Hypofunction of the ovaries

Ovarian hypofunction, resulting from damage at the level of the ovary itself, is primary. This form is also different in pathogenesis.

The endocrine function of the ovaries, though it has some autonomy, is generally controlled by 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, and also with the normal function of other endocrine glands.

It is well known that with a variety of endocrine diseases, the function of the ovaries, as a rule, also suffers. Its reduction is a 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.

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

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

Schematically, ovarian hypofunction is as follows.

Primary:

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

Secondary:

• isolated hypogonadrophic ovarian hypofunction;
• the functional nature of the hypothalamic-pituitary system (stress, anorexia nervosa, hyperprolactinaemia, other endocrine and nonendocrine diseases);
• organic nature of the defeat of the hypothalamic-pituitary system (tumors of the hypothalamus, III ventricle, pituitary gland, craniopharyngioma, infectious and inflammatory lesions, circulatory disorders, trauma, radiation, intoxication, genetic factors - olfacto-genital dysplasia syndrome).

Also hypofunction of the ovaries is divided into the following forms:

• hypergonadotropic:
  • anomalies of differentiation of gonads (karyotype 46ХУ, Shereshevsky-Turner syndrome)
  • syndrome of exhausted ovaries;
  • syndrome of resistant ovaries;
  • menopause;
  • secretion of biologically inactive forms of gonadotropins;
  • autoimmune diseases;
  • various lesions due to irradiation, chemotherapy (alkylating drugs), surgical interventions on pelvic organs, severe inflammatory processes of infectious mumps;
• hypogonadotropic:
  • hypothalamic genesis (congenital insufficiency of GnRH (Kalman's syndrome), acquired GnRH deficiency);
  • pituitary origin: decreased production of LH and FSH (dysfunctional pituitary tumors, pituitary cysts, partial necrosis of adenohypophysis, Shien syndrome);
• normogonadotropic:
  • violation of the cirrhotic rhythm of GnRH secretion and the ovulatory peak of LH (hyperprolactical hypogonadism, hypothyroidism, thyrotoxicosis, adrenal diseases).

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

[1], [2], [3]