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2.1 From reproductive cycle to menopause The female reproductive lifespan is governed by the hypothalamic-pituitary-ovarian (HPO) axis, which orchestrates cyclical hormonal dynamics essential for ovulation, endometrial remodeling, and fertility ( Perimenopause precedes this transition and is characterized by fluctuating hormone levels and irregular menstrual cycles, often accompanied by vasomotor symptoms, mood disturbances, and sleep disruption ( 2.2 Premature ovarian insufficiency (POI) POI is defined as the loss of ovarian function before age 40, leading to hypoestrogenism, elevated FSH levels, and infertility ( Although hormone replacement therapy (HRT) remains the standard of care, it neither restores ovarian reserve nor addresses the underlying molecular damage