Hypergonadotropic amenorrhea
This disease consists in stopping menstruation as a result of excessive formation in the body of a woman's pituitary hormones( gland of the brain), stimulating the function of the ovaries. Normally, ovarian( ovarian) failure is observed in all women in menopause, when physiological depletion of the ovaries occurs. Hypergonadotropic amenorrhea may be due to various genetic disorders. Congenital abnormalities of sexual development, as a rule, are accompanied by a high level of gonadotropins( pituitary hormones that affect the female genital glands) and the absence of menstruation( amenorrhea).
Syndrome of exhausted ovaries - the onset of irreversible amenorrhea in women younger than 37-38 years old who had normal menstrual and reproductive functions in the past, due to genetically determined pathology of the ovaries.
In the development of this disease, the leading factor is the presence of chromosomal abnormalities, which lead to the formation of small ovaries with a deficiency of the follicular apparatus. In 46% of cases, relatives of the first and second( mother and daughter or sisters) of the degree of relationship had menstrual dysfunction and early development of menopause. Probably, against the background of a genetic predisposition, any external influences( stress, infection, intoxication, radiation, starvation) can lead to a disruption of the function of the follicular apparatus of the ovaries. Various adverse factors affecting the female body contribute to the destruction of germ cells in the period before and after puberty, damage to the gonads and replacement of their connective tissue.
The disease begins with the fact that menstruation becomes, in comparison with the usual, less scanty and less prolonged. Such changes, as a rule, last from six months to three years. Another beginning of the disease may be a sharp cessation of menstruation in general. Against the backdrop of the emerging deficit of female ovarian hormones( ovarian hypoestrogenia), after the termination of menstruation, a complex of symptoms develops in women, typical of menopausal syndrome. At the same time, the following manifestations occur: headaches, depression, "hot flashes", impaired concentration, anxiety, decreased libido and disability, dryness in the vagina, inflammation of the vagina, urogenital disorders, various metabolic disorders, increased cardiovascular and disease rates, Osteoporosis often develops.
Gynecological examination reveals a decrease in the size of the uterus and ovaries. Rectal temperature( temperature in the rectum) remains unchanged at any time. The changes observed with ultrasound are identical to the changes that occur after the onset of menopause. In this case, there is a progressive decrease in the size of the uterus and ovaries. Ovarian follicles are not detected. When hormonal studies indicate a sharp change in the hormonal background.
To identify the disease, a histological examination of the ovarian tissue is performed, in which characteristic changes are detected. In addition, it is necessary to conduct samples with hormones. In this case, the cyclic introduction of female sex hormones leads to an improvement in the woman's well-being and the appearance of an organism reaction identical to the onset of menstruation.
Criteria for diagnosing the syndrome of exhausted ovaries are the following symptoms: irreversible cessation of menstruation and infertility before the age of 37;normal menstrual function in the past;characteristic manifestations of climacteric syndrome;characteristic changes in the hormonal background during laboratory blood tests;absence of follicles and atrophy of the ovaries, determined by histological examination of organ tissue.
Syndrome of malnourished ovaries should be distinguished from osindrome resistant( resistant) ovaries. The syndrome of resistant ovaries is characterized by cessation of menstruation, infertility, normal development of secondary sexual characteristics, female sex chromosomes( 46, XX), moderate increase in the level of gonadotropic hormones in the pituitary gland, and a moderate decrease in female sex hormones( estrogen).In this syndrome correctly formed, somewhat underdeveloped ovaries with a sufficient number of follicles are revealed. It is assumed that this disease is transmitted by an autoimmune type of inheritance, in which the formation of antibodies in the body of the woman to receptors for ovarian hormones affecting the pituitary gland. It is believed that with prolonged administration of large doses of gonadotropins, activation of ovarian function can occur until its complete recovery.
The criterion for diagnosing a syndrome of resistant ovaries is the presence of the following signs in a woman: a reversible( in contrast to the above disease) cessation of menstruation and infertility at the age of 37;normal menstrual function in the past;presence of all signs of climacteric syndrome;characteristic changes in the hormonal background in the study of blood serum;a sufficient number of follicles, determined by histological examination of organ tissue.
The reason for the decrease in the functional activity of the ovaries can also be various lesions of this organ, including irradiation or exposure to chemotherapeutic drugs( especially used in the treatment of various cancers).The menstrual cycle and ovulation in some women can recover independently even after a prolonged existence of the disease and a marked decrease in the content of female sex hormones( estrogen).
The literature describes cases of ovarian insufficiency in women who have had an infectious parotitis, and after severe inflammation in the pelvic area. Surgical castration also leads to the development of hypergonadotropic amenorrhea.
Treatment. All women with hypergonadotropic amenorrhea, irrespective of the presence or absence of estrogen reduction manifestations, are prescribed sex hormone replacement therapy, which is performed before and after the natural menopause. In the absence of contraindications, pregnancy in women with this disease is possible with the artificial fertilization of donor eggs with the sperm of the husband in vitro, followed by the transfer of the embryo to the prepared uterus. Such methods became possible as a result of the development of in vitro fertilization programs.