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Resistant ovarian syndrome.
Last reviewed: 05.07.2025
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[ Reasons
The exact causes of development have not been established. Ovarian failure in this rare syndrome is caused by the insensitivity of receptors on ovarian cells to gonadotropic hormones. Proposed causes: autoimmune nature of the disease with the formation of antibodies to gonadotropin receptors.
Symptoms
The main clinical symptoms are amenorrhea and infertility, sometimes complaints characteristic of climacteric syndrome are noted. During examination, patients show normal development of internal and external genitalia.
It should be noted that resistant ovary syndrome can be combined with many autoimmune diseases. Thus, in 25% of cases it is combined with autoimmune thyroiditis, in 10% of cases - Addison's disease, in 2% of cases - with type 1 diabetes mellitus and myasthenia.
Primary ovarian failure may be part of peligonular failure syndromes, characterized by a combination of autoimmune damage to several endocrine glands at once: autoimmune polyglandular syndromes of types 1 (mucocutaneous candidate, hypoparathyroidism, Addison's disease) and 2 (primary hypocorticism, autoimmune thyroiditis, diabetes mellitus type 1).
How to recognize resistant ovary syndrome?
Diagnosis criteria:
- Amenorrhea and infertility before the age of 40;
- History of normal menstrual function;
- Mild symptoms characteristic of climacteric syndrome;
- High levels of FSH and LH in the blood serum, estradiol levels are slightly reduced;
- The first progesterone test is usually positive, the second and third tests are negative;
- Ultrasound of the pelvis: the ovaries are usually reduced in size, a sufficient number of primordial follicles and single small maturing follicles are found in them;
- Diagnostic laparoscopy with ovarian biopsy (reveals the presence of only primordial and preantral follicles).
Differential diagnosis
This disease must be differentiated from ovarian depletion syndrome, hypogonadotropic hypogonadism, and “pure” gonadal agenesis.
Treatment
To normalize the menstrual cycle and prevent metabolic disorders up to 45-50 years of age, combined hormone replacement therapy with two- and three-phase estrogen-gestagen drugs is carried out.
Errors and unjustified appointments
Long-term monotherapy with estrogens in women with an intact uterus is not indicated, as it can lead to the development of hyperplasia and even endometrial cancer.