miR-320a, enriched in exosomes secreted from human amniotic mesenchymal stem cells (hAMSC-exos), reduces the expression of SIRT4 by targeting the 3′ untranslated region of SIRT4 mRNA, thereby decreasing ROS production in a mouse model of premature ovarian insufficiency (POI) and in human primary granulosa cells (hGCs) obtained from POI patients. Here, SIRT4 is linked to premature menopause.