How perimenopause, menopause and primary ovarian failure can be misdiagnosed?

Many women come to us worried about menopause. They can be in their twenties, thirties and forties. They are experiencing the common symptoms — irregular periods, missing periods, hot flashes, vagina dryness, low sexual desire — and their hormone test results usually show high FSH and LH, and low oestradiol. Most have been prescribed HRT (hormone replacement therapy) and some have been taking it. 

You may be wondering why women as young as in their twenties might be diagnosed with menopause (or premature ovarian failure), but this is to do with its definition. In Western medicine, it is not about the age of a woman, but about her hormones and periods: A woman has menopause if she has high FSH and her periods have been missing for a consecutive 12 months. If she fulfils both criteria, then she gets diagnosed as being in menopause. The term perimenopause is used when the woman has not quite met all the diagnostic criteria yet, eg she still has periods but they are highly irregular. The message here is that, menopause will come soon.

But a perimenopause, menopause or primary ovarian failure diagnosis can be wrong: These conditions share much of the same diagnostic criteria as severe hormonal balance. A woman who suffers from severe hormone imbalance may also have irregular periods, missing periods, hot flashes, vagina dryness and low sexual desire. Their hormone test results usually show high FSH and LH, and low oestradiol, just as women with perimenopause, menopause or primary ovarian failure. It is thus easy for severe hormone imbalance to be misdiagnosed as a woman’s no longer having any egg reserve, or menopause.

How primary ovarian failure occurs


Research has shown that stress can impact on periods. In extreme cases, stress can reduce the age that menopause begins. Stress impacts hormonal productions by increasing endorphins and cortisol (an important stress hormone), which leads to abnormal menstrual cycles. In extreme cases, menstrual cycles can completely stop.

Prolonged Breastfeeding

An increasing number of women seem to be breastfeeding their newborn babies for an unusually long periods, sometime over a year. Some came to us saying that their periods have become highly irregular or completely missing. Breastfeeding requires a raised level of prolactin. High prolactin suppresses Oestradiol and may raise FSH making menstruation and ovulation highly unlikely. When a woman is in this state for a long time, she may find that when she eventually stops breastfeeding, her abnormal hormonal pattern may fail to revert to a normal pattern. As a result, her highly irregular or missing periods remain.

Autoimmune origin

We can also see, from research, that a small number of primary ovarian failure cases are associated with autoimmune origin. Patients typically have arthritis like symptoms such as joint pains, swelling and stiffness. It is noteworthy that traditional Chinese medicine (TCM) has been proven by scientific studies to work well with some autoimmune diseases — see our resources page for more.

What is the usual treatment from Western medicine?

In Western medicine, once menopause is diagnosed, HRT (hormone replacement therapy) is offered. It is not a treatment as it will not reverse the menopause. It supplies your body with hormones you’re not producing. It does not encourage your organs to function better so that they go back to making the right hormones to bring your natural periods back. Instead, they are designed to deal with symptoms such as vagina dryness, and risks that may associate when you no longer have natural periods, like maintaining the thickness of your uterus and your bone density. It carries its own risks however such as higher chances of ovarian cancer.

Although HRT is not a contraceptive, once you are on HRT, it is highly unlikely that you will be able to get pregnant.That is why endocrinologists usually recommend stopping HRT if a woman still wants to have a child.

Can PRP help with primary ovarian failure?

Some of our patients have tried PRP (platelet-rich plasma injections) before they come to us, thinking PRP will regenerate their ovaries and bring back their natural periods.

PRP is a procedure that helps support wound healing and joint injury. The technique is also used to for male pattern baldness, by stimulating the growth of hair transplants, and to enhance other cosmetic procedures.

It is unclear how PRP can help to regenerate ovaries. After all, in the case of early menopause, the problem is not a physical one — the ovaries are not injured. The ovaries simply cease to function properly and they are not responding to the stimulation from the brain, as we’ve explained in a previous blog.

Patients told us that after PRP, they are often asked to check their AMH levels. It should be clear that primary ovarian failure is not diagnosed by AMH level. It is diagnosed by checking FSH and LH, as high levels of these two hormones can stop periods completely. AMH does not impact periods. We at TCM Healthcare see many women with very low AMH who have regular periods. This is why the test to see if treatment for early menopause or primary ovarian failure should be checking that FSH and LH levels have lowered.

Some other women who go for PRP thinking it will regenerate their ovaries hope that it will increase their low AMH levels. This often doesn’t work as these women already have periods, so their ovaries are working fine already — the issue is not the egg reserve. What actually needs to be done is to improve the key reproductive hormones so that good quality eggs are produced. A successful natural pregnancy is not the result of multiple eggs being impregnated. It is about one good-quality egg being impregnated. The focus, therefore, should be quality, not quantity.

How to know if my primary ovarian failure diagnosis is correct

As menopause and severe hormone imbalance share similar symptoms, it is easy to see that the wrong diagnosis can sometimes or indeed often be made.

In short, you can’t be certain that you have the wrong diagnosis, but the diagnosis is likely to be questionable if:

  • You are not in menopausal age — 45 or over
  • Your high FSH is triggered by traumatic events, which can cause severe and chronic stress, like the death of a loved one
  • You have been subject to highly stressful situations for a sustainable period of time, for whatever reason
  • You had a history of prolonged breastfeeding
  • Your Oestradiol is high, instead of low

Ultimately, the only sure way to find out if you really are in menopause is to see if your periods can come back, and if they do, be maintained at a reasonable level. For example, if your periods come back every 2 or 3 months, you are not in menopause by definition (as menopause means not having any periods for 12 months). Basically, the only sure way to see if you have menopause is to try some sort of treatment, such as with traditional Chinese medicine, and see if your periods return.

Traditional Chinese medicine success with primary ovarian failure

The reason why we at TCM Healthcare believe we can help women with primary ovarian failure is because, in many cases in our over 20 years’ experience, the diagnosis is wrong. These women we’ve treated were, in fact, suffering from severe hormone imbalance (such as from chronic or extreme stress) and weren’t in perimenopause nor menopause.

Traditional Chinese medicine has a long tradition of focusing on health, rather than illness. Our approach is to nurture, replenish and improve the functioning of the organ systems responsible for key reproductive hormone production by using herbal medicine. We have an excellent track record and numerous testimonials from women who’ve not only seen their periods return, but also managed to get pregnant naturally after treatment with us.

Our success rate in improving hormones is 80%. We track our patients’ progress by asking for up-to-date hormone test results (less than 3 months old) before treatment (we can help arrange hormone tests), and then check them again 3 months after treatment. We also consult our patients monthly to monitor their symptoms and experience: We find that our primary ovarian failure patients start getting signs of periods — back pain, cramping, or even blood spotting — as their hormones return to their normal levels, before they get their periods back.

To read reviews from our patients, click here.

If you want to read stories about some of our patients’ fertility journeys, click here.

And to learn about our treatment protocol for primary ovarian failure, click here.

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Late cancellation fee £50
We appreciate that you might not be well or have urgent matters to attend. As a result you may have to postpone the appointment. We would like to have at least 24 hours’ advance notice. A late cancellation fee of £50 is payable if advance notice is not given.

Are there patients we cannot help?

Yes. No medical system is foolproof and medical practitioners, however good, are not omnipotent. As great as our success rates are, they are not 100%. There are times patients do not respond to our treatments despite our best efforts.

Delayed improvements are possible when patients rest a little. However, even with rest, patients may still not respond well. Fortunately, these cases are in the minority. We minimise the number of these cases by trying to understand our patients’ conditions as much as possible before taking them on. We minimise time and financial commitments from patients by insisting they have hormone or sperm test results prior to treatment, and to get retested after 3 months — following our evidence-based approach.

At TCM Healthcare, we will always have your best interests in mind and we will do our best.