Hoan experienced rapid weight gain, fatigue, darkened and dry skin, hair loss, and irregular menstruation. She visited Tam Anh General Hospital TP HCM, weighing 82 kg, and was diagnosed with class two obesity and visceral fat double the safe limit.

Doctor of Internal Medicine Vo Tran Nguyen Duy from the Department of Endocrinology and Diabetes stated that Hoan exhibited many signs of premature aging despite her young age. Test results showed her estrogen levels were very low, below 10 pg/mL, which is lower than post-menopausal levels. Her female hormone indicators were abnormal, with follicle-stimulating hormone (FSH) levels very high, exceeding 40 IU/L (normal range 7,1-9,9 IU/L). Her ovarian reserve index was below 0,5 ng/mL, indicating almost no egg reserve remaining.

Hoan during a follow-up visit with doctor Duy after weight loss. *Photo: Tam Anh General Hospital*.

According to doctor Duy, Hoan suffered from primary ovarian insufficiency due to autoimmunity, which is rare and often mistaken for common endocrine disorders. "This condition occurs when the immune system mistakenly produces antibodies that attack ovarian tissue, damaging the ovarian follicles and eggs inside", doctor Duy explained.

Ovarian insufficiency leads to a severe decline in estrogen hormone levels. Estrogen, a female sex hormone produced in the ovaries, plays a role in maintaining female sexual characteristics, regulating the menstrual cycle, and supporting pregnancy. A deficiency of this hormone results in premature ovarian aging and increases the risk of dyslipidemia, obesity, diabetes, cardiovascular disease, and osteoporosis.

The doctor prescribed obesity treatment combined with hormone replacement therapy to supplement the deficient estrogen. She used weight loss medication, adjusted her diet, reduced calorie intake, prioritized lean protein, green vegetables, fruits, and exercised 30 minutes daily.

After three months, the patient lost 14 kg, her darkened and dry skin improved, and hair loss stopped. Her goal is to reach 60 kg.

Doctor Duy noted that Hoan's premature ovarian insufficiency meant hormone replacement therapy could alleviate estrogen deficiency symptoms but would not restore her ovarian reserve. Hoan could conceive through egg donation and in vitro fertilization.

Ovarian insufficiency and obesity have a reciprocal relationship: estrogen deficiency contributes to overweight and obesity, while obesity promotes chronic inflammation and oxidative stress. Early diagnosis of ovarian insufficiency requires patients to manage their weight, as the condition increases the risk of osteoporosis and cardiovascular disease.

Duc Hanh

*The patient's name has been changed*