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Functional tests in gynecology
Last reviewed: 23.04.2024
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Functional tests are used to clarify the functional state of various parts of the reproductive system. The principle of research is based on the fact that hormones introduced into the body have the same properties as endogenous.
The following samples are most often used.
Sample with gestagens
Indication: to determine the extent of estrogen deficiency and the reactivity of the endometrium. Assigned to amenorrhea of any etiology.
The test consists in the administration of progesterone progestogen at 10-20 mg per day for 3-5 days (oxyprogesterone capronate 125 mg once intramuscularly or norkolut 5 ml per day for 8 days).
The appearance of bleeding 3-5 days after the end of the test is evaluated as a positive result, the absence - as a negative.
A positive test indicates moderate estrogen deficiency, since progesterone causes secretory transformation of the endometrium and rejection of it only if the endometrium is sufficiently prepared with estrogens. A negative test can be with the uterine form of amenorrhea or with estrogen deficiency.
The sample can be used as a differential diagnostic for the syndrome of sclerocystic ovaries. Before and after it, excretion of 17-CS (17-ketosteroids) is investigated . If after the sample the excretion of 17-CS decreases by 50% or more, the sample is evaluated as positive and indicates a hypothalamic-pituitary disease. Absence or insignificant changes in the level of 17-CS is a negative test, indicating an ovarian genesis.
A sample with estrogens and gestagens
Indication: eliminate diseases or damage to the endometrium (the so-called uterine form of amenorrhea) and find out the extent of estrogen deficiency. It is performed with amenorrhea.
Comes in the introduction of estrogens (folliculin 20 000 ED, synestrol 2 mg, mikrofollin 0,1 mg) for 8-10 days, then - progestogen for 5-7 days. The absence of a menstrual-like response 2-4 days after the end of the test is assessed as a negative reaction and indicates the uterine form of amenorrhea. A positive test indicates ovarian hypofunction.
[Test with gonadotropin
Indications: Suspicion of primary ovarian failure. Applied to establish the cause of anovulation.
Intramuscular intramuscular (150 IU) is used for 5-7 days or gonadotropin chorionic (prophase) 1500-3000 IU for three days.
Control is the determination of the content of estradiol in the blood before and after the administration of the drug. With a positive sample, an increase in the level of estradiol 3-5 times. A negative test indicates a primary inferiority of the ovaries.
In addition, a decrease in CI (less than 50%), an increase in basal temperature, an ultrasound examination of the ovaries, in which the presence of follicles with a diameter of more than 18 mm are recorded , are of diagnostic significance in the sample . A positive test indicates a primary failure of the hypothalamic-pituitary system.
A sample with clomiphene
To determine the level of disturbance of the hypothalamic-pituitary system, a clomiphene sample is also used.
Indications: diseases accompanied by chronic anovulation with amenorrhea or hypomenstrual syndrome.
Before the test, a menstrual-like reaction (gestagens or oral contraceptives) is caused. From the 5th to the 9th day from the onset of the reaction, clomiphene is administered at a dose of 100 mg per day (2 tablets). By its action, it is an antiestrogen that causes a temporary blockade of estrogen receptors and an increase in the secretion of lylyberyrin (gonadotropin releasing hormone). This leads to the release of the pituitary gland FSH ( follicle stimulating hormone ) and LH ( luteinizing hormone ) and the maturation of follicles in the ovary with the synthesis of steroid hormones.
A positive test indicates a preserved activity of the hypothalamus, pituitary gland and ovaries.
A sample with clomiphene is monitored at basal temperature and a menstrual-like reaction occurs 25-30 days after taking clomiphene.
Anovulatory cycles are possible (menstrual reaction has occurred, basal temperature is monophasic), ovulatory cycles (basal temperature two-phase, menstruation on time) and cycles with luteal phase insufficiency (basal temperature two-phase with shortened less than 8 days by the second phase and menstruation on time).
Negative test - no increase in estradiol, gonadotropins in the blood, monophasic temperature, absence of a menstrual-like reaction - indicates a disruption in the functional ability of the hypothalamus and pituitary gland.
Sample with hormonal contraceptives
Indication: clarification of the genesis of hyperandrogenia. Drugs such as OK (oral contraceptives) are prescribed for 2 tablets a day for 10 days. The excretion of 17-CS is determined before and after the test. A positive test (decrease in the excretion of 17-CS by 50% or more) indicates the ovarian genesis of the disease, the negative - about the adrenal.
To establish the source of hyperandrogenism in women with clinical manifestations of virilization, a test with dexamethasone is used.
Increased secretion of androgens by the ovaries is possible with endocrine diseases and virilizing tumors. The source of androgens can be the adrenal glands, so before the sample is performed, it is necessary to exclude the ovarian tumor (using ultrasound or laparoscopy ). The test is based on the inhibitory effect of high concentrations of glucocorticoids on ACTH release in the anterior pituitary gland, resulting in decreased formation and secretion of androgens by the adrenal glands.
There are two types of sample - small and large. A small test consists in administration of 0.5 mg dexamethasone 4 times a day for three days. Before and after sampling, the content of 17-CS is determined.
A large test consists in prescribing 2 mg of dexamethasone every 6 hours for three days also with a determination of the content of 17-CS.
The sample is considered positive when the content of 17-CS decreases by 50-75% compared to the initial one and indicates the adrenal origin of the disease (hyperplasia of the cortex).
A negative test (no decrease in 17-CS) indicates the presence of a virilizing tumor of the adrenal glands, since in it the secretion of androgens is autonomous and does not decrease with blockade of the ACTH pituitary gland by dexamethasone.
Skin and allergic test
It is based on the appearance of an allergic reaction in response to the administration of hormonal drugs.
0.2 ml of a 0.1% oestradiol benzoate oil solution is injected into the skin of the inner surface of the forearm. At the injection site a small papule with a diameter of 5-6 mm is formed. During ovulation (the maximum content of estrogens in the body) there is a local allergic reaction in the form of reddening of the papule and increasing it in diameter up to 10-12 mm, the appearance of itching. At anovulyatornom a cycle of change of a papule are absent. To diagnose dysfunction of the yellow body, 0.2 ml of a 2.5% oil solution of progesterone is administered. The ovulation and satisfactory function of the yellow body is indicated by the reddening and enlargement of the papule into the late luteal phase (maximal function of the yellow body).
The test is indicative if it is carried out for several menstrual cycles.
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