Ovarian hypofunction

Ovarian hypofunction, which occurs as a result of damage at the level of the ovary itself, is primary. This form also varies in pathogenesis.

The endocrine function of the ovaries, although having some autonomy, is generally under the control of the hypothalamic-pituitary system. Their full function is possible only with adequate interaction of all levels of regulation: the central nervous system, hypothalamus, pituitary gland, uterus, as well as with normal function of other endocrine glands.

It is well known that with various endocrine diseases, the ovarian function usually suffers. Its decrease is secondary hypofunction. It also includes those forms of the disease that occur as a result of disorders in the hypothalamic-pituitary system. The genesis of these disorders can be different: from functional disorders to tumor changes.

The complex mechanisms of regulation of the reproductive system function are based on a strictly consistent relationship between the level and rhythm of secretion of hypothalamic and pituitary hormones, constantly controlled by releasing hormones of the hypothalamus. At the same time, it is the ovarian hormones that play the main regulatory role in the reproductive system. Various etiological factors can lead to disruption of the CNS-hypothalamus-pituitary-uterus chain. But the consequence of these disruptions is always ovarian hypofunction, clinically manifested by chronic anovulation, menstrual cycle disorders or amenorrhea.

Ovarian hypofunction occurs in 0.1% of women under 30 years of age and up to 1% of women under 40 years of age, and in 10% of patients with secondary amenorrhea.

Schematically, ovarian hypofunction is represented as follows.

Primary:

• early menopause;
• resistant ovary syndrome;
• various lesions (chemotherapy, radiation, inflammation, tumors, castration).

Secondary:

• isolated hypogonadotropic ovarian dysfunction;
• functional nature of the hypothalamic-pituitary system disorder (stress, nervous anorexia, hyperprolactinemia, other endocrine and non-endocrine diseases);
• organic nature of damage to the hypothalamic-pituitary system (tumors of the hypothalamus, third ventricle, pituitary gland, craniopharyngiomas; infectious and inflammatory lesions, circulatory disorders, injuries, radiation, intoxication; genetic factors - olfacto-genital dysplasia syndrome).

Also, ovarian hypofunction is divided into the following forms:

• hypergonadotropic:
  • anomalies of gonadal differentiation (karyotype 46ХУ, Shereshevsky-Turner syndrome)
  • ovarian failure syndrome;
  • resistant ovary syndrome;
  • menopause;
  • secretion of biologically inactive forms of gonadotropins;
  • autoimmune diseases;
  • various lesions resulting from radiation, chemotherapy (alkylating drugs), surgical interventions on the pelvic organs, severe inflammatory processes of infectious mumps;
• hypogonadotropic:
  • hypothalamic genesis (congenital GnRH deficiency (Kallmann syndrome), acquired GnRH deficiency);
  • pituitary genesis: decreased production of LH and FSH (non-functioning pituitary tumors, pituitary cysts, partial necrosis of the adenohypophysis, Sheehan syndrome);
• normogonadotropic:
  • violation of the circadian rhythm of GnRH secretion and the ovulatory peak of LH (hyperprolactidemic hypogonadism, hypothyroidism, thyrotoxicosis, adrenal diseases).

Thus, ovarian hypofunction is a term that unites a large group of diseases that differ in both etiology and pathogenesis, but have similar symptoms, such as amenorrhea or opsomenorrhea, infertility, hypoestrogenism, and uterine hypoplasia.

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