Resistant ovarian syndrome. In rare cases, ovarian failure may be due to resistant ovary syndrome (SAR; Savage syndrome). In women younger than 35 years, there is amenorrhea, infertility, micro- and macroscopically unchanged ovaries with a high level of gonadotropins. Secondary sexual characteristics are developed normally. The causes of FAR have not been studied; The autoimmune nature of this pathology is assumed. It is known that hypergonadotropic amenorrhea can be combined with autoimmune diseases: Hashimoto disease, myasthenia, alopecia, thrombocytopenic purpura, autoimmune hemolytic anemia. Ovarian resistance to high levels of gonadotropins may be related to the abnormality of the FSH molecule or the absence of biological activity in the hormone. A large role is given to intra-ovary factors involved in the regulation of ovarian function. There is evidence of the effect of iatrogenic factors – X-ray therapy, cytotoxic drugs, immunosuppressants, and surgical interventions on the ovaries. The development of resistant ovaries can be promoted by damage to the ovarian tissue in tuberculosis, parotitis, and sarcoidosis.
Clinical symptoms and diagnosis. Onset of the disease most patients are associated with stress, severe viral infections. The first menstruation, as a rule, comes in time, and after 5–10 years amenorrhea develops, but in 84% of patients menstruation occasionally occurs later. Pregnancy and childbirth are observed in 5% of patients. Patients with SAD correct constitution, satisfactory nutrition, with well-developed secondary sexual characteristics. Periodically they feel hot flashes to the head. Examination of functional diagnostics tests revealed signs of ovarian hypofunction: thinning of the mucous membranes of the vulva and vagina, a weakly positive pupil phenomenon, low KPIs (from 0 to 25%).
Gynecological examination, ultrasound, laparoscopy of the uterus and ovaries are somewhat reduced. Most authors believe that the diagnosis of FRY can only be made after laparoscopy and ovarian biopsy, followed by histological examination, in which primordial and preanthral follicles form. With laparoscopy, translucent follicles are visible in the ovaries.
Hormonal studies indicate a high level of FSH and LH in plasma. Prolactin levels are normal.
Hormonal tests are of great diagnostic value. A decrease in the level of FSH with estrogen administration and an increase in the level of FSH and LH in response to the introduction of lyuliberin indicate the safety of the feedback mechanism between the hypothalamic-pituitary system and sex steroids.
Treatment. Therapy FRY presents great difficulties. In the treatment of gonadotropins obtained conflicting data. Some authors have noted an increase in follicles and menstrual-like discharge on the background of the introduction of FSH and LC, others – only the growth of follicles (empty follicles) without increasing the level of blood estrogen.
The purpose of estrogen is based on the blockade of endogenous gonadotropins and the subsequent rebound effect (reflection effect). In addition, estrogen increases the number of gonadotropic receptors in the ovaries and, possibly, in this way enhances the response of follicles to endogenous gonadotropins. Restoration of generative function is possible only with the help of assisted reproductive technologies (IVF donor egg).
Ovarian exhaustion syndrome (SIA) is a pathological symptom complex that includes secondary amenorrhea, infertility, and vascular disorders in women younger than 38 years of age with past normal menstrual and reproductive function.
Etiology and pathogenesis. Chromosomal abnormalities and autoimmune disorders, expressed in small congenital ovaries with follicular deficiency, pre- and post-pubertal destruction of germ cells, primary lesion of the CNS and the hypothalamic region, are considered the leading cause. SIA is a generalized autoimmune diathesis.
In the occurrence of PIR, many factors play a role in the ante-and post-natal period leading to damage and replacement of the gonads with connective tissue. Apparently, against the background of a defective genome, any exogenous effects (radiation, various drugs, starvation, hypo-and vitamin deficiencies, influenza and rubella virus) may contribute to the development of SIA. In the majority of patients, adverse factors acted during the period of intrauterine development (preeclampsia, extragenital pathology in the mother). The onset of the disease is often associated with severe stressful situations, infectious diseases.
PIA may be hereditary: in 46% of patients with a relative, menstrual dysfunction was noted – oligomenorrhea, early menopause.
Clinical symptoms. The onset of the disease is amenorrhea or hypo-, opso-, oligomenorrhea, followed by persistent amenorrhea, which is accompanied by autonomic-vascular manifestations typical of postmenopause — hot flashes, sweating, weakness, and headache with impaired working capacity. Against the background of amenorrhea, progressive atrophic processes in the mammary glands and genitals develop. Patients with PIS of the right physique, satisfactory nutrition. Obesity is not typical.
Diagnosis is based on anamnesis and clinical picture. Menarche timely, menstrual and reproductive functions are not impaired for 10–20 years.
Reduced ovarian function causes pronounced persistent hypoestrogenism: negative pupil symptom, monophasic basal temperature, low KPIs (0–10%). Hormonal studies also indicate a sharp decrease in ovarian function: the estradiol level practically corresponds to that in young women after oophorectomy. The level of gonadotropic hormones (FSH and LH) is sharply increased: FSH is 3 times the ovulatory peak and 15 times the basal level in healthy women of the same age; LH content approaches the ovulatory peak and is 4 times higher than the basal level in healthy women. Prolactin activity is 2 times lower than in healthy women.
Gynecological and additional research methods detect a reduction in the uterus and ovaries. When ultrasound, in addition to reducing the uterus, there is a sharp thinning of the mucous membrane of the uterus when measuring M-Eha. Laparoscopy also shows small, wrinkled, yellowish ovaries; the yellow body is absent, the follicles do not shine. A valuable diagnostic feature is the absence of a follicular apparatus, confirmed by histological examination of ovarian biopsy specimens.
For in-depth study of the functional state of the ovaries using hormonal tests. The test with the cyclic appointment of estrogen (phase I) and gestagens (phase II) is accompanied by a menstrual-like reaction 3-5 days after the completion of the sample and a significant improvement in the general condition. Signs of organic damage to the central nervous system no.
The treatment of patients with SIA is aimed at the prevention and treatment of estrogen-deficient states. With infertility, only the use of assisted reproductive technology is possible – IVF with a donor egg cell. Stimulation of the exhausted follicular apparatus of the ovaries is inexpedient and not indifferent to the health of the woman. Patients with SIA show hormone replacement therapy until the age of natural menopause.