Hypo-ovaria
Description:
The hypo-ovaria is the collective concept including various morbid conditions caused by many reasons, but which are shown ovarian insufficiency. At the same time owing to the insufficient level of sex steroid hormones overdue puberty with an amenorrhea or a hypomenstrual molimina, or with development of pathology in the genital period — a secondary amenorrhea with the phenomena of premature sexual withering (an early climax) can take place.
Hypo-ovaria symptoms:
The clinical picture of the ovarian insufficiency which arose till the puberty period is characterized by its delay. Later and insufficiently also secondary sexual characteristics develop primary. The hypofunction of ovaries which arose in childbearing age is shown by hypotrophic changes in generative organs and withering of secondary sexual characteristics. There can be neuromental, vegeto-vascular and endocrine and exchange disturbances.
Depending on expressiveness of symptoms it is clinically possible to allocate three degrees of a hypo-ovaria. At easy degree of ovarian insufficiency at girls slightly underdeveloped secondary sexual characteristics, a hypoplasia of mammary glands are noted. The uterus is rather developed with a proliferating endometria, but in insufficient degree for its correct transformation. Menstrual function at patients is broken (an amenorrhea, a hypomenstrual molimina, juvenile uterine bleedings). Shpofunktion of ovaries of moderate severity удевочек is characterized by the expressed underdevelopment primary and secondary sexual characteristics: external genitals, a vagina and a uterus are sharply underdeveloped, slight pilosis, mammary glands are infantile. Periods are absent.
At a severe form of a hypo-ovaria during puberty generative organs of a gipoplastichna. The uterus is small, dense, with a nonfunctioning endometria, much more the smaller sizes in comparison with age norm, with hyper - anti-or a retroflexion. Mucous external genitals and vagina sharply atrofichna, brilliant, light pink color. Pilosis and mammary glands are almost absent.
The clinical picture of insufficiency of ovaries which developed at puberal age also depends on pathology degree of manifestation. In mild cases of a hypo-ovaria only the secondary amenorrhea with quite developed uterus and a proliferating endometria takes place. At heavier degree of manifestation of ovarian insufficiency with an amenorrhea vegeto-vascular and psychoneurological symptoms, as are noted at a pathological current of a climacteric.
Uterus at the same time small, dense, with an atrofichny endometria. Usually at a hypo-ovaria of the genital period the easy current with an amenorrhea passing into a severe form as the following stage of a disease is noted in the beginning.
Hypo-ovaria reasons:
The reasons of a hypo-ovaria are diverse. The inborn hypoplasia of ovaries contacts influence of harmful factors during pre-natal development. Acute and persistent infections (a clumsy rubella, parotitis, tuberculosis, etc.), can lead different types of radiation, and also alimentary factors (a hyponutrient, lack of vitamins) to a hypo-ovaria. Influence of harmful factors can be shown by injury of both ovaries, and other structures of generative system.
The pathogeny of this disease depends on character of the damaging agent, term and duration of its influence. It can lead to morphological disturbances of ovaries (a sklerozirovaniye, cellular infiltration, fibrosis and scarring), and also to pathology of fermental systems of a steroidogenesis. At morphological injuries of ovaries at the last the functional condition of the receptor device and their sensitivity to gonadotrophins changes and can be broken. Perhaps, the syndrome of "resistant ovaries" so develops.
Depending on extent of injuries of ovaries more or less expressed insufficiency of products of sex steroid hormones develops. It results in sexual and somatic infantility with a hypoplasia of generative organs and their mucous membrane and consequently and to disturbance of perception of hormonal influences. Other bodies of reproductive system for the second time are already involved in process and a certain symptom complex of ovarian insufficiency develops.
Treatment of the Hypo-ovaria:
Treatment of a hypo-ovaria depends on time of its emergence (to or after puberty) and severity.
At the expressed hypo-ovaria which arose till the puberty period, treatment is carried out step by step:
The I stage — therapy is directed to stimulation of maturing of generative organs of the girl;
The II stage — treatment provides creation of cyclic functioning of reproductive system with cyclic transformation of an endometria;
The III stage is carried out in need of performance of generative function;
The IV stage is directed to rehabilitation and prevention of palindromias.
At the I stage after establishment of the full diagnosis in a form and severity of a disease the events directed to elimination of pathological and harmful factors (treatment of extragenital diseases, persistent infections, household and professional adverse effects), normalization of a day regimen and alternation of work and rest, intellectual and exercise stresses, the organization of a balanced diet using a complex of vitamins and increase in an immunoreactivity of an organism are held.
At this stage natural and preformirovanny physiotherapeutic factors and LFK, first of all for the purpose of improvement of blood supply of bodies of a small pelvis are widely used. Physiotherapeutic procedures should not be very intensive. It is not recommended to apply such powerful influences as gryaze-, parafino-and ozokeritoapplikation. From hormonal means only oestrogenic connections on 16 — 20dneys 10 — 12-day breaks within 2 — 3 months for increase in the sizes and the correct functioning of generative organs are used in the beginning. Increase in uterus sizes, emergence of a symptom of "pupil", increase in a kariopiknotichesky index according to cytologic researches are the basis for purpose of cyclic hormonal therapy.
It is necessary to remember that here hormonal therapy is not replaceable, and activating. Therefore hormonal drugs are appointed in small doses with gradual decrease on the 2nd and 3rd months. Are used folliculin on 2000 — 3000 PIECES a day, ethinylestradiol (Microfollinum) on 0,25 — 0,05 mg/days. At the II stage all actions of the I stage continue, but instead of oestrogenic connections cyclic hormonal therapy for the purpose of induction of cyclic changes in reproductive system and emergence of cyclic bleedings is carried out.
Oestrogenic connections (ethinylestradiol on 0,05 mg/days) during 1 — 18 days, and then gestagena (progesterone on 5 mg intramusculary or Pregninum on 30 mg under language in days) within 8 — 10 days are appointed, and then in 8 — 10 days the new course begins. The second or third month hormonal means can be applied in a day.
In total cyclic hormonal therapy for the purpose of activation of reproductive system is carried out within 2 — 3 months, in 2 — 4 months repeats, and so in need of the same order during 1 year. All treatment is carried out under control of tests of functional diagnosis, hormonal researches and ultrasonography. Maturing of follicles and emergence of ovulatory cycles are criteria of efficiency of the carried-out therapy. At easy degree of ovarian insufficiency cyclic hormonal therapy without preliminary use of estrogen can be carried out at once.
Treatment of the hypo-ovaria which arose during the reproductive period in many respects similar with stated, but has the features. At the I stage all events for elimination of harmful factors and fortifying character are held. Cyclic hormonal therapy (the II stage) imitates that menstrual cycle which women had earlier. Than the form of a disease, subjects of a high dose of hormones is heavier (folliculin on 10 000 PIECES, progesterone on 10 mg/days). Courses of cyclic hormonal therapy last for 2 — 3 months with 2 — 4-month breaks. The last are necessary as after cancellation of hormones there is an activation of neurohumoral system of regulation of reproductive function.
Treatment at III and IV stages is carried out equally for women with primary and secondary hypo-ovaria. The III stage of treatment on stimulation of an ovulation for performance of reproductive function at women is carried out in process of emergence of such need after achievement of efficiency at the II stage of therapy. Stimulation of an ovulation in such cases is carried out by clomifene and other means according to traditional schemes without use of gonads of otropny hormones as gonadotropic function of a hypophysis at a hypo-ovaria is significantly increased. The IV stage of treatment of such patients providing prevention of palindromias is carried out by medical examination with regular dynamic inspection and holding corrective actions during all life.
The forecast depends on severity of ovarian insufficiency, terms of its emergence and efficiency of the held events for treatment. Quite often already at the first stage of treatment there are periods, even without performing hormonal therapy that testifies to the favorable forecast. At a secondary amenorrhea at women after 30 years quite often it is necessary to spend a long time hormonal therapy. Induction of spontaneous menstrual function manages to be realized more often. In such situations tactics is carried out as at a menopausal syndrome when with the replaceable purpose it is long estrogen-gestagennye drugs are used synthetic.
