Resistant ovary syndrome

The syndrome of resistant ovaries (Savage-syndrome) is 2-10% among all forms of amenorrhea.

[1], [2], [3], [4], [5],

Causes

The exact causes of development are not established. Ovarian insufficiency in this rare syndrome is due to insensitivity of receptors on ovarian cells to gonadotropic hormones. Supposed reasons: autoimmune nature of the disease with the formation of antibodies to the receptors of gonadotropins.

[6], [7], [8]

Symptoms

The main clinical symptoms are amenorrhea and infertility, sometimes there are complaints characteristic of menopausal syndrome. When viewed from patients, normal development of internal and external genital organs is noted.

It should be noted that the syndrome of resistant ovaries can be combined with many autoimmune diseases. So, 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 and myasthenia gravis.

Primary insufficiency of the ovaries can be a part of the syndromes of peliglundular insufficiency, characterized by a combination of autoimmune lesions of several glands of internal secretion: autoimmune polyglandular syndromes of the 1st (mucocutaneous candidate, hypoparathyroidism, Addison's disease) and type 2 (primary hypocorticism, autoimmune thyroiditis, type 1 diabetes).

How to recognize the syndrome of resistant ovaries?

Criteria for diagnosis:

• Amenorrhea and infertility before the age of 40;
• Normal menstrual function in the anamnesis;
• Slightly expressed symptoms, characteristic for climacteric syndrome;
• The high content of FSH and LH in the serum, the level of estradiol is reduced slightly;
• The first progesterone test is often positive, the second and third samples are negative;
• Ultrasound of the small pelvis: the ovaries are usually reduced, they contain a sufficient number of primordial follicles and single small ripening follicles;
• Diagnostic laparoscopy with ovarian biopsy (reveals the presence of only primordial and preantral follicles).

Differential diagnosis

This disease must be differentiated from the syndrome of exhausted ovaries, hypogonadotropic hypogonadism, "pure" gonad agenesis.

[9], [10], [11], [12]

Treatment

For the normalization of the menstrual cycle and the prevention of metabolic disorders up to 45-50 years, combined hormone replacement therapy is carried out with two- and three-phase estrogen-progestational medications.

Errors and unreasonable appointments

Prolonged monotherapy with estrogen in women with a preserved uterus is not indicated, since it can lead to the development of hyperplasia and even endometrial cancer

[13], [14], [15], [16]

Forecast

Pregnancy is possible only with in vitro fertilization with the use of a donor egg.

[17], [18], [19], [20]