hypovarianism - a large group of pathological conditions caused by the weakening of the normal hormonal activity of the ovaries.Hypovarianism clinical diagnosis is not, it should be seen as a consequence of pathological processes in the ovaries or systems to control their hormonal activity.
Primary hypovarianism often associated with improper sexual development of girls, and usually detected during adolescence.If hormonal disorders develop in normally functioning gonads, hypovarianism is secondary.
By physiological state is hypovarianism female menopause.
ovary - a female hormone steam iron.He owns three vital functions:
1. generative function.Monthly ovary produces an egg than a woman's body provides the ability to bear children.
2. autonomic functions.Promotes the female phenotype and the proper development of female secondary sex characteristics.
3. Hormonal function.In collaboration with other endocrine glands in the ovary cyclically produce estrogen and progesteron
in the ovaries of healthy women of childbearing age mature egg each month.Until the full maturation is egg inside the follicle - "graafova bubble" with a thin shell filled with follicular fluid.Maturing follicles stimulates the production of estrogen by the ovary.The full development of the egg in the first half of the menstrual cycle provides a follicle stimulating hormone pituitary (FSH).
During ovulation (mid-cycle) Graaf bubble bursts from the follicle mature egg is released in its place formed by the corpus luteum.The source of the formation of the corpus luteum cell membranes are destroyed follicle.Outside the ovary mature egg remains viable for only two days, and then dies.For two weeks after ovulation, the corpus luteum functions as a temporary hormone gland: produces the hormone progesterone.It is necessary for the proper formation of pregnancy after fertilization.If fertilization does not occur, the corpus luteum is destroyed, and after the next ovulation is formed again.The second half of the cycle control luteinizing hormone (LH).
parallel cyclical changes in the ovaries to the uterus there are processes of proliferation of the inner layer (endometrium) in the first phase and its rejection - the second.If the ovarian hormonal failure occurs, the endometrium and begin lesions.Therefore, the nature of menstruation always indicates the status of the ovaries.
about how "right" the ovaries work can be judged by the nature of the menstrual cycle.The two-phase menstrual cycle and ovulation are the criteria of the presence of the correct operation of the ovaries.
Clinically hypovarianism women accompanied by disturbances of the menstrual cycle, regression of secondary sexual characteristics and infertility.In primary hypofunction of sexual organs remain underdeveloped.
diagnosis of ovarian hypofunction begins with a general examination of the patient and ends instrumental examination.The volume of necessary diagnostic procedures is determined individually, depending on the underlying disease that caused the violation of the hormonal function.
ovarian hypofunction Therapy involves the elimination of the causes of its occurrence.
Often listeners heard the question, how are combined hypovarianism and pregnant women.If the secondary hypovarianism not accompanied by severe hormonal shifts and flows into mild, pregnancy is possible.Often, however, this combination leads to miscarriages.
are more likely secondary hypovarianism and pregnancy are rare.Reduced estrogen production by the ovaries leads to infertility.
Causes Ovarian hypofunction
hypovarianism present in the clinic sets gynecological ailments.It is associated with changes in ovarian tissue or cause disturbances in the hypothalamic-pituitary system.
weakening of hormonal ovarian function is considered to be the primary, if it has a connection with violations of normal fetal development.Congenital hypoplasia of the ovaries (gonadal dysgenesis) is due to the negative impact of harmful factors.Some infections have the ability to adversely affect the proper development of the fetus.Therefore, if during pregnancy the woman was ill with measles or rubella, the fetus female ovaries are often underdeveloped.A similar situation occurs in the presence of an expectant mother hormonal disorders, hereditary diseases and psycho-emotional disorders.
Women with well-formed genitals secondary hypovarianism develops after a period of normal functioning.The weakening of the hormonal activity of the ovaries can trigger:
- non-physiological weight loss.Inadequate commitment to lose weight, strong depletion from socially disadvantaged women, anorexia nervosa (an aversion to food intake), and diseases associated with significant weight loss, affect the normal functioning of the ovaries.
- Unbalanced diet with deficiency of important vitamins and fats lead to a decrease in estrogen levels.
- Infectious and inflammatory processes in the tissues of the ovaries.
- Pathological conditions in the hypothalamic-pituitary area after head trauma or brain tumor is likely to disrupt the mechanisms of regulation of the ovaries and provoke them hypofunction.
- Endocrine pathology: thyroid disease and adrenal insufficiency of the work.
- Structural changes in the ovaries on the background of tumors, or polycystic ovary syndrome exhaustion.
- incorrect long-term use of oral contraceptives.The main contraceptive effect of these drugs is inhibition of ovulation mechanism.If the drug is selected or incorrectly received in incorrect operation, hormonal ovarian function decreases dramatically.
hypovarianism is a collective term, it set of causes and mechanisms of development.We can say that it is the cause of any condition which leads to a significant reduction in the amount of estrogen.
Symptoms and signs of ovarian hypofunction
as the basis of any genesis of ovarian hypofunction is gipoestrogeniya, leading the clinical manifestations of this condition can be divided into three groups:
1. Changes in the normal structure of the genitals.When the ovaries are damaged in childhood, against estrogen deficiency uterus, appendages and mammary glands are underdeveloped, "female form" no body hair growth in the underarm and pubic areas is missing or is scarce.Underdevelopment of sexual organs in adult women is expressed not so bright, and the body has the correct feminine traits.
Long hypovarianism leads to structural changes - the development of multiple sclerosis, scarring and sclerosis of the stroma.
2. menstrual dysfunction.Menses scanty, sparse, often observed their absence - amenorrhea.Primary amenorrhea is considered if the patient after the completion of puberty (15 years) of any of menstruation was not.Secondary amenorrhea occurs on the background of existing menstrual function after six months of absence of menstruation.
3. Infertility or miscarriage.
These attributes are complemented by ovarian hypofunction symptoms of the disease, which it provoked.For example, if the function of the ovaries affects tumor of the pituitary gland, synthesizing a lot of prolactin will molozivopodobnoe discharge from the nipples of mammary glands.
The nature of clinical manifestations affect the severity of ovarian hypofunction.Mild hypofunction stored normal or slightly reduced the size of the uterus, and there is a well-formed, but underdeveloped endometrium.Secondary sexual characteristics are expressed satisfactorily marked hypoplasia of mammary glands.Menstruation, but they are irregular (rare) and scarce.Amenorrhea is secondary.
With the average severity of ovarian hypofunction menstruation does not occur.There is a significant underdevelopment of the external genitalia, the size of the uterus and ovaries do not meet the age norm.Mammary glands are underdeveloped.
hypovarianism that developed after a normal puberty, as a rule, does not have a pronounced clinic.State begins with a change in menstrual function: menses are scanty and short, and the period between them increases.Without adequate medical care hormonal ovarian function continues to fade, there are amenorrhea, and starts the regression of the genital organs.
Severe ovarian hypofunction uncommon.Genitals undeveloped secondary sexual characteristics are absent.There is a primary amenorrhea.
hypovarianism with long, large gipoestrogeniya young women leads to menopause symptoms: amenorrhea, reduce the size of the ovaries and uterus, endometrial atrophy and severe psychoneurotic disorders.
diagnosis of ovarian hypofunction means:
- assessment body and its compliance with the age of the patient;
- pelvic examination to determine the extent to which the development of sexual organs and the correctness of their position age norm;
- ultrasound examination of the uterus and appendages;
- study of hormonal ovarian function using laboratory methods of examination;
- additional examination methods related to the underlying disease.
Treatment of ovarian hypofunction
hypovarianism never goes unnoticed patient, as always accompanied by menstrual disorders.Secondary hormonal changes in the ovaries of adult patients mild respond well to therapy, and severe degree of hypoactivity of ovaries congenital origin does not imply a full recovery of ovarian function.
For the treatment of ovarian hypofunction important time of its appearance relative to the period of puberty (before or after) and the severity of the process.
Treatment is always a long and multi-stage.The first stage is carried out at girls with ovarian hypofunction dopubertatnogo and aims to stimulate their proper ripening.Appointed estrogens cycled to ovarian maturation process was the most similar to the natural.In parallel with the hormone treatment is carried out to eliminate all adverse factors: stress, infections, and other diseases neginekologicheskih.Generally, treatment is complete in three months.
the treatment of hypofunction, which appeared after the reproductive period, to stimulate puberty is not necessary, so the first stage is designed only to eliminate the negative factors.
If the response to estrogen therapy increases the size of the uterus, and there are signs of hormonal activity of the ovaries, begin the second phase of treatment.His goal - the formation of cyclic changes in the ovaries.Hormonal drugs are prescribed according to the phases of the cycle, and should simulate it with maximum reliability to the ovaries "woke up".Progesterone is added to estrogen.
Hormone therapy controlled laboratory and ultrasound.The criterion of effectiveness is the presence of mature follicles and the appearance of the cyclic changes in the endometrium.
third stage of healing is necessary for patients wishing to have children.His goal - to biphasic ovulatory cycle.The success of treatment is determined by the severity of hormone deficiency and timing of its appearance.
In the fourth stage, the rehabilitation and relapse prevention.In fact, this stage lasts all subsequent treatment for years and involves surveillance and timely correction of hormonal disorders.