Case Study: 36-year-old Female Patient with
Premature Ovarian Failure (POF)

by Ray Rubio, D.A.O.M., L.Ac., Dipl. Ac., Dipl. CH, FABORM

Susan originally presented at my office at the age of 35 with a 12-year history of ulcerative colitis. She had been on low-dose prednisone for most of that period to control the inflammation and bleeding, as well as Asacol and Rewasa suppositories. During this time she had been hospitalized three times and her symptoms were barely under control most of the time. Her symptoms and signs included abdominal cramping and bloating, urgent and loose stools with blood and mucous, fatigue, depression, nausea, and a feeling of cold. She also had a past history of asthma that was always worse in the winter.

Her tongue was tender and pale, and the coating was wet. Her pulse was thin, weak, and deep, especially in the right guan, left guan, and both chi positions, with a slippery-tight quality in each lower jiao. Her TCM diagnosis related to her ulcerative colitis was Kidney yang and Spleen qi deficiency and Liver blood deficiency with lingering damp-heat in the Large Intestine.

I treated Susan for most of the next year on a weekly basis with herbs and acupuncture to help her bring her ulcerative colitis under control and to help her get off of her medications – both of which were her stated goals when she first came to me. Over the year of treatment, many herbs to clear heat and drain damp were employed, as well as herbs to fortify the Spleen qi and Kidney yang. Gradually Susan felt stronger and healthier, her stools normalized, and she was able to discontinue her medication. However, concurrently during this year of treatment, Susan’s menses unexpectedly stopped – right about the time, or soon thereafter getting off of her prednisone. She also started to develop some menopausal symptoms such as hot flashes, vaginal dryness, night sweats, insomnia, irritability, and joint pain. She was obviously concerned, and so was I.

I referred Susan to a reproductive endocrinologist that I work closely with and after some testing her results confirmed our worst suspicions: Susan’s ovaries were failing. Susan’s follicle stimulating hormone (FSH) levels were very high at 109 mIU/mL – with normal level for a reproductive female being <10 mIU/mL. With Susan’s perimenopausal signs and symptoms combined with this high serum FSH level, and with her lack of any menses for the previous 6 months, Susan was given the heart-breaking diagnosis of Premature Ovarian Failure (POF). Even though she was only 36 years old, she was informed that her childbearing years were over and that she should look into either an egg-donor or adoption if she hoped to have a family. Just to be sure of the diagnosis, a repeat FSH was drawn 60 days later, and the levels were still above 100.

When Susan came to me in tears with the news of her presumptive diagnosis, I could tell how distraught she was. Susan came from a large family and despite the fact that she was not currently in a relationship, she still held out the hope of having a family of her own one day. She looked at me with reddened and sad eyes and asked if there was anything I could do to help. Because she had had such success with TCM in the treatment of her ulcerative colitis, she thought there might be hope for her POF despite what the doctor had told her. I didn’t have the heart to tell her that I had personally never encountered a woman with a FSH that high at her age. Yes, I had definitely dealt successfully with many women diagnosed with diminished ovarian reserve who were undergoing treatment for infertility with IVF or IUI, but their FSH levels were considered high at 14-20 mIU/mL. Susan’s was 109 mIU/mL! Also, these other patients were having regular menstrual cycles, whereas Susan had not had a period in close to six months. Furthermore, she was exhibiting all the signs of premature menopause. Lastly, I knew that if we were to have any hope of helping to return the tide of Susan’s menses, and restore her ovarian function, it would require large and long term doses of rich tonic herbs. Given her history of bowel disease, I was not sure that her system would be able to handle this. However, if she was willing to give it a try, I was determined to give it my best. The following is a summary of Susan’s TCM diagnosis, treatment principle, acupuncture, and herbal medicine:

TCM Diagnosis
Kidney and Liver yin and blood deficiency with empty heat and dryness of the Chong and Ren meridians. Underlying Spleen qi deficiency.

Treatment Principle
Tonify the Kidney and Liver yin and blood, clear empty heat, replenish the Chong and Ren. Protect and support the Spleen qi.

Acupuncture
Sanyinjiao (SP 6), Lougu (SP 7), and Yinglingquan (SP 9) – this combination is called the 3 Emperors in the Tong Family style of acupuncture and they are said to simultaneously replenish the Spleen and Kidneys. Liexie (LU 7) and Zhaohai (KI 6) to open the Ren meridian. Gongsun (SP 4) and Neiguan (PC 6) to open the Chong meridian. Qichong (ST 30), Qixue (KI 13), Guanyuan (CV 4), Yinjiao (CV 7), and Chengjiang (CV 24) all of which are intersecting points on the trajectory of the Chong meridian. Dazhu (BL 11), Geshu (BL 17), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Mingmen (GV 4), and Xuanzhong (GB 39) – all of which help to replenish the marrow and blood. Taibai (SP 3), Zusanli (ST 36), Shangjuxiu (ST 37), and Zhongguan (CV 12) – all of which fortify and protect the Spleen, thereby producing post-heaven qi and essence. And of course, Taixi (KI 3), the Earth point on the Water/Kidney channel which therefore builds the Kidney energy while simultaneously fortifying the Earth/Spleen and Stomach energies.

*Notes: The points above were mixed and matched with variations from treatment to treatment based upon Susan’s symptoms and signs. Not all of the above points were used at every session.

Chinese Herbal Medicine
Zhi Bai Di Huang Tang with additions

Results of Treatment
To my great surprise and Susan’s pleasure, the vast majority of her menopausal symptoms, such as hot flashes, joint pain, night sweats, vaginal dryness, and insomnia, were resolved within the first 30-40 days of treatment. Within three months of beginning treatment, her periods had started again and remained on regular 28-day cycles from there forward. Within 9 months of beginning treatment, with no more menopausal symptoms and regular periods for the previous 6 cycles, I recommended to Susan that she repeat her day-3 serum FSH levels. To our great astonishment and delight, her new serum FSH levels came back at 9.1 mIU/mL, with normal reproductive levels being <10 mIU/mL. A drop of over 100 points in only 9 months. We repeated the test two-cycles later just to be sure, and the results were virtually the same – FSH at 9.0 mIU/mL.

About the Author:

Ray Rubio, D.A.O.M., L.Ac., Dipl. Ac., Dipl. CH, FABORM

Dr. Ray Rubio has been in private practice at Westlake Complementary Medicine in Los Angeles for over a decade, and was on the clinical staff at the Toluca Lake Health Center – a multidisciplinary outpatient medical clinic – for half of that time. Dr. Rubio’s specialty is Women’s Health, with an emphasis in Reproductive Medicine and the treatment of infertility. He works both with patients who would prefer to conceive naturally, and those who will be utilizing Assisted Reproductive Techniques (ART). He speaks to infertility support groups on a regular basis and is a member of the American and Pacific Societies for Reproductive Medicine (ABORM). He is currently in the process of conducting a clinical trial on the treatment of diminished ovarian reserve with Chinese Herbal Medicine in patient undergoing IVF.

To learn more about infertility, Dr. Ray Rubio is speaking on the following topic for Lotus Institute. The class is approved for 8 CEUs/PDAs by the California Acupuncture Board, Illinois Acupuncture Board, and NCCAOM.

Class by the Author:

Male and Female Infertility: Tx Strategies & Clinical Pearls

• 8/23/09 Oakland, CA