Efficacy and Safety of Huanjingjian Decoction in Women With Premature Ovarian Insufficiency

This study is a prospective, randomized, controlled clinical trial designed to evaluate the efficacy of the traditional Chinese herbal formula Huanjingjian decoction in combination with hormone replacement therapy for the treatment of premature ovarian insufficiency. The primary objective is to determine whether the addition of Huanjingjian decoction to hormone replacement therapy provides greater improvement in clinical symptoms compared with placebo combined with hormone replacement therapy. It is hypothesized that, at 12 weeks, treatment with Huanjingjian decoction in combination with hormone replacement therapy will result in superior clinical outcomes relative to placebo combined with hormone replacement therapy.

• Huanjingjian decoction (Drug): Participants will receive the traditional Chinese herbal formulation Huanjingjian decoction, administered at a dose of one vial (10 ml) twice daily, taken 30 minutes after breakfast and dinner. The intervention will commence immediately following the cessation of menstruation and will continue until the onset of the subsequent menstrual period. Upon the completion of each menstrual cycle, the treatment will be resumed. Each treatment course spans 28 days, with a total of three consecutive cycles administered.
• Hormone replacement therapy (Drug): Participants will begin oral administration of Utrogestan (estradiol valerate) on the 5th day of menstruation at a dose of 1 mg daily for 21 consecutive days. Starting from day 17 of treatment, medroxyprogesterone acetate will be added at a dose of 10 mg per day.
• Placebo (Drug): Participants will take the placebo oral solution at a dose of 10 mL twice daily (30 minutes after breakfast and dinner). The placebo intervention will commence immediately after the cessation of menstruation and will continue until the onset of the subsequent menstrual period. At the completion of each menstrual cycle, the treatment will be resumed. Each treatment course will last for 28 days, with a total of three consecutive cycles administered.

Primary outcomes

• Disease-Specific Quality of Life Assessment [From the time of enrollment through the 6-month follow-up period]: The Chinese version of the Menopause-Specific Quality-of-Life questionnaire (CMS) will be used to assess disease-specific quality of life. This validated instrument demonstrates high reliability, validity, and sensitivity, and is widely recognized as a comprehensive tool for evaluating the physical and psychological well-being of Chinese women during menopause. The CMS is self-administered and uses a Likert-scale format. Each item evaluates the impact of menopausal symptoms experienced in the past month. The CMS includes 29 items across four domains: vasomotor (3 items), psychosocial (7 items), physical (16 items), and sexual (3 items). Respondents first indicate whether a symptom is present; if endorsed, they rate its severity from 0 (not bothersome) to 6 (extremely bothersome). Each item is scored from 1 (not present) to 8 (extremely bothersome). Assessments will be conducted at baseline, 3 months, and 6 months.

Secondary outcomes

• Changes in serum anti-Müllerian hormone (AMH) levels [From the time of enrollment through the 6-month follow-up period]: Assessments will be conducted at baseline, 3 months, and 6 months, with measurements taken on day 3 of the menstrual cycle.
• Change in follicle-stimulating hormone (FSH) levels [From the time of enrollment through the 6-month follow-up period]: Assessments will be conducted at baseline, 3 months, and 6 months, with measurements taken on day 3 of the menstrual cycle.
• Change in luteinizing hormone (LH) levels [From the time of enrollment through the 6-month follow-up period]: Assessments will be conducted at baseline, 3 months, and 6 months, with measurements taken on day 3 of the menstrual cycle.
• Change in estradiol (E2) levels [From the time of enrollment through the 6-month follow-up period]: Assessments will be conducted at baseline, 3 months, and 6 months, with measurements taken on day 3 of the menstrual cycle.
• Antral follicle count [From the time of enrollment through the 6-month follow-up period]: Antral follicle count (AFC) will be assessed by transvaginal ultrasound between days 2 and 5 of the menstrual cycle at baseline, 3 months, and 6 months. Menstruation may be spontaneous or induced with progestin; in cases of persistent amenorrhea, ovarian function assessment will be performed irrespective of the menstrual cycle.
• Ovarian volume evaluation [From the time of enrollment through the 6-month follow-up period]: Ovarian volume evaluation will be assessed by transvaginal ultrasound between days 2 and 5 of the menstrual cycle at baseline, 3 months, and 6 months. Menstruation may be spontaneous or induced with progestin; in cases of persistent amenorrhea, ovarian function assessment will be performed irrespective of the menstrual cycle.
• Menstrual recovery rate [From the time of enrollment through the 6-month follow-up period]: The menstrual recovery rate (%) will be calculated as follows: Menstrual Recovery Rate (%) = (Number of participants with menstrual recovery ÷ Total number of participants) × 100%. Assessment of this outcome will be conducted at 6 months.
• Generic quality of life [From the time of enrollment through the 6-month follow-up period]: Generic quality of life will be assessed using the Short Form-36 Health Survey (SF-36) at baseline, 3 months, and 6 months to evaluate the overall impact of the intervention on health-related quality of life. The SF-36 is a validated and widely used instrument comprising eight domains: physical functioning, role limitations due to physical or emotional problems, bodily pain, general health, vitality, social functioning, and mental health. Scores range from 0 to 100, with higher scores indicating better perceived health status.

Other outcomes

• Number of participants with adverse events as assessed by CTCAE v4.0 （Safety Outcome） [From the time of enrollment through the 6-month follow-up period]: All adverse events occurring throughout the intervention and follow-up periods will be recorded.
• Morisky Medication Adherence Scale (MMAS-8) [From the time of enrollment through the 6-month follow-up period]: The Morisky Medication Adherence Scale (MMAS-8) is a widely used self-reported questionnaire designed to assess patients' medication adherence. The scale consists of 8 items, with a total score ranging from 0 to 8. Higher scores indicate better adherence. A score of 8 indicates high adherence, scores of 6-7 indicate medium adherence, and scores below 6 indicate low adherence. The assessment will be conducted at 6 months.

Sex: Female, ages: 18 Years to 39 Years

Inclusion Criteria:

* Age between 18 and 39 years
* Meet the diagnostic criteria for Premature Ovarian Insufficiency (POI) according to the 2024 ESHRE Guideline on Premature Ovarian Insufficiency

Exclusion Criteria:

* Menstrual disorders attributable to congenital gonadal dysgenesis or acquired structural pathologies;
* Menstrual irregularities secondary to endocrine disorders, including polycystic ovary syndrome (PCOS), hyperprolactinemia, dysfunctional uterine bleeding (DUB), gonadal hormone deficiency, hyperthyroidism, and other related endocrine conditions;
* Oligomenorrhea or amenorrhea induced by surgical or medical interventions, such as chemotherapy, pelvic radiotherapy, ovarian cystectomy, ovarian drilling, ovarian wedge resection, salpingectomy, tubal ligation, pelvic abscess surgery, or uterine artery embolization;
* History of abnormal vaginal bleeding accompanied by clinically significant findings on endometrial biopsy, or unexplained irregular vaginal bleeding within the preceding 12 months;
* Suspected cervical malignancy or precancerous cervical lesions, suspected malignant breast tumors, or a known or suspected history of hormone-dependent tumors or malignancies;
* Previous or current history of deep vein thrombosis (DVT), pulmonary embolism, thrombotic disorders, or cerebrovascular events (stroke);
* Presence of uncontrolled and/or undiagnosed systemic diseases that could confound study results or compromise patient safety, including severe hepatic, renal, cardiac, or neurological disorders;
* Known hypersensitivity or allergy to any study-related medications;
* Pregnancy or lactation;
* Participation in other clinical trials within the last 3 months;
* Failure or refusal to provide written informed consent.

• TE LIU, Doctor, Study chair, Shanghai Geriatric Institute of Chinese Medicine