Premature ovarian insufficiency: decoding oxidative stress, metabolic pathways, epigenetic regulation, and the therapeutic role of yoga.

Premature ovarian insufficiency (POI) is a heterogeneous multifactorial disorder characterized by amenorrhoea, hypoestrogenism and elevated serum gonadotropins in women below 40 years. Genetic predisposition, infections, iatrogenic, autoimmune conditions and endocrinopathies are few of the known causes of POI, but majority cases of POI are idiopathic which is attributed to be due to environmental factors, epigenetic changes, oxidative DNA damage or faulty DNA repair mechanisms. These epigenetic changes and cumulative oxidative DNA damage can pass transgenerationally to subsequent generations. Management of POI involves hormone replacement to alleviate the symptoms of hypoestrogenism and in some cases treatment for infertility, comorbid stress and depression. The broad spectrum of decreased quality of life and psychosocial impact of the medical condition is less often addressed. Lifestyle modification and yoga can act as adjunct therapy in conjunction with the standard treatment protocol to alleviate the stress, anxiety and depression. YBLI exerts immunomodulatory effects and provides a natural way to decrease oxidative stress, DNA damage, inflammation, restoring hormonal normality and in turn protect accelerated oocyte atresia.