Early aging of the ovaries. Syndrome of premature (early) ovarian failure. Pathology and pregnancy

Ovarian wasting syndrome (OSS) presented in the literature under the names “premature menopause”, “premature menopause”, “premature ovarian failure”.

The terms “premature menopause” and “premature menopause” certainly indicate the irreversibility of the process, but their use to characterize a pathological condition in young women is unjustified.

The term “premature ovarian failure” indicates a pathological process in the ovaries, but does not reveal its essence. In addition, an indication of the insufficiency of the function of any organ always implies the possibility of compensation during pathogenetic therapy. In patients with SIJ, therapy aimed at stimulating ovarian function is usually ineffective.

V.P. Smetnik (1980) presents an analysis and critical assessment of the inconsistency of these terms and proposes his own name - “ovarian wasting syndrome.”

The frequency of this syndrome in the population is 1.65%; is one of the forms of premature ovarian failure, the essence of which is that normally formed ovaries cease their function earlier than the usual or expected time of menopause (up to 49.1 years).

The syndrome manifests itself as a complex of various pathological symptoms, including amenorrhea, vegetative-vascular changes - “hot flashes”, increased sweating, irritability, decreased ability to work, etc. All these symptoms appear in young women due to premature exhaustion ovaries due to disruption of central regulatory mechanisms physiological functions female body.

Pathogenesis of Ovarian Fatigue Syndrome.

There are a number of theories that explain the causes of ovarian depletion: pre- and postpubertal destruction of ovarian germ cells, chromosomal abnormalities, autoimmune disorders, destructive processes caused by tuberculosis, etc. However, they do not fully reveal the pathogenesis of this syndrome. It is believed that it develops more often in patients with three X chromosome syndrome.

N.V. Svechnikova and V.F. Saenko-Lyubarskaya (1959), M.L. Krymskaya et al. (1965) consider the primary pathogenetic factor of this syndrome to be damage to the central parts of the reproductive system with subsequent involvement of the ovaries in the process. N.B. shares the same opinion. Schwartz (1974). The author explains the pathogenesis of this syndrome by damage to the ovaries due to increased production of gonadotropic hormones, causing premature atresia of the follicles.

D.M.Sykes and S.Ginsburg (1972), V.B.Manesh (1979) believe that with this syndrome, primary damage to the ovaries occurs. V.I. Bodyazhina (1964), V.P. Smetnik, Z.P. Sokolova (1979) and other researchers, based on the results of studying the functional state and reserve capabilities of the hypothalamic-pituitary system in patients with SLI, agree with this statement . The authors observed stable retention functional state hypothalamic-pituitary system and explain the data of their studies by the initial level of gonadotropins in response to the administration of exogenous releasing hormone. Consequently, increased secretion of gonadotropic hormones in these patients occurs secondary to a sharp decrease in the hormonal function of the ovaries.

V.P. Smetnik and E.A. Kirillova (1986) associate the causes of primary ovarian damage with hereditary factors. Based on clinical genetic studies, the authors point to the role of genetic and environmental factors in the occurrence of ovarian wasting syndrome. The genealogical history of patients with SIS in 21.4% of cases turned out to be more genetically burdened (amenorrhea, oligomenorrhea, late menarche, early menopause).

E.A. Kirillova (1989) considers the hereditary cause of this syndrome to be a gene mutation, and the mechanism of inheritance is different in specific families. The author notes that an autosomal dominant type of transmission of the pathological gene is observed, and 10-12% of patients have chromosomal abnormalities in the karyotype.

In 16.4% of cases, patients have menstrual dysfunction; in some cases, similar anomalies were noted in relatives (mother, sister). In addition, the majority of them (81%) had unfavorable factors during fetal development, pre- and puberty: gestosis, extragenital pathology in the mother, high infectious index in childhood.

In addition, the authors also do not exclude the development of this syndrome under the influence of various damaging factors on germ cells in the pre- and postpubertal period, i.e. influence of environmental factors. V.P. Smetnik (1986) admits that against the background of a defective genome, any exogenous influences (infection, intoxication, stress, etc.) can contribute to atresia of the ovarian follicular apparatus.

As one of the reasons Ovarian Wasting Syndrome Galactosemia cannot be excluded (with a hereditary disorder of galactose metabolism) due to the direct effect of galactase on the ovaries or due to changes in the carbohydrate parts of FSH, LH, when they become inactive.

Consequently, SIS is a multifactorial disease associated with gene diseases, hypothalamic lesions, birth infections, intoxication, stress, starvation, radiation, etc.

V. P. Smetnik (1980) presents detailed data from 52 women examined for the presence of ovarian wasting syndrome. The following methods were used in the examination of these patients: craniography, GHA, PPG, determination of sex chromatin and karyotype, FSH, LH, prolactin, estradiol and cortisol. The history of 65% of women revealed extremely difficult material and living conditions (stress, starvation, etc.), half of them were born during the war. In childhood there were many infectious diseases: mumps, rubella, chronic tonsillitis- 4 times more often than in the population; during adulthood - intoxication, x-ray exposure, work with toxic substances. 80% of patients had a severe premorbid background. Genealogical data of 28 women was also studied. It turned out that 46.4% of probands had various menstrual dysfunctions. Among 1st and 2nd degree relatives, 13.4% of them had primary infertility. In 21% of patients, the disease began with the appearance of persistent amenorrhea, in the rest - with hypomenstrual syndrome lasting from 0.5 to 5 years with further amenorrhea.

When examining patients, hypotrophic changes in the mammary glands and external genitalia were revealed; no metabolic and trophic changes were noted. The content of sex chromatin in the nuclei of cells of the oral mucosa is on average (19.3+1.0)%; Karyotype anomalies were found only in 3.5% of cases, which makes it possible to exclude chromosomal aberration as a cause of premature ovarian failure. According to tests functional diagnostics evidence of severe ovarian hypofunction was obtained: the pupil symptom was negative, basal temperature indicated ovarian hypofunction. The uterine form of amenorrhea was excluded.

When studying hormones, the following was revealed: the level of est-radiol in the blood plasma was (25.8 + 2.3) ng/ml (with a normal range of 40 to 300 ng/ml). Thus, estradiol is practically not synthesized in the gonads of these women. The test with progesterone (gestagens) turned out to be negative. A test with dexamethasone and hCG showed a sharp decrease in cortisol from (53.7 ± 4.1) to (2.2 ± 0.7) ng/ml, which indicates a clear inhibition of the ACTH-adrenal cortex system. During the administration of hCG, no stimulation of the ovaries was detected; the author even notes a decrease in estradiol levels. A test with clomiphene (after 2-3 months) was also negative; no increase in the level of estradiol and CPI was noted. The FSH level was increased 10-15 times, and LH - 4 times. With the introduction of LH-RG, an even greater increase in FSH and LH was noted. After the administration of estradiol, a decrease in FSH is observed. The increase in the level of gonadotropic hormones and their adequate response to the administration of LH-RH allowed us to believe that in SUS, the reserve abilities of the hypothalamic-pituitary system are preserved.

A number of authors express the opinion that autoimmune processes are involved in the genesis of this syndrome. W. M. Hagne et al. (1987) when examining 70 women with secondary amenorrhea in at a young age 4 of them showed a family tendency to early menopause, 3 out of 50 patients had antibodies to ovarian tissue, and 24 - to other tissues of various organs. M. D. Damewood et al. (1986) with this syndrome in 14 out of 27 patients identified antiovarian antibodies in the cells of the granulosa membrane and in the oocytes in 9 out of 14 patients. When studying cellular immunity, an increase in T cells, especially T helper cells, was revealed, and the number of T suppressor cells and B cells did not exceed the indicators healthy women. The levels of JgG, JgA and JgM did not exceed those in healthy people. A decrease in the activity of inhibiting the migration of lactophages was also revealed when using AT HaemaphilesinfluenzaeCandidaalbicansuvuridase(Mignot M.H. et al., 1989). Autoimmune phenomena were found in most patients. Taking into account the fact that autoimmune diseases may not manifest clinical symptoms for a long time, the authors believe that further immunological monitoring of women with SIS is necessary. Consequently, they do not exclude the immunological genesis of this syndrome.

Clinic of Ovarian Fatigue Syndrome.

The clinical picture of SIJ most often manifests itself at the age of 37-38 years and develops as a result of switching off the gonad against the background of unchanged function of the hypothalamic-pituitary system with the manifestation of all the symptoms characteristic of estrogen deficiency (Smetnik V.P., 1980). Characteristic is amenorrhea or oligomenorrhea followed by persistent cessation of menstruation. Vegetative symptoms (“hot flashes” to the head) begin after 1-2 months. after the cessation of menstruation, then weakness, headaches, fast fatiguability, pain in the heart area, decreased ability to work and other symptoms of autonomic disorders. The author believes that menopausal syndrome occurs as a result of switching off the function of the gonads against the background of a kind of diencephalic syndrome and is characterized by numerous symptoms against the background of metabolic disorders. M. M. Alper et al. (1986) believe that premature menopause in SIS may be cyclical, i.e. Some patients may become pregnant. The authors note that in 6 patients who developed SIA after severe illness, pregnancy occurred after replacement therapy (estrogens, progesterone). Based on this, it has been suggested that exogenous estrogens can sensitize granulosa cells to the effects of FSH and induce ovulation.

IN objective status In patients with SIS, the following is revealed. All of them are of the correct physique, a typical female phenotype. The mammary glands are normal, there is no discharge from the nipples. On gynecological examination, the external genitalia are unremarkable, the cervix and body of the uterus are hypoplastic.

On GHA the vast majority of patients experience a decrease in the size of the uterus and a sharp thinning of its mucous membrane; the fallopian tubes, as a rule, are passable.

On BCP the ovaries are significantly reduced in size, compacted, the external structure is preserved, the uterus is small.

At ultrasound examination:

• The size of the uterus is small (length 25-30 mm, anteroposterior size reduced to 17-25 mm, transverse - 20-25 mm). The size of the uterus almost corresponds to the II degree of genital infantilism described by M.A. Fuchs et al. (1987). The structure of the uterus is homogeneous, its cavity is visualized in the form of a linear echo signal. The ovaries are reduced in size: length up to 28 mm, width - 17-19 mm, thickness - 19 mm. The structure of the ovaries is homogeneous, moderately hyperechoic, sometimes small, up to 2-3 mm, liquid formations (follicles) can be visualized in the stroma.

At laparoscopy:

• ovaries are reduced in size, yellowish in color. The cortical layer is transformed into connective tissue, noted complete absence follicles and corpus luteum(Danchenko OV., 1989). The author, during laparoscopy among patients with endocrine infertility, identified SIA in 14.9% of cases. This research method for diagnosing ovarian wasting syndrome is valuable and objective.

Histological examination ovarian biopsies:

• no follicles are detected, the ovarian stroma is fibrotic in places, with single primordial follicles, or the ovarian stroma with single white and fibrous bodies. Endometa biopsyriya - stage of atrophy (Danchenko O.V., 1989). However, with the introduction of estrogen-gestagen drugs, a menstrual-like reaction appears, which indicates the preservation of the sensitivity of endometrial receptors to sex hormones.

Functional diagnostic tests:

• the “pupil” symptom is always negative; karyopyknotic index is reduced D° 0-5%, cervical number 1-0 points. Basal temperature is monophasic.

Sex chromatin - N; The karyotype was disrupted in only one patient (Smetnik V.P., 1980).

Hormonal status. The FSH level is increased (3 times higher than the ovulatory level and 10-15 times higher than the basal level), on average (118.7 ± 7.4) mU/l; the LH content approaches its level during the ovulatory peak [(51.8+2.3) mU/l]. LҐ/FSH index 0.4:0.2. The secretion of gonadotropic hormones increases secondarily in response to a decrease in ovarian hormonal function. The level of estradiol in plasma is sharply reduced [(28.1+2.4) ng/ml], corresponding to the values ​​after ovariectomy. The amount of prolactin in the blood is slightly reduced.

Electroencephalographic studies N.M. Tkachenko, V.P. Smetnik (1984) revealed disorders characteristic of the pathology of hypothalamic structures in a number of patients. They manifested themselves as functional changes in the central nervous system, and the authors associate them with the activation of adrenergic structures of the hypothalamus. No irreversible destructive changes were found. After the introduction of estrogen there was full recovery electrical activity of the brain, which indicated the selective effect of sex steroids on adrenergic structures reticular formation brain stem. The authors associate persistent changes characteristic of the electrophysiological activity of the brain with a significant decrease in the level of sex steroids.

Hormonal tests:

1. Sample with progesterone, No menstrual-like reaction is observed.
2. Sample with estrogens or gestagens(in cyclic mode). In all patients, against the background of improvement in general condition, a menstrual-like reaction may appear 3-5 days after progesterone withdrawal, which confirms the severity of ovarian hypofunction and the preservation of the functional activity of the endometrium. These hormonal tests are aimed at identifying the functionality of the gonads and the reactivity of the endometrium.
3. Sample with dexamethasone And HG. After the administration of dexamethasone, there is a sharp decrease in the level of cortisol in the blood from (53.7±4.1) to (2.2+0.7) ng/ml, which indicates inhibition of the activity of the ACTH-adrenal cortex system. When hCG is administered, no activation of ovarian function is detected.
4. Sample with clomiphene. Prescribed 100 mg per day for 5 days. This test is usually negative, i.e. there is no increase in the karyopyknotic index and no increase in basal temperature; the “pupil” phenomenon is negative; the level of estradiol before and after the test does not change.
5. Sample with estradiol. Aimed at clarifying the pathogenetic mechanisms of impaired secretion of gonadotropic hormones. After the administration of estradiol, a natural decrease in the level of gonadotropins was noted, which indicates the preservation and functioning of the feedback mechanisms between the hypothalamic-pituitary structures and sex steroids (Smetnik V.P., 1986).
6. Sample with LH-RG. Positive. It is aimed at identifying the reserve capabilities of the hypothalamic-pituitary system. At the same time, V.P. The estimator noted an increase initially elevated levels FSH and LH, which indicates the preservation of the reserve capabilities of the hypothalamic-pituitary system.

S.Yu. Kuznetsov (1995) studied the dynamics of some indicators lipid spectrum blood and density bone tissue. Significant changes in the lipid spectrum of the blood were revealed in all forms of amenorrhea, including SIJ syndrome, high levels of triglycerides (TG), decreased bone density at points 1/3 and 1/20 of the radius compared with data in healthy women of reproductive age by 9.8 and 25.3%, respectively, which indicates the predominance of bone tissue resection processes in patients with SUS. Based on the results of their studies, the authors explain hypoestrogenism in patients with SI syndrome by metabolic and endocrine disorders, including an increase in the atherogenic potential of the blood. A high content of antiatherogenic lipoproteins in the blood indicates a high risk of developing atherosclerosis and cardiovascular pathology in this syndrome. W.J. Jerber (1994) revealed unidirectional changes in patients with SUS, postovariectomy syndrome and in postmenopausal women.

Osteopenia in patients after oophorectomy was significantly higher than that in the postmenopausal period. All these changes indicate the risk of developing atherosclerosis, coronary disease heart and osteoporosis. S.Yu. Kuznetsov used treatment for SIJ with anteovin (6 months) and presomin and noted the disappearance of symptoms characteristic of hypoestrogenism. After 3 months after treatment with Presomin, the antiatherogenic potential of the blood was completely restored. The process of demineralization of bone tissue was stopped. Similar results were obtained by W.J. Jerber, S. Polacios et al. (1994). Based on literature data and his own research, S.Yu. Kuznetsov concludes that it is necessary to prescribe hormone replacement therapy to young women with long-term estrogen deficiency in order to prevent the development of atherosclerosis and osteoporosis.

In work carried out at the Department of Endocrinology of the Scientific Center for Aging and Pediatrics of the Russian Academy of Medical Sciences (Smetnik V.P. et al., 2001), bone mineral density (BMD) was established in young women with various forms of amenorrhea and after oophorectomy. The state of BMD of the femur and spine in SSI was similar to that in women after oophorectomy (more than 2-5 years) without the use of HRT.

Summarizing the possibilities of diagnosing SUS, the following methods can be distinguished: a well-collected anamnesis; study of the level of pituitary and ovarian hormones (FSH, LH, estradiol); conducting hormonal tests, ultrasound, laparoscopy and gonadal biopsy. The most valuable for diagnosis are hormonal studies and laparoscopy with ovarian biopsy.

Differential diagnosis.

It is necessary to differentiate from resistant ovarian syndrome, pituitary tumor and other diseases.

• For resistant ovarian syndrome characterized by a complete absence of vasomotor symptoms, moderate estrogen saturation, and occasional independent menstruation. With ultrasound and PPG: the uterus and ovaries are usually of normal size. Macro- and microscopically the ovaries are not changed. The level of gonadotropic hormones is slightly increased. There is moderate estrogen saturation. When large doses of gonadotropins are administered, activation of ovarian function is rarely observed. With this pathology, the follicular apparatus is preserved, cytoplasmic receptors are affected, and therefore menstrual function is disrupted.
• At hypogonadotropic hypogonadism the level of gonadotropins is low, there are no vasomotor disorders and signs of sexual infantilism. Tests for ovarian stimulation with hCG and clomiphene are positive. During laparoscopy: the ovaries are small, the follicles are visible, their presence is confirmed histologically.
• At pituitary tumors characteristic data are revealed using radiation research methods (radiography of the skull, MRI) > ophthalmological, neurological, etc.
• Tuberculosis of the genitals. Characteristic medical history, chronic course of the inflammatory process, infertility. With this pathology, ovarian depletion is possible in a severe process (pyo-ovary).

diagnosticcriteria	Syndrome resistant ovaries		Gonadal dysgenesis
1	2	3	4
Amenorrhea	Amenorrhea primary or secondary after regular menstrual cycles or rare episodic menstruation	Amenorrhea after a period of regular menstruation and reproductive well-being	Amenorrhea primary or secondary after several irregular menstruation
"Tides"	Can be unexpressed "tides"	Severe hot flashes, increased sweating, decreased ability to work. While taking hormonal medications, hot flashes disappear and condition improves	There are no hot flashes or may occur after discontinuation of hormone therapy
Vaginal dryness	Not always	Vaginal dryness	Rarely
Progesterone test	Positive in 84% of cases	Negative	Negative
Test with pergonal	May be positive	Negative	Negative
Test for cyclical hormone therapy	Positive	Positive	Positive
Phenotype	Female	Female	Underdevelopment secondary signs: their formation is noted against the background of taking cyclic hormone therapy
Genotype	46 XX	46 XX	Mosaicism translocations, monogenic
Sex chromatin	Within normal limits	Within normal limits	Reduced

Treatment.

Taking into account the depletion of the ovarian follicular apparatus, it is inappropriate and not indifferent for the patient to carry out treatment aimed at stimulating ovarian function. Estrogenic hormones, increasing the initially high level of gonadotropins, can contribute to the activation of hyperplastic processes in the target organs for gonadotropins: mammary glands, adrenal medulla (Smetnik V.P., 1980). However, D. Kreiner et al. (1988) proved spontaneous and pharmacologically induced remissions in these patients. In 7 patients with ovarian failure with amenorrhea lasting from 2 to 14 years, ovulation was induced, and in 3 of them pregnancy occurred. Patients received micronized E2 in increasing doses with maintenance doses of progesterone as replacement therapy.

Hormone replacement therapy gives best results and is etiopathogenetic. Femoston, Klimo-Norm, Klimen, Organametril are used; in young women - Mercilon, Marvelon, Novinet, Regulon, Logest, Silest. At the age of up to 40 years, it is advisable to regulate the cycle differently, then the dose of drugs can be reduced or Femoston, Livial can be prescribed for the treatment of vegetative-vascular disorders, prevention of genitourinary disorders, early atherosclerosis, coronary artery disease, stroke and osteoporosis. Treatment should be continued until the age of natural menopause.

This therapy should be combined with general somatic and sanatorium-resort methods (physical therapy, acupuncture, massage of the collar area, electrophoresis according to Shcherbak, electroanalgesia, psychotherapy, auto-training; water procedures - circular shower and Charcot shower, iodide-bromine, carbon dioxide, pearl, pine, radon baths) .

Vitamin therapy: vitamins S, E, groups IN. Sedative therapy: grandaxin, novopassit, valerian, hawthorn, peony.

Non-hormonal drugs containing phytoestrogens include Remens, Klimaktoplan, Klimadinon, Altera Plus.

Products rich in phytoestrogens are sprouted grains of wheat, rye, rice, nuts, berries, soybeans, red clover, Abraham tree, alfalfa, potato juice, sage, ginger, etc.

Rational management of patients leads to normalization of quality of life. Restoration of reproduction is possible when using IVF using donor oocytes.

Gynecologists often refer to ovarian depletion syndrome as “premature menopause/menopause/”. This occurs in more than 1.5% of women, and various types of amenorrhea - among 10%.

It is important to know! A universal remedy has been found with which you can treat any gynecological disease - cervical erosion, fibroids, ovarian tumor or cyst, vaginal dysbiosis, persistent menstrual irregularities. (recommended by our subscribers!)

The syndrome is manifested by the insufficiency of the glands, which were previously fully formed and worked as expected.

Ovarian wasting syndrome (OSS) is a complete or partial loss of the full functionality of the glands before the due date.

The pathology is very often diagnosed in women under 40 years of age who have not previously complained about reproductive function and menstrual cycle.

This syndrome is characterized by depletion of the ovarian follicular apparatus.

Depleted ovaries, which is associated with a meager follicular apparatus that does not have a reserve of ovarian follicular reserve, lead to secondary amenorrhea, infertility, disruptions in the vegetative-vascular system, resulting from stress, malnutrition, heredity and other environmental factors.

As a result, women do not ovulate and the production of sex hormones is reduced.

Women who are faced with this problem may notice a decrease in sexual desire for their partner, feel hot flashes, and note an unstable emotional state.

For treatment and prevention of various types gynecological diseases(cyst, erosion, fibroids, endometriosis, endometritis) our readers successfully use the proven method. Having carefully studied it, we present it to your attention.

This is why many women confuse the syndrome with approaching menopause, postponing visits to the gynecologist and treatment of the pathology.

Premature ovarian failure

Premature ovarian failure is an unpleasant syndrome that women face.

The biggest problem due to the progression of pathology is infertility. But if the problem is diagnosed in a timely manner and treatment is started, pregnancy can occur.

Premature ovarian failure syndrome is accompanied by symptoms similar to early menopause.

As a rule, menopause occurs after 45 years. But in women diagnosed with early ovarian failure syndrome, menopause occurs earlier - about 40 years.

This may be a consequence of autoimmune diseases, in which the female body was forced to produce antibodies to glandular tissues. Very often this condition leads to chromosomal abnormalities.

Causes

As we have already noted, the reasons that cause ovarian depletion can be of different nature, but most often the etiology of the syndrome is explained by the following:

1. autoimmune disorders;
2. exposure to iatrogenic factors;
3. chromosomal abnormalities.

As medical statistics show, about ½ of patients “received” the disease by inheritance. Especially at risk are girls who have had amenorrhea, early menopause, or oligomenorrhea in their female line.

In addition, the development of ovarian depletion syndrome can be triggered by intrauterine damage to the follicular apparatus, for example, gestosis, maternal use of medications with a teratogenic principle of operation, exposure to radiation and chemicals.

In the postnatal period, there is a high probability of “infection” after suffering from rubella, influenza, mumps, vitamin deficiency, and frequent stress.

Depletion can also be preceded by subtotal resection of the glands due to the formation of a cyst, treatment of which is usually started during conservative myomectomy or with an ectopic pregnancy.

Such rash actions result in a decrease in the follicular reserve in the glands and, as a result, their depletion.

Symptoms of the syndrome

The main symptom accompanying ovarian wasting syndrome is the absence of menstrual flow.

Sometimes, before the complete cessation of the cycle, oligomenorrhea may occur, in which the regularity of the cycle is disrupted and the abundance of discharge is reduced.

Also, signs of gland depletion may include a sudden cessation of menstruation.

This process in most cases is accompanied by symptoms similar to the onset of menopause, namely:

1. sweating increases;
2. hot flashes occur;
3. discomfort or pain may occur during sexual intercourse;
4. is decreasing sexual attraction to a partner;
5. the woman becomes irritable and depressed;
6. memory and performance decreases.

The above symptoms for depleted ovaries bring great discomfort to women’s daily life, reducing its quality. But only in the presence of such symptoms is it not worth making a diagnosis.

In any case, you need to see a doctor, get tested, and only if the diagnosis is confirmed, begin high-quality treatment of the pathology.

Diagnostic methods

Thanks to highly developed medicine today, diagnosing any pathology is not difficult. Let's look at the most informative techniques that are used for exhausted ovarian syndrome:

1. Vaginal and bimanual examination. During this procedure, vaginal dryness and a reduction in the size of the uterus can be diagnosed.
2. Transvaginal ultrasound scan. During the scan, the gynecologist evaluates the structure of the ovaries and uterus, as well as their size. If the ovaries are pathological, their size will be smaller than normal.
3. Diagnostic laparoscopy. This procedure allows you to identify wrinkled ovaries, where neither follicles nor the corpus luteum are visible.
4. Histology. During the study, a biopsy of the glands is taken, after which the absence of a follicular reserve is confirmed or refuted.
5. Hormonal studies. Helps diagnose an increase in gonadotropin levels against the background sharp decline estradiol.

Also, to obtain more specific and accurate information, doctors prescribe additional hormonal testing.

Treatment

Treatment of exhausted ovarian syndrome should be based on correcting the woman’s general well-being, as well as eliminating urogenital disorders, osteoporosis, and cardiovascular diseases.

The greatest success can be achieved if hormone replacement therapy is used as contraception until the woman reaches the age of natural menopause.

With hormone replacement therapy, you can receive treatment either orally or intramuscularly.

If there are concomitant diseases of the genitourinary system, treatment can be supplemented by the introduction of suppositories or the use of ointments.

Medication

To treat ovarian depletion in women, it is common to use the following pharmacological drugs:

1. hormones in high concentrations or dosages (such treatment is not equally suitable for everyone due to a possible negative reaction from the body);
2. multicomponent agents (for example, Ovariamin);
3. hormone replacement therapy;
4. mild sedatives;
5. vitamin complexes.

Folk remedies

Treatment of pathology folk remedies is selected depending on the course of the disease.

As a rule, therapy is aimed at supporting the functioning of the glands before menopause, which can be effective as an addition to the traditional treatment complex or for preventive purposes.

Vitamin E is very popular among people. You can take it in the form of a ready-made pharmaceutical product or supply the body with food high in it.

Foods rich in vitamin E are:

1. seeds;
2. nuts;
3. egg yolk;
4. seafood.

In addition to the fact that vitamin E has a positive effect on the female body, it is also recognized as a powerful antioxidant.

When glands are depleted, it is very useful to increase the consumption of foods rich in lecithin, namely:

1. caviar;
2. legumes;
3. cauliflower inflorescences.

Common folk recipe is an egg-lemon tincture. It can be taken both for problems with the glands and for early menopause.

To prepare the tincture, you need to chop 5 medium lemons (with peel) and mix them with the crushed shells of 5 eggs.

Infuse the mixture until the shell dissolves. Take the tincture 3 times a day, 20 g each. Duration of treatment is 1 month.

Also useful for problems with women's health accept:

1. peppermint infusion;
2. infusion of blackberries and viburnum;
3. freshly squeezed juice from fresh beet with the addition of honey.

Other methods

In addition to the generally accepted medicinal methods treatments and proven folk remedies, a big role in recovery is played by:

1. physiotherapy;
2. acupuncture course;
3. relaxing massages.

Complications

If a woman, regardless of her age, has received a diagnosis of “depleted ovarian syndrome” from a doctor, she must strictly follow all recommendations and instructions.

If the disease is not diagnosed in time and treatment of the pathology is not started, the likelihood of the following complications is high:

1. premature aging of the body;
2. increasing the likelihood of being among the patients who have suffered dysfunction of the cardiovascular system;
3. osteoporosis;
4. depression and other psycho-emotional disorders;
5. decline in living standards;
6. loss of interest in a partner during intimacy.

Prevention

If, for any reason, a woman is at risk of developing glandular depletion syndrome, it is necessary today to adjust her lifestyle so that the first signs of pathology can be avoided or at least delayed.

To achieve this goal, you need:

1. eat properly and healthy food;
2. give up all kinds of diets, especially taking any drugs for weight loss;
3. begin timely treatment of viral infections, even if they are accompanied only by nasal discharge;
4. avoid chemical and radioactive effects on the body;
5. do not resort to self-medication with medications;
6. control the level of anti-Mullerian hormone;
7. Visit a gynecologist regularly, at least once every 6 months.

How does ovarian wasting syndrome affect a woman’s appearance?

It doesn’t matter what was the impetus for the development of the pathology, the main symptoms of the disease are the same for all women:

1. hot flashes throughout the body;
2. redness of the face and décolleté;
3. increased sweating;
4. lack of air.

Since during the syndrome the level of female sex hormones is significantly reduced, a woman’s sexual desire also weakens.

With a lack of estrogen, the vaginal walls become dry, which can cause pain and discomfort during intercourse.

Such, at first glance, harmless symptoms they are not reflected in the appearance of women, but the general dissatisfaction with the quality of life immediately becomes noticeable.

Women often lose interest not only in intimacy, but also in their appearance, feeling unattractive, overwhelmed, and stopping taking care of themselves.

Is it possible to get pregnant if your ovaries are depleted?

As we said, therapy for this syndrome is aimed at alleviating symptoms, that is, it allows you to delay aging, preserving a woman’s not only external attractiveness, but also health.

To do this, the body has to be fed with missing hormones that are not produced directly by the woman’s body.

Cases have been recorded when hormonal therapy played the role of a push for the female sex glands, after which the body was able to resume ovulation and even conceive healthy child. But such cases are exceptional, so you shouldn’t get your hopes up prematurely.

Today, experts are of the generally accepted opinion that ovarian depletion and pregnancy are incompatible.

In order for a woman with aged gland syndrome to become pregnant, she needs to resort to a procedure, which requires a donor egg.

As you can see, glandular pathology is a serious illness that requires the fastest possible diagnosis and high-quality, comprehensive treatment.

Monastic collection helps with such diseases and conditions

1. Diseases of the uterus (fibroids, erosion, endometritis, bends and prolapses of the uterus);
2. ovarian cysts, inflammation of the appendages;
3. thrush and unpleasant odor;
4. pain during sex;
5. infertility;
6. discomfort when urinating.

IN medical practice There is such a disease as ovarian depletion. It represents pathological condition, in which women's reproductive function is impaired. What is this disease and how to cure it? This can be understood by studying the pathology and methods of its treatment in more detail.

Causes of the disease

Ovarian wasting syndrome is a pathology in which a woman reaches menopause much earlier than expected. Typically, this disease is observed in patients under 40 years of age with normal functioning of the reproductive organs.

As a result of the research, scientists concluded that this disease is most often provoked by a hereditary predisposition. This is evidenced by a large percentage of patients whose relatives also suffered from depletion of the reproductive organs.

Experts believe another reason congenital anomaly, which occurs due to gene mutations. This is possible if, while carrying a girl, the woman drank alcoholic beverages, consumed narcotic substances, was exposed to frequent stressful situations, suffered from severe pathologies, and received serious injuries. Her child is then more likely to experience decreased reproductive organ activity in the future.

In some cases, early ovarian failure syndrome occurs due to the development of autoimmune processes in the body. This means that a woman produces antibodies that have a negative effect on organ tissue. This usually occurs when a woman suffers autoimmune pathologies organs that produce hormones.
The main causes of ovarian depletion are:

• Intoxication chemicals.
• Radiation exposure.
• Small ovaries.
• Infectious pathologies that occur in severe form.
• Frequent stressful situations.
• Failure of metabolism in the body.
• Low body weight.
• Surgery on the ovaries and other organs located in the pelvis.

Clinical picture

The symptoms of ovarian wasting syndrome are the same as during menopause itself. From the very beginning, patients notice that their menstrual cycle has become irregular. Menstruation does not come every month, is scanty, and then disappears completely.
Exhausted ovarian syndrome and its symptoms may include the following:

1. Hot flashes increased sweating. Usually this manifests itself unexpectedly, at night, after a stressful situation, taking large quantity food, temperature changes external environment. The patient feels her heartbeat and feels pain in the chest area.
2. Changes in psycho-emotional state. Due to lazy ovaries, the patient is worried about irritability, tearfulness, and a tendency to depression. If she has any psychical deviations, then they can get worse. There are also problems with sleep and sex life.
3. Disturbances in the urogenic zone. Due to depleted ovaries, changes in the mucous membrane of the vagina and vulva appear in the body. Patients note dryness, itching in the intimate area and urination channel. A woman's sex life brings discomfort due to the fact that during intercourse the vagina is dry and a burning sensation is felt.
4. Aging. The patient's skin ceases to be elastic, becomes thin, and many wrinkles appear on it. Hair also changes; it becomes dull, brittle, dry, and excessively thin. The disease also has a bad effect on the nails. They begin to peel off, acquire grooves, irregularities, and white spots.
5. Failure of metabolism in the body. Lazy ovaries cause changes in a woman's production of other hormones. There is often a disruption of the thyroid gland, which leads to thyrotoxicosis. As a result, the patient’s hands tremble, blood pressure, heart rate and body temperature increase, and outbursts of anger occur.

Read also Effective ways therapy for follicular atresia

If patients do not undergo treatment, the decline of ovarian function will only progress, which will greatly worsen the quality of life of women.

Complications of the disease

Ovarian wasting syndrome causes difficulty conceiving a child. Patients may also suffer from heart problems, for example, ischemia, heart attack, arrhythmia. Doctors note another consequence such as fragility of bone tissue.
It occurs due to the fact that the body contains a small amount of calcium. Due to this ovarian pathology, a woman loses interest in sex, she is often accompanied by depression, and her ability to work decreases. Therefore, treatment of ovarian wasting syndrome must be carried out immediately.

Pathology and pregnancy

Ovarian depletion and pregnancy are practically incompatible due to the early consumption of egg reserves. When a woman develops such a disease, attempts to become pregnant are often futile. But if you eliminate premature ovarian failure syndrome, your chance of conceiving a child increases.
In order to restore reproductive function, patients are prescribed hormone replacement therapy. This treatment helps restore ovulation and achieve conception. Not all patients succeed. But modern medicine also offers ways to become a mother if the ovaries are not functioning properly. The most popular procedure is IVF.

Cryopreservation of eggs

Ovarian wasting syndrome is often observed in young women. In such a situation, they begin to worry because they are starting late and for a long time the menstrual cycle is established. Therefore, patients go to the doctor and undergo examination.
If the doctor suspects that a girl is developing or may develop ovarian depletion syndrome in the future, he suggests cryopreservation of the eggs. This will allow you to become the mother of a genetically native baby in the future.

Medicine offers different ways freezing and thawing eggs, with which they can be stored for a long time. The preservation procedure does not in any way affect the structure of oocytes and does not have a negative impact on their functioning.

Children who are born using this method are no different from babies born naturally. Therefore, you should not worry about the development of congenital defects.

Methods of treating pathology

Is it possible to get rid of pathology? The disease can be eliminated. The necessary diagnostics for the ovaries are prescribed by a gynecologist. Based on the examination results, a treatment plan is drawn up.
Treatment for wasting syndrome aims to restore hormonal balance in organism. To do this, doctors recommend drinking oral contraceptives, which contain estrogen and progesterone. Throughout therapy, women need to be regularly monitored by a doctor and have blood tests for sex hormones.
This treatment is carried out until healing or extinction of ovarian function occurs naturally, that is, until approximately 45-50 years of age. As an addition to hormone therapy, the attending physician prescribes vitamins, dietary supplements, and sedatives.
The doctor may recommend taking Ovariamine. It belongs to dietary supplements and is able to improve a woman’s reproductive function. How to use this remedy The attending physician will tell you, the dosage is calculated individually.

Ovarian depletion in women is successfully treated with stem cells.
This is done by administering injections that contain them. These cells are taken from the patient’s own body. Typically material is removed from the area around femur.
They are then grown in special laboratory. This takes approximately 2-3 weeks. The stem cell injections are then injected back into the woman's body, where they help the reproductive cells regenerate.

Treatment with traditional methods

As a supplement to the main method of therapy, women often undergo treatment with folk remedies. This technique is also possible as a prevention of the occurrence of pathologies of the reproductive organs.
Along with stem cell treatment or any medications, you need to take vitamin E. Doctors advise eating nuts, seeds, egg yolks and fish. This vitamin has a beneficial effect on women's health and has a strong antioxidant effect.

Lecithin treatment helps a lot. Usually, patients do not have enough of this substance in their body, so it is necessary to take it. To do this, it is best to give preference to natural products. For example, you can include in your diet cauliflower, lentils, beans.
The following decoctions and infusions can be used to treat pathology:

• Take a tablespoon of boron uterus, add 300 ml of water and boil for 10 minutes. Then leave to infuse for one hour. After this, you can take a tablespoon 5 times a day an hour before meals. The course of treatment is 3 weeks with a break of 7 days, after which therapy continues until the disease subsides.
• Pour 10 g of wintergreen into 100 ml of vodka, leave for 10 days, then drink half a teaspoon three times a day. Treatment is also necessary after the arrival of menstruation for 1.5 months.

Ovarian wasting syndrome is a pathological condition with premature (up to 40 years) decline in women reproductive function. Other names for the pathology are premature menopause, resistant ovarian syndrome, etc. It is characterized by the onset of amenorrhea, the inability to get pregnant, and the appearance of vegetative-vascular disorders.

Causes of early loss of fertility

There are several justified reasons that cause the premature cessation of menstruation in a woman:

1. Three X chromosome syndrome is a gene mutation caused by the influence of teratogenic factors on the fetus during intrauterine development (as a rule, the factor should act on a pregnant woman during the period of division of the zygote and the formation of organs in the embryo). In this case, there will be underdevelopment of the ovaries (there is no ovarian enlargement syndrome) and the follicular apparatus. This pathology can be diagnosed in adolescence.
2. Increased production of gonadotropins causes damage to the woman’s reproductive system, and also provokes damage to the centers that regulate the functioning of the ovaries to one degree or another.
3. Autoimmune reactions - in this case, immune complexes are formed in the woman’s body, which aggressively affect the body’s own tissues (in this case, the ovaries), contributing to the destruction of their structure.

Menopause before 40 years of age is a pathology that negatively affects a woman’s health and self-esteem

Factors that contribute to the development of resistant ovarian syndrome include:

• malnutrition (small amount of food, poor quality, indigestibility nutrients in the gastrointestinal canal);
• some infectious diseases transmitted to childhood(flu, mumps, rubella);
• stress and extreme fatigue;
• poisoning and, as a consequence, chronic intoxication;
• effect on the body of above-threshold doses of ionizing radiation;
• autoimmune diseases affecting any of the hormone-producing organs;
• surgical interventions localized in the female genital area (removal of an ovarian cyst or tumor and others).

Symptoms of ovarian failure syndrome depend on individual characteristics the body, the degree of development of the pathological process and the complications that it entailed.

How does the syndrome manifest?

Early ovarian failure syndrome includes the following symptoms:

• dizziness and frequent headaches;
• weakness, increased fatigue;
• irritability, sleep disturbances (insomnia);
• amenorrhea or oligomenorrhea;
• dysfunction of the cardiovascular system, arrhythmias;
• sweating and hot flashes characteristic of menopause;
• infertility.

All these signs are directly related to ovarian hypofunction, as a result of which all metabolic processes in a woman’s body are disrupted. Treatment of resistant ovarian syndrome should be based on the patient taking hormonal medications to support and normalize hormonal levels.

Treatment of early ovarian failure

Maintaining the functioning of the female body is carried out through replacement therapy. Since estrogen is not produced by the ovaries in sufficient quantities, the woman is prescribed oral hormones. Replacement therapy is necessary until menopause occurs naturally.

Physiotherapy and other procedures aimed at strengthening natural protective forces body, reducing the intensity of symptoms of SIJ, stimulating metabolic processes in the body.

Important! With the help of replacement therapy it is possible to prevent metabolic disorders, pathological processes in the urinary system, as well as bone osteoporosis.

A woman with ovarian hyperinhibition syndrome needs to carefully monitor her diet. It is useful to eat more foods that contain phytoestrogens (for example, wheat germ, rice, rye, ginger, nuts, etc.).

Treatment of ovarian depletion syndrome with folk remedies is also effective, but only if all remedies are agreed upon with the doctor and approved by him.

How to prevent the development of the syndrome

Prevention is ineffective only in the case of a genetic abnormality - three X chromosome syndrome. In other cases, it is possible and necessary to prevent premature ovarian failure syndrome. To do this you need:

• good nutrition;
• reduction in frequency stressful situations, physical fatigue, mental stress;
• protection against radiation, overdoses medicines, poisoning and intoxication;
• timely treatment pathological processes in the genitourinary system;
• prevention autoimmune diseases;
• adequate treatment viral diseases, occurring in severe form and accompanied by complications;
• Regularly visiting a doctor and undergoing a gynecological examination.

Taking care of your health is the basis for the proper functioning of the organs of a woman’s reproductive system

Treating ovarian wasting syndrome is much more difficult than preventing it. A woman should always be attentive to her health and promptly eliminate any pathological reactions and processes in the body.

Sometimes, for various reasons, women who have not reached menopausal age experience premature decline in reproductive function. Typically, young women around the age of 40 face this problem, and sometimes earlier. Gynecologists call this ovarian wasting syndrome (OSS) or early menopause. The problem is not only the untimely loss reproductive function, but also in the fact that in female body processes characteristic of this occur - hormonal changes and, in most cases, decreased fertility. This process is irreversible; restoration of natural reproductive function, unfortunately, is impossible in most cases. However, a woman needs therapy aimed at restoring normal hormonal levels for her young age.

Causes of premature ovarian failure

Several factors have been studied that may contribute to the occurrence of this pathology. In most cases, ovarian wasting syndrome occurs in women who have hereditary predisposition. Almost 25% of women who consult a gynecologist with this problem have older female relatives who have experienced amenorrhea, late menarche, or early menopause.

A possible cause of SIA may be congenital genetic abnormality, resulting from gene mutations (during examination, a third X chromosome is often detected in women). If during pregnancy with a girl the mother used alcohol and drugs, experienced stress and suffered serious illnesses or injuries, then the likelihood of developing SSI in her daughter increases significantly.

Sometimes this pathology develops as a result of some autoimmune processes, when antibodies appear in the body that attack ovarian tissue. This often occurs against the background of autoimmune diseases of other hormone-producing organs.

There are other possible causes not related to congenital anomalies:

• poisoning with chemicals, including drugs, chronic intoxication;
• exposure to radiation;
• infectious diseases suffered in severe form with complications (, etc.);
• constant ;
• metabolic disorders (in particular, galactosemia);
• constant malnutrition, exhaustion, anorexia;
• ovarian surgery (resection to remove a cyst or tumor).

Symptoms of ovarian wasting syndrome

Symptoms usually occur suddenly during normal reproductive function. The woman notices that it becomes irregular, menstruation becomes scanty, and after a while it stops altogether.

A couple of months after the cessation of menstruation, symptoms characteristic of menopause appear:

The appearance of tides(hot flashes, excessive sweating, palpitations, dizziness and darkening of the eyes, sometimes this occurs with excitement, but most often for no reason).

Deterioration of psycho-emotional status(increased irritability, tearfulness, anxiety, depression, insomnia, etc.).

Decreased libido, often associated with the fact that a decrease in estrogen production leads to atrophy of the mucous membrane of the vagina and vulva. As a result, unpleasant symptoms appear, such as dryness and itching in the vagina and urethra, which leads to discomfort during sexual intercourse.

Frequent, and others inflammatory diseases genitourinary system. This is also associated with atrophy of the mucous membranes and a decrease in the production of substances with protective properties.

Aging of the skin and the whole body. Hormones produced by the ovaries are involved in maintaining the tone and elasticity of the skin and other body tissues. Therefore, after menopause, the aging process accelerates.

These symptoms often disrupt the usual rhythm of life and cause many different problems. That is why women experiencing SIA need hormone replacement therapy, which helps to almost completely get rid of these unpleasant symptoms.

Diagnostics

Typically, diagnosing this pathology does not cause serious difficulties for the doctor. A gynecologist can suspect SIA after collecting anamnesis from the patient. During the examination, the doctor may notice dryness of the vaginal mucosa and a decrease in the size of the uterus. An ultrasound examination also determines a decrease in the size of the uterus, thinning of the endometrium, a decrease in the ovaries, and the absence of follicles in them.

To clarify the diagnosis, a study of the concentration of hormones in the blood is carried out. Typically, a decrease in the level of estrogen and progesterone is detected, while the level of follicle-stimulating (FSH) and luteinizing hormone (LH) produced by the pituitary gland is increased. The doctor may also prescribe hormonal tests with various hormones to carry out differential diagnosis with other pathologies that have a similar clinical picture (for example, resistant ovarian syndrome).

The most objective and reliable method is diagnostic laparoscopy followed by examination of histological material taken during manipulation.

SIA treatment

Therapy is aimed at correcting hormonal changes that cause autonomic disorders. For this purpose, women are prescribed oral contraceptives containing estrogen and progesterone. Patients should be constantly monitored by a gynecologist, and periodic control studies of the level of sex hormones in the blood are carried out. This maintenance therapy continues until the average age of menopause (45-50 years).

Patients are also recommended multivitamin complexes, dietary supplements containing phytoestrogens (Remens, Klimadinon, Klimaktoplan, etc.) and sedatives (mainly of plant origin). It is useful to introduce into the diet foods rich in vitamins A, E, and unsaturated fatty acids(omega-3,6,9), and natural phytoestrogens.

Ovarian wasting syndrome and pregnancy

Since this pathology often occurs in young women planning to have children, they are concerned about the question of whether it is possible to get pregnant with ovarian wasting syndrome.

In 5-10% of cases, hormonal therapy still leads to spontaneous restoration of the normal menstrual cycle and reproductive function. Most often this happens if SIA is a consequence of any disease, intoxication or exhaustion.

In most cases the only way Getting pregnant means IVF (in vitro fertilization). Before the procedure, hormonal therapy is performed to restore the endometrium and prepare it for embryo implantation. Then the woman is given a donor egg, fertilized with the partner’s sperm. During pregnancy, hormone replacement therapy is also necessary. normal work ovaries.

Cryopreservation of eggs

In some cases, SIA occurs in women at a very young age (20-25 years). In this case, the alarm is often sounded by the parents of young girls whose menstrual cycle begins late and takes a long time to establish, sometimes it never becomes regular. As a result of the examination, the doctor may suspect this pathology or assume its occurrence in the future.

If SIA is detected in early age, cryopreservation of a woman’s eggs is, in fact, the only way to give birth to a genetically native child in the future. To date, methods have been developed for freezing and thawing eggs that allow them to be preserved for several decades. The preservation process does not damage the structure of oocytes and does not affect their function in any way. Children born using cryotechnology do not differ from those conceived naturally, the risk congenital pathologies They also do not increase.

Which doctor should I contact?

If there is a late onset of menstruation or early symptoms of menopause, you should consult a gynecologist. In some cases, consultation with an IVF specialist is indicated. In addition, an examination by a cardiologist, neurologist, or psychologist is scheduled. Timely hormone replacement therapy helps restore hormonal background women and improve their well-being.