and rich clinical experiences had demonstrated that TCM prescriptions were beneficial in treating POF. Zigui Yijing decoction combined with Zishen Yutai pills reduced the level of FSH and LH and increased the level of E2 and AMH. They improved the ovarian blood supply and the thickness of the endometrium in POF patients. With combined medication, POF patients' symptoms such as insomnia, hot flashes, night sweats, and dry mouth and throat were improved. The total effective rate of the treatment groups was 63.6%.

TCM relied primarily on apoptosis, immunity, and aging to treat POF based on the studies of domestic and foreign literature. Zuogui pills inhibited mitochondrial-dependent apoptosis in the treatment of POF. Huyang Yangkun formula regulated the downstream of the Bcl-2 family to resist apoptosis through the aquaporin-1 protein. Modified Bazhen decoction regulated apoptosis in POF by regulating X-linked inhibitors of apoptosis protein. Bushen Tianjing recipe was effective in treating POF by promoting angiogenesis and preventing apoptosis. As for immunity, Bushen Jianpi prescription and Er-Xian decoction cured autoimmunity POF models and increased follicular development-related protein expression. Bushen Huoxue Tang improved ovarian function and reduced ovarian inflammation by regulating the Nrf2/Keap1 signaling pathway and T lymphocytes. Taohong Siwu decoction promoted the proliferation and differentiation of granulosa cells of POF mice by regulating the TGF-β1/Smads signaling pathway. In addition, ginsenoside Rg1 and Jiajian Guisheng formula treated POF by regulating cell aging-related mechanisms. Si Wu Tang treated POF by activating the angiogenesis-related proteins. The goal of this review is to serve as a reference for in-depth research into the treatment of POF with TCM and provide inspiration for new diagnostic methods and treatment options.

Representative references:

1. Li M, et al. Beneficial Effects of Traditional Chinese Medicine in the Treatment of Premature Ovarian Failure. Evid Based Complement Alternat Med. 2022 Nov 26;2022:5413504.

2. Chen S., Zhao Y., Zhang Y. Study on treatment of premature ovarian failure with Zigui yijing decoction combined with zishen Yutai Pills. Journal of Guangzhou University of Traditional Chinese Medicine . 37(01):41–45.