The follicular apparatus is preserved. Ultrasound of the ovaries to detect ovulation

The growth of the follicle and the subsequent ovulation of the egg that has matured in it are key processes that ensure the readiness of the female reproductive system for conception. Disruption of this natural mechanism is one of the most common causes of infertility. And all IVF programs include a stage of stimulating follicle growth to induce hyperovulation.

Depending on the protocol used, it is performed on the biological mother or an egg donor. In this case, folliculometry is required to track the number of maturing follicles, their size and readiness for ovulation.

A little theory

Follicles are special formations in the ovaries, consisting of a 1st order oocyte (immature egg) and several layers of special cells surrounding it. They are the main structural formations of the female gonads, performing endocrine and reproductive functions.

Follicles are formed in utero. They are based on oogonia - primary germinal germ cells that migrate into the embryonic ovary at approximately 6 weeks of pregnancy. After meiotic division and proliferation, first-order oocytes are formed from these precursors. These immature germ cells are covered with cuboidal epithelium and form the so-called primordial follicles. They will remain dormant until the girl begins puberty.

Subsequently, the primordial follicles are successively transformed into preantral, antral and preovulatory. This process is called folliculogenesis. Normally, it ends with ovulation - the release of an egg that is mature and ready for fertilization. At the site of the follicle, an endocrine active corpus luteum is formed.

When conception occurs, it is maintained under the influence of human chorionic gonadotropin. The progesterone it produces helps prolong pregnancy. In all other cases, the corpus luteum is reduced, which occurs before menstruation. The accompanying sharp drop in progesterone levels provokes the onset of menstruation with the rejection of the overgrown glandular (functional) layer of the endometrium.

It is possible that a mature follicle does not ovulate. At the same time, it can continue to increase in size, transforming into a reduced egg. Such formations can be single and gradually resolve. But sometimes cysts persist for a long time, deforming the surface of the organ. In this case we talk about . This diagnosis is prognostically unfavorable for conception; it is usually accompanied by persistent dishormonal disorders and infertility.

How many follicles are there in the ovaries?

Not all follicles initially established in utero in the ovaries are preserved at the time of puberty and subsequently develop. About 2/3 of them die and dissolve. This natural process is called apoptosis or atresia. It begins immediately after the formation of the gonads and continues throughout life. A girl is born with approximately 1-2 million primordial follicles. By the beginning of puberty, their average number is 270-500 thousand. And during the entire reproductive period, only about 300-500 follicles ovulate in a woman.

The sum of all follicles capable of further development is called the ovarian reserve. The duration of a woman’s reproductive period and the onset of pregnancy, the number of productive (with ovulation) menstrual cycles and, in general, the ability to re-conceive depends on it.

The process of progressive depletion of the ovarian reserve in the ovaries is observed on average after 37-38 years. This means not only a decrease in a woman’s ability to conceive naturally, but also the beginning of a natural decrease in the level of major sex hormones. The cessation of follicle development in the ovaries means the onset of menopause. It can be natural, early and iatrogenic.

Graafian bubble formation phase

The amount of follicular fluid progressively increases, it pushes the entire epithelium and egg to the periphery. The follicle grows rapidly and begins to protrude through the outer lining of the ovary. The egg in it is located on the periphery on the so-called ovarian mound. Approximately 2 days before ovulation, the amount of secreted estrogens increases significantly. This feedback principle initiates the release of luteinizing hormone by the pituitary gland, which triggers the process of ovulation. A local protrusion (stigma) appears on the surface of the Graafian vesicle. It is at this point that the follicle ovulates (ruptures).

As a result of ovulation, the egg, ready for fertilization, leaves the ovary and enters the abdominal cavity. Here it is captured by the villi of the fallopian tubes and continues its natural migration towards the sperm.

How is the “correctness” of folliculogenesis assessed?

The stages of folliculogenesis have a clear relationship with the days of the ovarian-menstrual cycle. Moreover, they depend not on the age and race of the woman, but on her endocrine status.

The growth and development of the follicle is regulated primarily by follicle-stimulating hormone from the pituitary gland. It begins to be produced only with the onset of puberty. At a certain stage, folliculogenesis is additionally controlled by sex hormones, which are produced by the cells of the wall of the developing follicle itself.

Any hormonal imbalance can disrupt the process of egg maturation and ovulation. At the same time, determining the level of hormones does not always provide the doctor with all the necessary information, although it allows one to identify key endocrine disorders. Therefore, diagnosing disorders of the folliculogenesis process is the most important stage in examining a woman at the stage of pregnancy planning and in identifying the cause of infertility.

In this case, the doctor is interested in how large the follicle grows and whether it reaches the stage of Graaf’s vesicle. Be sure to monitor whether ovulation occurs and whether a sufficiently sized corpus luteum is formed. During anovulatory cycles, the maximum size of developing follicles is determined.

An accessible, informative and at the same time technically uncomplicated method is. This is the name for monitoring follicle maturation using ultrasound. It is performed on an outpatient basis and does not require any special preparation for the woman. Folliculometry is a dynamic study. Several repeated ultrasound sessions are required to reliably monitor changes occurring in the ovaries.

In the process of folliculometry, a specialist determines the number, location and diameter of ripening follicles, monitors the formation of a dominant vesicle, and determines the size of the follicle before ovulation. Based on these data, you can predict the most favorable day of the cycle to get pregnant naturally.

In IVF protocols, such monitoring allows one to assess the response to hormonal therapy, set a date for the administration of drugs to stimulate ovulation and subsequent puncture collection of eggs. The key parameter of folliculometry is the size of the follicle by day of the cycle.

Norms of folliculogenesis

Folliculometry is carried out on certain days of the cycle, corresponding to the key stages of folliculogenesis. The data obtained during repeated studies are compared with the average statistical norms. What size follicle should be on different days of the ovarian-menstrual cycle? What fluctuations are considered acceptable?

Normal follicle size on different days of the cycle for a woman aged 30 years with a 28-day cycle, not taking oral contraceptives and not undergoing treatment with hormonal stimulation of ovulation:

• On days 1-4 of the cycle, several antral follicles are detected, each of which does not exceed 4 mm in diameter. They can be located in one or both ovaries. Their number depends on the woman’s age and her available ovarian reserve. It is normal if no more than 9 antral follicles mature simultaneously in both ovaries.
• On the 5th day of the cycle, the antral follicles reach a size of 5-6 mm. Their development is quite uniform, but already at this stage atresia of some vesicles is possible.
• On day 7, the dominant follicle is determined; its size is on average 9-10 mm. It is he who begins to actively develop. The remaining bubbles will gradually be reduced, and they can be detected in the ovaries during ovulation.
• On the 8th day of the cycle, the size of the dominant follicle reaches 12 mm.
• On day 9, the vesicle grows to 14 mm. The follicular cavity is clearly identified in it.
• Day 10 – size reaches 16 mm. The remaining bubbles continue to decrease.
• On day 11, the follicle increases to 18 mm.
• Day 12 – the size continues to increase due to the follicular cavity and reaches 20 mm.
• Day 13 – Graafian vesicle with a diameter of 22 mm (this is the minimum follicle size for ovulation in the natural cycle). At one pole of it, stigma is visible.
• Day 14 – ovulation. Typically, a follicle that reaches 24 mm in diameter bursts.

Deviations from these standard indicators in a downward direction are prognostically unfavorable. But when assessing the results of folliculometry, the duration of a woman’s natural cycle should be taken into account. Sometimes early ovulation occurs. In this case, the follicle reaches the required size on days 8-12 of the cycle.

Follicle size during IVF

With IVF protocols, ovulation is drug-induced and pre-planned.

How many follicles must be in the ovary for conception to occur and for a woman to become a future mother?

Not only the initial number is important, but also the quality of the remaining follicle and its normal ripening.

Any deviations are dangerous - both up and down.

They can lead to the appearance of cysts, and in severe cases, even to a diagnosis of infertility. So, the number of follicles in the ovaries is normal and pathological, read on.

A follicle is an immature egg surrounded by layers of other cells for protection. Their main function is to protect the “core”. How well this task is performed determines the normal development of the egg and its ability to become an embryo and attach to the wall of the uterus after fertilization.

The most interesting thing is that the number of eggs “sleeping” in the follicles is laid in the body at the embryonic stage.

Here, as much as nature has allocated, it will not appear again during life.

Their number ranges from fifty to twenty thousand. Not everyone survives to the point of puberty.

When it occurs, the pituitary gland signals the ovaries to gradually release eggs, which happens every month (except during pregnancy, of course) until menopause.

The ovarian follicles are busy with another important task - the production of estrogen, an important female hormone.

What is the norm and what is not? The number of follicles is calculated according to the day of the female menstrual cycle. The presence of several follicles in the ovaries 2-3 days after the end of menstruation is normal. But they develop differently:

1. On the fifth day, ultrasound can see up to a dozen antral follicles 2-4 mm in size on the periphery of the ovary.
2. By the end of the week they grow to 6 mm. You can see a network of capillaries on their surface.
3. Another day later, dominant follicles are diagnosed, which will continue to grow and develop.
4. On the 9-10th day, the doctor can determine the dominant follicle by ultrasound. It is the largest (14-15 mm). The rest, with delayed development, will be half as much.
5. From the 11th to the 14th day, the follicle continues to grow and reaches 25 mm. There is active production of estrogen. During an ultrasound, the specialist can clearly see the size of the follicle by day of the cycle. Signs of impending ovulation are noticeable.

If the body works without failures, ovulation occurs on the 15-16th day. The follicle bursts and the egg comes out, ready for fertilization.

Deviations from the norm: causes and dangers

Both an insufficient number and an excess of follicles are considered pathology.

If there are more than a dozen of them in the ovaries, the ovaries are called “multifollicular”.

When an ultrasound examination shows many tiny bubbles, they speak of “polyfolicularity.”

If their number increases several times, the woman is diagnosed with polycystic disease.

In this case, the formation of a cyst is not necessary. It’s just that there are a large number of follicular elements scattered around the periphery of the ovary. Such crowding can interfere with the growth of one dominant formation, and, accordingly, all further processes preceding conception.

Pathology can arise due to stress and then return to normal in a short period of time. A woman needs treatment if the failure is caused by:

• problems with the endocrine system;
• rapid weight loss or vice versa – weight gain;
• poor choice of oral contraceptives.

The second option, also caused by problems with hormone levels, is a lack of follicles. Their number is usually checked on the seventh day of the monthly cycle.

If during ultrasound the follicles in the ovaries are found in the following quantities:

• from seven to sixteen - conception is possible;
• from four to six – the likelihood of pregnancy is low;
• less than four – there is practically no chance.

There are many reasons for deviations; there may be several of them at once. Having recognized the first warning signs, it is important to seek help from a doctor in time.

Dominant follicle

Before ovulation, basically, a single large follicle remains, from which an egg capable of fertilization emerges.

It is called dominant. The onset of menstruation is a sign that this dominant follicle has burst in the ovary.

For all sorts of disorders and problems with conception, the process of analysis described above is carried out in dynamics based on ultrasound. It starts on the 10th day of the cycle.

If the dominant element grows poorly and there is no ovulation, treatment is prescribed and the examination is repeated during the next cycle.

With the help of special therapy, maturation can be accelerated, and then the long-awaited pregnancy will occur.

Sometimes two dominant follicles in one ovary mature at once (usually with hormone therapy). This happens less frequently on the left side.

As a result, almost simultaneous fertilization of two eggs and the appearance of two embryos (and the birth of twins as a result) are possible. When having sexual intercourse with different partners in a short period of time, conception from two fathers is possible.

The egg cell lives very little - no more than 36 hours. That is why a couple planning to conceive should track the time of ovulation as accurately as possible - this increases the chances of a quick pregnancy.

Persistent follicle

Follicular ovarian cyst is a very common disease among women of reproductive age.

Its development in all cases causes a “persistent” follicle.

The failure occurs when the dominant follicle, which has grown to the desired point, for some reason does not burst.

The egg remains inside, there is no ovulation, and the follicle begins to accumulate fluid and turns into a neoplasm.

Most often, disturbances are caused by hormonal imbalances (for example, excess testosterone). In cases where such pathologies occur systematically, the woman is diagnosed with infertility.

Treatment of follicle persistence is associated with adjusting hormone levels.

Lack of follicles

Sometimes women are diagnosed with a complete absence of follicles. Pathology can be caused by early menopause or ovarian dysfunction. The occurrence of a problem is signaled by disruptions in menstruation. When they are gone from 21 to 35 days, this is an alarm bell. You need to urgently visit a specialist.

In addition, follicles (and with them eggs) may die due to:

• a course of drugs that interfere with normal blood circulation in the reproductive system;
• surgical intervention in the pelvic organs;
• radiation or chemotherapy performed;
• violations of nutritional rules, strict diets or hunger strikes;
• smoking, alcohol abuse;
• hormonal abnormalities.

If you need to correct your figure, you should choose a diet with a specialist, without exhausting yourself with improper or insufficient nutrition, because this can have a detrimental effect on reproductive function.

Follicles are formed in the female body, even at the stage of embryonic development, then it is impossible to adjust their number in any way.

If failures are detected, you should not despair either - well-chosen treatment often helps, and a woman who is found to have too many or too few follicles later becomes a mother.

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The follicles in the ovaries are an integral part of the female reproductive system, which make it possible to conceive a child. Deviations from the norm in the development of these elements are fraught with unpleasant pathologies and sometimes infertility.

Ultrasound of the ovaries. Follicles

The ovarian cycle consists of two phases - follicular and luteal. We are interested in the first one.

The follicle contains an egg, which is surrounded by a layer of epithelial cells and two layers of connective tissue. Whether a woman can get pregnant and carry a baby depends on how reliably the egg is protected and whether it can be preserved. Thus, the main functional significance of these structures is to provide the egg with protection from the negative influence of various factors, which is very important during pregnancy. One such formation matures in a month.

All follicles in the ovaries contain an egg that is not fully mature. It will finally mature only after the fertilization process.

Another, no less important function of such formations is the production of the hormone estrogen. In the fairer sex, follicles are continuously formed throughout life. Of these, 99.9% die and do not ovulate. And only one, rarely 2-3 follicles undergo ovulation.

Dominant follicles and their role

The dominant follicle is the element that is the largest and most mature, providing protection to the egg ready for fertilization.

Before ovulation, it is capable of reaching two centimeters in size. Usually located in the right ovary.

Having reached a state of maturity and being under the influence of hormones, the dominant follicle ruptures and the ovulation process occurs. The egg quickly moves to the fallopian tubes. If the dominant element does not mature, then there will be no ovulation.

There are situations when dominant formations mature in both ovaries at the same time. There is no need to worry about this. Most likely, such a woman has every chance of conceiving twins after ovulation. However, this is only possible if the dominant elements in both the right and left ovaries have both ovulated at once. This doesn't happen often.

Number and norm of follicles in the ovaries

Follicles in the ovaries are counted based on the day the menstrual cycle starts. If multiple follicles are detected a couple of days after the end of your period, this is not considered a deviation.

The middle of the cycle will be marked by one or two elements that will be larger in size than the rest. At the end of the cycle, only one will remain large. An egg should come out of it, which at that moment is ready for fertilization. The rupture of the formation itself is manifested by the beginning of the menstrual cycle.

Find out more about the number of follicles in the article.

If the quantitative composition of follicles in the ovary exceeds 10, this is considered to be a violation. Such a pathology can be diagnosed only by ultrasound results. Moreover, their number does not change at all over the course of the cycle. During an ultrasound examination, a large number of small bubbles are noted. If their number increases several times, the woman is diagnosed with polycystic disease. characterized by the formation of multiple follicular formations along the periphery.

Polycystic disease can interfere with the formation of a dominant element, the ovulation process and conception. The development of such problems can provoke nervous disorders and stress. In this case, polycystic disease does not require special treatment, and the deviations will easily return to normal.

However, in some cases, underdevelopment of follicular elements requires special therapy. These include the following:

• if oral contraceptives were chosen incorrectly;
• if endocrine problems occur;
• when gaining excess weight or, conversely, sudden weight loss.

If the follicles in the ovary are higher than normal, this does not necessarily mean that polycystic disease has developed or is a signal of any illness. It is likely that the reason for this was overwork, stress, and constant emotional overstrain. In this case, after the first ovulation their number returns to normal.

Since obesity can provoke follicular failure and lead to an imbalance in the functioning of the ovaries, women are advised to monitor their diet and pay due attention to physical activity.

Every woman must regularly visit a gynecologist-endocrinologist. This will allow you to promptly identify the pathology and promptly begin to treat it.

Only a gynecologist can determine why the follicles in the ovaries are formed abnormally from the norm after undergoing certain tests and a special examination.

Persistent follicle

The question of what a follicle is is asked by those who have received a similar diagnosis. Pathology means that the formation of the dominant element occurred as it should until the very moment when it was supposed to burst. This did not happen and the egg, accordingly, is not released. Regardless of where the appearance of a persistent follicle was diagnosed on the right or left ovary, ovulation does not occur. The cause of the disease may lie in hormonal imbalances in a woman, in cases where the male hormone is present in excess. If you do not intervene in such a process in a timely manner, then the development of infertility is possible.

The essence of treatment comes down to hormonal therapy.

At the initial stage, medications are taken that will suppress male hormones in the body.

The second stage involves the introduction of hormones intramuscularly. In addition, it is necessary to carry out massage procedures, laser therapy, and ultrasound effects on the pelvic organs.

Lack of follicles

However, sometimes it happens that the follicular structures on the ovaries are completely absent. The reason for this lies in the early onset of menopause or failures in the functioning of the ovaries. In this case, the doctor prescribes hormonal treatment. You can find out about the presence of such a problem by irregularities in the menstrual cycle.

The body of the fairer sex must produce a certain number of follicles. If there are more or less of them, this is always considered a deviation. Sometimes everything can end in the development of infertility. Therefore, when faced with menstrual irregularities, a woman should immediately contact a doctor to determine the cause and prescribe the necessary treatment.

Follicles in the ovaries are fluid-filled sacs, each of which contains an immature egg. FSH promotes their maturation by encouraging them to produce more estrogen.

As the follicles develop, the main one is selected - the dominant one, with a maturing egg, which will then be fertilized and attached to the walls of the uterus. That is, follicles play an important role in conception. If not enough of them mature, it is difficult for a woman to become pregnant. It's time to understand in more detail what it is, scanty ovarian follicular apparatus, and how it is treated.

Norm

Follicular reserve is the number of follicles currently available that can be used for conception. The main task of an immature egg is to protect the nucleus. The normal development of the egg and its transformation into an embryo depends on this.

From birth until puberty, the number of follicles in a girl’s body ranges from fifty to 20 thousand. Of course, when puberty occurs, the pituitary gland signals the appendages to gradually release the eggs. This process is called menstruation.

Follicle development occurs in different ways. On different days of the cycle, you can see different numbers of them on an ultrasound. What is the norm?

The norm of follicular reserve depending on the day of the menstrual cycle:

• Day 5 - up to 10 antral follicles measuring 2–4 mm;
• Day 7 - the amount is the same, they grow to 6 mm;
• on the 8th day of MC, dominant follicles can be seen;
• on days 9–10, using a transvaginal ultrasound, the laboratory technician diagnoses 1 prevailing follicle, the size of which is 14–15 mm;
• 11–14 days - its growth is observed, estrogen is quickly produced, it increases to 25 mm.

If the critical days have begun, then fertilization has not occurred and the prevailing follicle has burst in the ovary.

Causes

Possible dysfunctions can only be detected by performing an ultrasound examination of the pelvic organs. Ovarian failure can be due to various reasons. The most important are:

• Breastfeeding a newborn. During this period, the mother’s body produces prolactin. It is a hormone that can influence the incomplete maturation of follicles.
• The second reason is oral contraception. Oral contraceptives should not cause failure after discontinuation.
• The use of pills and underdevelopment of follicles indicates that the doctor chose the wrong medicine for the woman. Usually, after stopping oral contraception, a couple has every chance of conceiving a baby.
• Ovarian insufficiency is also affected by excess weight.

These are the main reasons why most women experience dysfunction in follicular development. The listed conditions can be called natural, since the cause is not a disorder in the body and an external factor that is created by the woman herself.

Hypofunction

Hypergonadotropic hypofunction is observed in women with the following ovarian syndromes: dysgenesis, wasting, resistance.

Dysgenesis

Dysgenesis syndrome (Shereshevsky-Turner) means a pathology of the embryonic development of the functioning of the appendages. Such ailments are caused by chromosomal or gene disorders.

Sex chromatin in such patients is negative. The main symptom of dysgenesis syndrome is the underdevelopment of sexual characteristics, as well as the absence of menstrual bleeding. This syndrome is also characterized by scanty hair growth, underdeveloped mammary glands and preservation of the internal genital organs in pre-pubertal sizes.

The girl's appendages are small; ultrasound can detect ovarian insufficiency (primary follicles do not contain eggs or they are degenerative). Dysgenesis syndrome is discovered too late; people often find out about it if menstruation does not occur after 15. Also at this time, girls learn about existing infertility.

With this syndrome, symptoms such as infertility, opsomenorrhea (impaired menstrual cycle, in the form of an increase in its duration to 35 days or more), which turns into amenorrhea, as well as symptoms of early menopause, are observed.

This condition can be successfully treated. Girls are prescribed cyclic replacement therapy with estrogen and progestins. She will have to undergo such treatment throughout adulthood. Thanks to replacement therapy, secondary female sexual characteristics develop, organs return to normal and develop to the age norm, and regular menstruation also occurs.

Unfortunately, girls with dysgenesis syndrome will not be able to get pregnant. Due to the lack of normal eggs, they are sterile, but will be able to have a normal sex life.

In adulthood, the sex chromatin test will be positive. The appendages remain reduced, eggs will also be absent and the number of follicles is minimal, which also will not make it possible to get pregnant. Only with regular use of replacement therapy can it be possible to conceive a child, but due to persistent amenorrhea, these cases are rare.

Ovarian exhaustion

Premature ovarian failure is the loss of normal ovarian function in women under 40 years of age. The causes of this syndrome are:

• autoimmune disorders;
• chromosomal abnormalities;
• congenital deficiency of the follicular apparatus;
• late menarche (late first menstrual bleeding);
• early menopause;
• hypothyroidism;
• gestosis.

Damage to the gonads can also occur in the postnatal period. Their replacement is caused by influenza viruses, rubella, chronic tonsillitis, fasting and regular stress.

Ovarian wasting syndrome is manifested by amenorrhea or oligomenorrhea followed by a persistent absence of menstrual periods. Next, the woman begins to be bothered by the symptoms of menopause, she feels hot flashes, sweating, and headaches. The mammary glands do not enlarge; on the contrary, atrophic processes begin in them, as well as in the genitals.

Ovarian wasting syndrome (OSF) is diagnosed based on the collected history and clinical picture. Gynecological and ultrasound examinations are performed. Therapy is aimed at the prevention and treatment of estrogen deficiency conditions. It is possible to conceive a child with SIA, but only through IVF or with the help of a donor egg. Unfortunately, the possibility of natural fertilization is limited.

Ovarian resistance

This pathology is poorly understood, but scientists still managed to learn a little about this syndrome. With resistant appendages, there is a lack of receptors for gonadotropins in the ovarian tissue, which leads to a decrease in the amount of sex hormones with an increase in FSH and LH. Exogenous administration of sex hormones leads to a decrease in FSH and LH, and there is a follicular reserve in the appendages. These data indicate the absence of synthesis of sex hormones.

A test with gonadotropins will show a negative result. This condition develops up to 35 years of age and is characterized by the absence of menstrual bleeding and infertility. Resistant appendage syndrome is an acquired condition. The causes of this phenomenon are sexually transmitted infections, the use of cytotoxic medications and immunomodulatory drugs. Also, the acquisition of ovarian failure is affected by ionizing radiation and surgery on the appendages.

Savage syndrome is diagnosed by performing the following tests: progestogen test, with estrogens and gestagens. Estrogen is also injected into the body to determine the level of gonadotropins. If it decreases, then there is a connection between the ovaries and the pituitary gland. An ultrasound is performed to confirm the diagnosis. It allows you to determine the size of the uterus and appendage. With ROS, the reproductive organ may be slightly reduced in size, as well as the ovaries.

Laparoscopy is required. This examination method allows you to see the number of follicles. In Savage syndrome, the ovaries contain multiple follicles, the diameter of which is up to 6 mm. This means that they are primordial and preaternal, that is, immature.

FOS is treated with gonadotropic therapy and estrogens. After the end of therapy, the menstrual cycle is restored, the production of gonadotropins is suppressed. The woman is also prescribed immunomodulators, acupuncture, electrophoresis and other physical procedures to quickly restore the health of the pelvic organs.

Despite good treatment, women with resistant ovarian syndrome are unable to become pregnant on their own. Conception is possible only through in vitro fertilization or using a donor egg.

Normogonadotropic

Normoprolactinemic normogonadotropic ovarian failure means a disturbance in the circhoral rhythm of LH/FSH production. In this condition, a hormone releasing hormone is released into the blood by a part of the brain that regulates neuroendocrine activity and homeostasis of the body.

This release occurs every hour, a few minutes after it the concentration of follicle-stimulating and luteinizing hormone increases. With this kind of work, all systems work correctly, the secretion of sex hormones in the appendages is stimulated.

If the pulsation frequency of luliberin changes, there is a change in the FSH/LH ratio. What does it mean? This process leads to a change in the rate of production of sex hormones. As a result of a violation of the pulsation frequency of luliberin, it leads to a disruption of the normal ovulatory cycle.

Normoprolactinemic normogonadotropic insufficiency is not a death sentence. Yes, the probability of restoring normal menstruation is very low, but not zero. In any case, fertilization using IVF is possible.

Hypogonadotropic

This condition occurs due to insufficient stimulation of the function of the appendages by gonadotropic hormones of the pituitary gland. With such ovarian failure, the symptoms are as follows:

• primary or secondary amenorrhea;
• infertility;
• no tides;
• normal body type;
• blood pressure does not fluctuate;
• the uterus and appendages are reduced in size (confirmed by ultrasound);
• Hypoplasia of the mammary glands is possible (but this is a rare occurrence).

Hypogonadotropic hypofunction is of two types. There are congenital and acquired hypothalamic origin, as well as pituitary origin.

Congenital hypothalamic HH develops due to insufficiency of hormone releasing in tumors of the central nervous system and is inherited. Acquired HHH is the cause of cysts and neuroinfections, frequent increases in intracranial pressure, OMT trauma, severe obesity or weight loss in women.

HH of pituitary origin develops against the background of decreased synthesis of LH and FSH. The cause may be cysts, necrosis of the anterior pituitary gland.

The disease is treated by a gynecologist-endocrinologist. Usually, the hypothalamic-pituitary axis is stimulated to activate gonadotropic function.

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Causes, symptoms and treatment of premature ovarian failure syndrome

Early menopause is sometimes called premature ovarian failure syndrome. Menopause usually occurs in women after 45 years of age, but in some cases, a decrease in the amount of estrogen and depletion of the follicular reserve occurs much earlier.

Causes

According to statistics, about 1.6% of women suffer from SPIA. Its appearance is due to various reasons:

1. Chromosomal abnormalities, inherited predisposition. It has been proven that in 50% of cases there is a family history when the mother also experiences early menopause. Most often, we are talking about damage or absence of one of the two X chromosomes, which leads to hormonal disorders in several generations.
2. Autoimmune disorders. A woman's body perceives the ovaries as a foreign body and produces antibodies against them. This can occur as a result of endocrine diseases such as thyroiditis, hypothyroidism, adrenal insufficiency, and diabetes.
3. Violations received in utero. First of all, these are disturbances in the functioning of the follicular apparatus, provoked by gestosis, certain drugs that have a teratogenic effect, and chemicals.
4. Surgical interventions - for example, ovarian resection for an endometrioid cyst, or surgery for an ectopic pregnancy.
5. Wrong lifestyle, excessive dieting, fasting.
6. Stress, smoking.

Symptoms of early ovarian failure syndrome

Premature ovarian failure syndrome is often called “early menopause”

The disease has a fairly extensive list of symptoms and manifestations. Let's name those that occur most often.

• Irregular menstrual rhythm.

Read also: Causes and treatment methods for frigidity in women

This may be a lengthening or shortening of periods or absence of periods for several cycles. Intermenstrual bleeding is also common. In some cases, a period of oligomenorrhea (that is, scanty menstruation) may be followed by a state of no menstruation at all (amenorrhea).

• Increased sweating.

Hot flashes, which can be single or multiple (up to 30-50 per day), are a typical manifestation of the syndrome. The attack begins with redness of the chest and face, continues with the appearance of a feeling of heat, and after it - profuse release of cold sweat. Also during attacks there is a rapid heartbeat and a feeling of anxiety.

• Psycho-emotional disorders.

In the absence of pathologies, estrogens regulate the production of neurotransmitters - chemical substances that are responsible, among other things, for a good mood (among them, for example, serotonin). A decrease in the amount of estrogen entails a decrease in the level of these substances, which leads to mood swings, frequent feelings of fatigue, and irritability.

Sleep disturbances are observed in more than half of women suffering from PCIA. They are caused by a decrease in the level of melatonin, a hormone that regulates circadian rhythms.

Due to a decrease in estrogen levels, androgens in adipose tissue are converted into estrogens. To compensate for this process, the body produces more fat, which leads to weight gain.

• Urogenital disorders.

The muscle tone of the bladder and sphincter that holds urine decreases. As a result, there is an increase in urination and urinary incontinence that occurs when laughing or coughing.

Diagnostics

The term "premature ovarian failure syndrome" is used in the following cases:

• the patient is under 40 years old;
• she does not have regular periods;
• low levels of estradiol were recorded;
• high levels of FSH are diagnosed.

Diagnostics is carried out using the following methods:

1. Hormonal studies. A blood test demonstrates an increase in FSH levels (more than 20 mU/ml), a noticeable decrease in the concentration of estradiol.
2. A vaginal examination reveals excessive dryness of the mucous membrane, and the gynecologist also notes a reduction in the uterus.
3. Transvaginal ultrasound also records the reduction of the uterus and the correspondence of its size to the 2nd degree of genital infantilism. The ovaries are also reduced, the follicles are not visualized, the thickness of the endometrium does not exceed 0.5 cm.

In approximately half of the cases, some number of follicles are present in the ovaries. Such patients may experience spontaneous ovulation and even become pregnant.

How to cure the syndrome

The leading treatment method for SPIA is hormone replacement therapy. In addition, spa methods and sedative therapy are used. The goals of treatment are, first of all, to maintain normal hormonal levels in order to avoid the development of complications (for example, osteoporosis).

Treatment with hormonal drugs

The basis of treatment for the syndrome is hormone replacement therapy.

The basis of treatment is preparations containing estrogens. Their choice and dosage are determined by the woman’s age, as well as the absence or presence of menstruation. In addition, progesterones are prescribed, which protect the uterus from excessive exposure to estrogen.

In the practice of gynecologists, three modes of prescribing drugs for replacement therapy are used:

1. Monotherapy with estrogens alone (such as Proginova, Divigel, Ovestin and others). Prescribed in the absence of a uterus, usually for 3-4 weeks of use with breaks of a week.
2. Combination therapy (estrogens with progesterone) in a continuous mode.
3. Combination therapy in a course mode.

Women under 35 years of age may be prescribed the following drugs (as contraception):

• Marvelon
• Mercilon
• Logest
• Novinet
• Regulon

Patients over 35 years of age are prescribed the following medications:

• Femoston
• Klimonorm
• Orgametril

Other treatments

In addition to hormonal drugs, vitamins, phytoestrogens, and immunomodulators are prescribed. Among them may be:

• glutamic acid, which improves brain function and promotes the activation of hormone production;
• folic acid, which promotes egg maturation;
• Wobenzym in a minimal dosage to prevent side effects from taking hormones;
• herbal medicine with herbs that contain plant estrogens (for example, boron uterus and sage).

Sanatorium-resort methods are also used - circular showers, radon and iodine-bromine baths, acupuncture, auto-training and others.

About exhausted ovarian syndrome in the Health program

SPIA and pregnancy

In most cases, hormonal therapy improves the quality of life (relieves sweating, irritability, vaginal dryness and other symptoms of the disease). However, it does not affect reproductive function.

If infertility is not a problem for the patient, then replacement therapy continues until natural menopause occurs. If she is planning a pregnancy, it can only be achieved through IVF using a donor egg.

In this case, first of all, conditions are created for the growth of the endometrium (using individually calculated doses of estrogens) and only after that the embryos are transferred. Such a program cannot be implemented if irreversible changes occur in the endometrium, and in this case, turning to the services of a surrogate mother becomes the only opportunity to become a mother.

Sources:

1. Smetnik V.P., Tumilovich L.G. Non-operative gynecology - Moscow, 2005.
2. Nazarenko T.A., Mishieva N.G. Infertility and age: ways to solve the problem - Moscow, 2010.

ekomed.info

PREMATURE MENOPAUSE

The term “menopause” is derived from the Greek “menos” (month) and “pausos” (end) and means the permanent cessation of menstruation or menstrual cycles, caused by a pronounced decrease and/or cessation (switching off) of ovarian function.

Depending on the time of onset, the following types of menopause are distinguished:

• timely (45-55 years, average 49-52 years);
• premature (36-40 years);
• early (41-45 years);
• late (over 55 years old).

Timely menopause is the most striking manifestation of the menopause or transitional period in a woman’s life. “Climacteric” (from Greek - step, ladder), the terms “menopause”, “menopause”, “menopause” are synonyms denoting the transition from the reproductive period to old age. This period is divided into premenopause, menopause, postmenopause and perimenopause. What is most characteristic of this physiological period? It is characterized by a gradual decrease and exclusion of ovarian function from a complex ensemble of endocrine glands. First, reproductive function decreases and turns off, then, against the background of progressive depletion of the follicular apparatus of the ovaries, menstrual cycles stop (menopause), and 3-5 years after menopause, the hormonal function of the ovaries also turns off.

Both premature and late menopause require close attention and correction of possible disorders. Due to the fact that it is always difficult to estimate which menstruation was the last, it is customary to estimate the date of menopause retrospectively, namely: one year after the last menstruation.

The age of menopause often depends on heredity, which is convincingly shown in identical twins, when the difference in the age of the first and last menstruation in twins ranges from 4-6 months. However, illnesses suffered by the individual and environmental factors play an important role.

Premature menopause is quite rare (1-2%), but there are many reasons for its occurrence. Often the true cause is quite difficult to establish.

The ovary is a complex structure within which the cortical and medulla layers are distinguished. In the ovarian cortex, eggs are laid in utero, surrounded by granulosa cells, forming follicles with eggs. By the time of the first menstruation in puberty, 300-400 thousand of these follicles are found in the ovaries. During the 25-30 years of the reproductive period, follicle maturation, ovulation and death (atresia) of follicles through apoptosis constantly occur in the ovaries. Only 0.1% of the number of follicles ovulate and can give birth to offspring, and 99.9% are atretic. By the age of 40, an average of about 10 thousand follicles remain. In addition, both female (estrogens and progesterone) and, to a lesser extent, male sex hormones are synthesized in the ovaries. These hormones are involved in the formation of a typical female physique and monthly prepare the reproductive organs for pregnancy.

Receptors for estrogen and progesterone have been identified not only in the reproductive organs. Hormonal receptors (representations), through which sex hormones exert their influence, are found in the heart and walls of blood vessels, in the central nervous system, bone, genitourinary and other organs and systems of the body. Since a young woman secretes sex hormones in a cyclical mode, then the organs and tissues experience their effects also in a cyclical mode.

With premature menopause, the cyclic release and influence of female sex hormones on various organs and tissues that have been exposed to this effect for decades ceases. In addition, the woman also loses the ability to conceive.

In recent years, the opinion has become increasingly widespread that it may be more appropriate to call this condition not “premature menopause”, but “premature ovarian failure”. Although, in essence, we are talking about the same process, from the point of view of deontology, it is more appropriate for both the doctor and the patient to call this condition “premature ovarian failure.”

The main causes of premature ovarian failure:

• genetic factors;
• autoimmune process;
• viral infection;
• iatrogenic (chemotherapy, radiotherapy, surgery on the uterus and ovaries);
• idiopathic (environmental toxins, fasting, smoking - more than 30 cigarettes per day).

According to our practice, premature ovarian failure is often observed in mothers and daughters. Despite the fact that there are many reasons, processes in the ovaries mainly occur according to two main scenarios:

• complete depletion of the follicular apparatus of the ovaries, the so-called ovarian depletion syndrome;
• syndrome of resistant (silent, refractory) ovaries, in which follicles are detected in the ovaries, but they do not respond to their own gonadotropic stimuli.

Clinical picture

Common to both options:

• secondary amenorrhea, infertility;
• well developed secondary sexual characteristics;
• FSH and LH levels are high;
• estradiol levels are low;
• symptoms of estrogen deficiency: hot flashes, sweating, insomnia, irritability, decreased memory, and ability to work;
• during the first 2-3 years, osteopenia develops, sometimes osteoporosis; an increase in atherogenic lipid fractions (cholesterol, triglycerides, LDL) and a decrease in HDL;
• occasionally genitourinary symptoms appear: dryness during sexual intercourse, itching, burning;
• improvement occurs when taking sex hormones.

The main differences between the two forms of premature ovarian failure are as follows.

When the follicular apparatus is depleted:

• with ultrasound - small size of the ovaries, absence of follicles in them;
• persistent cessation of menstruation, symptoms of estrogen deficiency progress; improvement occurs with hormone replacement therapy (HRT);

  with ovarian resistance:

• the ovaries are reduced in size, but the follicles are visible;
• There are rare episodes of menstruation.

When the ovaries are depleted, the symptoms of estrogen deficiency or the symptoms of typical menopausal syndrome are more pronounced.

With resistant ovarian syndrome, estrogen deficiency symptoms are less pronounced, since it is possible, although extremely rare, to activate ovarian function and, accordingly, improve the general condition.

Management tactics for patients with premature ovarian failure

• Examination.
• Study of anamnesis.
• Determination of FSH, LH, TSH, prolactin, estradiol in the blood.
• Craniography, for headaches - computed tomography or nuclear magnetic resonance, color fields of vision.
• Ultrasound of the genitals with detailed characteristics of the ovaries and uterus.
• Determination of blood lipids.
• Mammography.
• For long-term amenorrhea (more than 2-3 years) - densitometry of the lumbar spine and femoral neck.

Since menopause is premature, and at this age the ovaries normally function, therefore, premature deficiency of sex hormones can contribute to the earlier appearance of typical menopausal disorders, the frequency of which is 60-70%.

Classification of menopausal disorders

Group I - early symptoms (typical menopausal syndrome)

Vasomotor: hot flashes, chills, increased sweating, headaches, hypotension or hypertension, rapid heartbeat.

Emotional-vegetative: irritability, drowsiness, weakness, anxiety, depression, forgetfulness, inattention, decreased libido.

Group II - medium-term (after 2-3 years)

Urogenital: vaginal dryness, pain during sexual intercourse, itching and burning, urethral syndrome, cystalgia, urinary incontinence.

Skin and its appendages: dryness, brittle nails, wrinkles, hair loss.

Group III - late metabolic disorders (after 5-7 years)

Cardiovascular diseases (coronary artery disease, atherosclerosis), postmenopausal osteoporosis or osteopenia.

Individual selection of therapy

Taking into account the above, it seems important to develop an individual “program for restoring and maintaining health” for the long term, taking into account the family and personal risk of the main diseases of aging. Such a program should include regular examination, namely ultrasound, mammography, densitometry and/or determination of biochemical markers of bone remodeling, lipid profile, tumor markers, etc., as well as recommendations for lifestyle changes, such as increasing physical activity, a balanced diet, avoiding Smoking and other bad habits help reduce the risk of cardiovascular diseases and osteoporosis.

In recent years, there has been a constant search and improvement of therapeutic approaches to the rational use of HRT in each specific patient (individualization of therapy). HRT preparations differ from each other only in their progestogen component, since the estrogenic component is represented by 17β-estradiol or estradiol valerate, which correspond in structure to ovarian estradiol. In addition, recently much attention has been paid to the choice of route of drug administration (oral or transdermal).

The type of hormone therapy is also selected taking into account the following factors:

• a woman's desire to have a monthly "menstruation";
• when indicating surgical interventions - indications and scope of the operation and the presence of the uterus;
• the presence of fear of pregnancy, especially with resistant ovaries;
• decreased or absent libido;
• indications of heart attacks in young parents, recurrent miscarriage, liver disease, thrombophlebitis.

The goal of HRT is to pharmacologically replace the hormonal function of the ovaries in women with deficiency of sex hormones, using such minimally optimal doses of hormones that would actually improve the general condition of patients, ensure the prevention of late metabolic disorders and are not accompanied by the side effects of estrogens and progestogens.

Basic principles and indications for prescribing HRT

• The use of only “natural” estrogens and their analogues for HRT is indicated.
• Estrogen doses are low and should be consistent with those in the early proliferation phase of young women.
• The combination of estrogens with progestogens makes it possible to protect the endometrium from hyperplastic processes with an intact uterus.
• Women with a removed uterus are advised to use estrogen monotherapy in intermittent courses or continuously. If the indication for hysterectomy was endometriosis, then a combination of estrogens with progestogens or with androgens, or monotherapy with progestogens or androgens in a continuous mode, is used.

Women need to be provided with appropriate information to enable them to make an informed decision to undergo HRT. All women should be informed:

• about the possible impact of short-term estrogen deficiency, namely the occurrence of early typical symptoms of menopausal syndrome and the consequences of prolonged deficiency of sex hormones: osteoporosis, cardiovascular diseases, genitourinary disorders, etc.;
• about the positive effects of HRT, which can alleviate and eliminate early menopausal symptoms, and also actually serve to prevent osteoporosis and cardiovascular diseases;
• about contraindications and side effects of HRT.

To ensure optimal clinical effect with minimal adverse reactions, it is essential to determine the most appropriate optimal doses, types and routes of administration of hormonal drugs.

There are three main modes of HRT.

1. Estrogen monotherapy. In the absence of a uterus (hysterectomy), estrogen monotherapy is prescribed in intermittent courses or continuously.
2. Combination therapy (estrogens with progestogens) in a cyclic mode.
3. Combination therapy (estrogens with progestogens) in a monophasic continuous mode.

Regimes 2 and 3 are prescribed to women with an intact uterus.

Estrogen monotherapy: intermittent courses (estrofem, progynova, estrimax, divigel, estrogel, climar patch, ovestin) or continuous regimen for 3-4 weeks with weekly breaks.

Combination therapy (estrogens with progestogens) in a cyclic mode:

• two-phase drugs: intermittent cyclic regimen (Divina, Klimen, Klimonorm);
• two-phase drugs: continuous mode (femoston 2/10 or femoston 1/10);
• three-phase drugs in continuous mode (trisequence, triaclim).

With this regimen, a menstrual-like reaction is observed, which is extremely important psychologically for a young woman.

Monophasic combination therapy (estrogens with progestogens) in a continuous mode (cliogest, climodien, pausogest).

With a continuous regimen of hormone therapy, a menstrual-like reaction is excluded.

Livial (tibolone) has continuous estrogenic, progestogenic and weak androgenic activity.

If a hysterectomy is performed for genital endometriosis, preference is given to monophasic combination therapy (Climodien, Cliogest, Pausogest) or Livial in order to exclude stimulation of possible endometriotic heterotopies by estrogen monotherapy.

If the clinical picture is dominated by changes in the cardiovascular system and atherogenic fractions of lipids in the blood, preference should be given to two- or three-phase drugs in which the gestagenic component is represented by progesterone derivatives (Climen, Femoston).

If the clinical picture is dominated by weakness, asthenia, decreased libido, pain in bones and joints, and osteoporosis, then preference should be given to biphasic drugs with a progestin component - a derivative of 19-nortestosterone (klimonorm), as well as Divin (MPA with a weak androgenic effect) ( table).

For urogenital disorders in perimenopause, preference is given to local (vaginal) monotherapy with estriol without the addition of progestogens. When urogenital disorders are combined with systemic metabolic disorders (osteoporosis, atherosclerosis), a combination of local and systemic therapy is possible.

Cyclic two- and three-phase HRT, along with improving the general condition, contributes to the regulation of the menstrual “cycle”, as well as the prevention of hyperplastic processes in the endometrium due to the cyclic addition of progestogens. It is extremely important to inform the woman about the following:

• when taking two- or three-phase HRT, a monthly menstrual-like reaction is observed;
• HRT drugs do not have a contraceptive effect.

So, combined two- and three-phase drugs are most suitable for women with premature menopause, as they provide cyclic protection of the endometrium with progestogens, similar to what happens in the normal menstrual cycle.

For severe diseases of the liver, pancreas, migraines, blood pressure more than 170 mm Hg. Art., with a history of thrombophlebitis, parenteral administration of estrogens in the form of a weekly patch (Klimar) or gel (Divigel, Estragel) is indicated. In such cases, with an intact uterus, it is necessary to add progesterone and its analogues (duphaston, utrozhestan).

• gynecological examination with oncocytology;
• Ultrasound of the genital organs;
• mammography;
• according to indications - lipid profile, osteodensitometry.

  Contraindications for prescribing HRT:

• vaginal bleeding of unknown origin;
• acute severe liver disease;
• acute deep vein thrombosis;
• acute thromboembolic disease;
• cancer of the breast, uterus and ovaries (current; if in history, then exceptions are possible);
• endometriosis (estrogens monotherapy is contraindicated);
• congenital diseases associated with lipid metabolism - hypertriglyceridemia, the use of parenteral forms is indicated.

If there are contraindications to HRT, the issue of using alternative therapy is decided: phytoestrogens (climadinon) or homeopathic remedies (climatoplan).

It is appropriate to note that if a woman has a severe reaction to “menopause” and fears of pregnancy, it is quite possible to use low- and micro-dose combined oral contraceptives: Logest, Mercilon, Novinet, Marvelon, Regulon, Yarina - since the number of contraindications increases with age.

Hormone therapy should be continued until the age of natural menopause (50-55 years); in the future, the issue is resolved individually, taking into account the woman’s wishes, her state of health, and reaction to hormonal drugs.

Premature menopause (premature ovarian failure) is a condition characterized by premature shutdown of the ovaries and the development of an estrogen deficiency state. Women with this condition are indicated for hormone replacement therapy to improve their general condition, improve quality of life, and prevent premature aging and diseases of old age.

V. P. Smetnik, Doctor of Medical Sciences, Professor of the Scientific Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, Moscow

Composition of biphasic drugs for HRT registered in Russia

www.lvrach.ru

Treatment of ovarian wasting syndrome in Israel | Book an appointment with a doctor 24/7

Ovarian wasting syndrome is a symptom complex characterized by the appearance of signs of menopause at an early age. Therefore, this condition is often called premature menopause, premature menopause or early ovarian failure. Menopause usually occurs between the ages of 45 and 50, but with this disease, symptoms of this condition appear before the age of 40. It is important that before the onset of premature menopause, reproductive and menstrual function in such patients was normal. The incidence of this pathological condition among women reaches 1.6%.

Causes of ovarian wasting syndrome

Experts call the following reasons for the development of such a condition as premature ovarian failure:

• chromosomal abnormalities, hereditary predisposition transmitted from mother to daughter. In this case, the patient has small ovaries, the follicular apparatus is not developed. This pathology is associated with mutations of certain genes inherited according to an autosomal dominant pattern of inheritance;
• damage to hypothalamic regulatory centers in the brain;
• autoimmune reactions - in this case, antibodies to the tissue of the ovaries, and sometimes other internal organs, are detected in the blood of patients;
• inflammatory diseases - some infectious diseases can lead to damage to ovarian tissue. This can happen, for example, with rubella, streptococcal infection;
• regular stress overexertion, neuropsychiatric diseases;
• hypovitaminosis, malnutrition;
• some metabolic disorders - a certain relationship has been noted between the incidence of ovarian depletion syndrome and a disease such as galactosemia. In this case, there is a direct damaging effect on the ovaries of galactase or carbohydrate fractions;
• the impact of pathogenic factors on the patient’s body in the prenatal period. These may be bad habits of the mother, taking terratogenic medications, or exposure to ionizing radiation. In this case, damage to the ovarian tissue is observed even in the prenatal period, and the number of egg precursor cells may decrease. The number of germ cells is laid down during the process of intrauterine development of the ovaries. Therefore, if the ovarian tissue is damaged within 12-15 years, the number of cells may simply exhaust itself, resulting in early menopause.

Symptoms of ovarian wasting syndrome

The following clinical symptoms are characteristic of ovarian wasting syndrome:

• the clinical picture of the syndrome develops at the age of 37-38 years;
• amenorrhea – absence of menstruation. It may appear suddenly, or there may be a gradual decline in menstrual function. In this case, delays and cycle irregularity are observed;
• hot flashes - sensations of stuffiness, heat, appear in the first months after the cessation of menstruation;
• increased sweating;
• general weakness;
• decreased ability to work;
• headache;
• irritability;
• atrophy of the mammary glands;
• painful sensations in the heart area.

Diagnosis of ovarian wasting syndrome

If ovarian wasting syndrome is suspected, the following studies are performed:

• blood test to determine hormone levels - with this blood disease in patients, a significant decrease in the level of estradiol, one of the female sex hormones synthesized in the ovaries, is detected. In addition, there is a decrease in the level of adrenal and thyroid hormones, which may indicate a central mechanism for the development of pathology. The level of hormones of the hypothalamus and pituitary gland - follicle-stimulating and luteinizing hormones - increases;
• hysterosalpingography - usually reveals a slight decrease in the size of the uterus, thinning of its mucosa; as a rule, no changes are detected in the fallopian tubes;
• ultrasound examination of the pelvic organs - reveals a decrease in the size of the uterus and ovaries, small follicles in the ovarian tissue;
• Laparoscopy is an invasive examination that is most informative for assessing the condition of the uterus and ovaries. When examining the pelvic organs using a laparoscope, atrophic changes in the ovarian tissue are detected (replacement of the cortical layer with connective tissue, absence of the corpus luteum);
• biopsy - this study is performed during laparoscopy. This involves taking samples of ovarian tissue, which are carefully examined under a microscope. The following changes are characteristic: absence of follicles, fibrosis of the organ stroma. When performing an endometrial biopsy performed during hysteroscopy, atrophy of this layer of the uterine membranes is detected;
• electroencephalogram - allows you to identify disorders that are characteristic of damage to the structures of the hypothalamus;
• hormonal tests - are carried out to assess the reaction of the endocrine system to the introduction of hormones into a woman’s body. This is how drugs such as progesterone, estrogen, and dexamethasone are used.

Treatment of ovarian wasting syndrome in Israel

In Israel, patients with ovarian wasting syndrome are successfully treated. The attentive attitude of the staff and the professional approach of experienced specialists will leave only good impressions of undergoing a course of treatment in clinics in this country. The main treatment for ovarian depletion syndrome is hormonal, replacement and stimulating therapy. Preparations containing female sex hormones (estrogens, gestagens) help restore the correct menstrual cycle, the development of ovulation, and the onset and gestation of pregnancy. Such drugs prevent the early development of osteoporosis, genitourinary diseases, and cardiovascular pathologies, which occur with the onset of menopause. Maintenance therapy is carried out until the natural onset of menopause.

Herbal medicine is used with herbs containing estrogen-like substances. Vitamin therapy and a nutritious diet are also important for ovarian depletion syndrome.

In addition, physiotherapeutic methods are used to stabilize the patients’ condition. Electrophoresis, acupuncture, electroanalgesia, and water procedures have a restorative and stimulating effect, improve metabolic processes in the body, and help increase blood flow in the pelvic organs. Physical exercise is of great importance. Experienced physical therapy specialists will create special sets of exercises that will help each patient increase muscle tone, relieve tension and pain in the joints, and feel a surge of strength.

Rational treatment of ovarian depletion syndrome prevents early aging of a woman and promotes the development of a desired pregnancy.

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hospital-israel.ru

2018 Blog about women's health.

During the next ultrasound examination, a woman may unexpectedly find out that she has multifollicular ovaries. This term is used by sonologists (ultrasound diagnostic specialists) to describe the condition of the gonads, but is not an independent disease or a guide to treatment. In most cases, this is the norm.

If a woman finds out that her ovaries are multifollicular, then she needs to contact a gynecologist. A decision about whether therapeutic manipulations are needed can only be made after a comprehensive examination.

The natural work of the ovaries is to perform important functions: generative (childbirth), hormonal and vegetative. A regular menstrual cycle indicates well-functioning gonads.

In the first phase of the cycle, which can last from 7 days to 3 weeks for different women, estrogen is produced. The ovaries gradually increase in size, forming follicles. One or more of them become dominant by the end of the first phase. To define this concept, sonologists use the term “Graafian vesicle.” Sufficient release of estrogen in the first phase of the cycle regulates the production of follicle-stimulating hormone by the pituitary gland.

Under the influence of luteinizing hormone, the secretion of which is responsible for the anterior lobe of the pituitary gland, the dominant follicle opens (less often, several at the same time). The egg leaves the site of its formation to meet the sperm. In an empty space, a yellow body is formed from the remains of the Graafian vesicle. If pregnancy occurs, it will maintain sufficient levels of progesterone. If conception does not take place, then within 2-3 days the egg dies, and the corpus luteum is destroyed several days before the next menstruation.

Normal functioning of the ovaries provides the fairer sex with the appearance that distinguishes them from men: an hourglass figure, thick hair on the head and light fluff on other parts of the body, a feminine gait, delicate skin.

Normally, by the time of ovulation, 1-2 dominant follicles and several antral ones are determined. If 8-10 bubbles or more are detected, the abbreviation MFN is indicated in the ultrasound report.

Does multifollicular mean polycystic?

Multifollicular changes in the ovaries are a large number of follicles formed once or during each cycle. Normally, the gonads include from 4 to 7 follicles. When the sonologist detects 8-10 or more, he says that there are echo signs of multifollicular ovaries. A large number of follicles may be normal. Multifollicularity is constantly or occasionally observed in 25% of all healthy women.

However, in some cases, such ultrasound signs make the doctor suspect a disease - polycystic ovary syndrome (PCOS).

This is not the same thing at all, although on ultrasound the two conditions are very similar. The main difference is that a woman with multifollicular ovaries without PCOS ovulates and has a regular monthly cycle. In this case, there is absolutely nothing to worry about: this condition does not prevent you from getting pregnant and living a full life.

With PCOS, in addition to the fact that there are many follicles in the ovaries, there are additional symptoms:

• Anovulatory cycle (lack of ovulation). The resulting bubbles undergo reverse development or remain unchanged (or);
• Irregular or too long monthly cycle;
• Increased ovarian size on ultrasound;
• There are more than 10 follicles, each with a size of at least 1 cm;
• Hormonal disorders: blood levels of LH and FSH, testosterone, insulin differ from the norm;
• Increased male pattern hair growth, tendency to be overweight, acne (sometimes, but not always);
• Infertility.

It is impossible to determine on your own what the patient is dealing with. Whether polycystic disease is present can be determined using additional diagnostic procedures. This condition requires mandatory correction. Polycystic disease is an endocrine gynecological disease in which the ovary acquires a dense capsule. The membrane does not allow the mature follicle to open and release the egg. Polycystic ovary syndrome is often accompanied by thyroid disease.

When the structure of the ovaries is multifollicular, but there are no other complaints or manifestations of hormonal disorders, the detected condition is considered normal. It does not require correction, but only involves monitoring the functioning of the gonads for several months.

Causes

The reasons for the formation of multiple follicles are external and internal. Having found out what caused the deviation, we can talk about the need for medical correction. For healthy women with proper functioning of the reproductive organs, it will be enough to eliminate the provoking factor. Multifollicular transformation of the ovaries occurs:

• when using hormonal drugs (long-term suppression of reproductive function followed by drug withdrawal leads to massive growth of follicles);
• during puberty (in girls during puberty, a hormonal surge occurs, which can lead to the growth of a large number of antral follicles);
• due to genetic predisposition (if close female relatives had such a feature while maintaining regular ovulation, then this fact should be considered a hereditary condition);
• due to disruption of the pituitary gland (due to insufficient release of LH, the opening of the Graafian vesicle does not occur);
• with endocrine abnormalities (can be triggered by stress, chronic fatigue, heavy loads);
• in women with excess or underweight.

The true causes of polycystic disease remain unknown today. Obviously, the provocateur of this process is hormonal imbalance. An imbalance of estrogen and progesterone occurs due to inflammatory diseases, malfunction of the adrenal glands and pituitary gland, and decreased sensitivity to insulin.

Symptoms

Women need to know about multifollicular ovaries that this condition may not manifest itself in any way. When the gonads are functioning smoothly, the fairer sex does not feel that the left or right ovary is suddenly filled with multiple bubbles. Less often, the patient feels discomfort during sexual intercourse, as well as during defecation. Menstruation may be more painful or remain normal. In 7 out of 10 patients, an increase in the number of antral follicles is detected quite suddenly, which confirms the asymptomatic course.

Polycystic ovary syndrome is always accompanied by menstrual dysfunction, long cycles, infertility, pain in the lower abdominal segment and other symptoms. Often polycystic disease is complemented by other hormonal diseases, for example, endometriosis, hyperplasia, tumors.

Does it need to be treated?

Treatment of multifollicular ovaries begins only when the pathological cause of their occurrence is confirmed, that is, if a diagnosis of polycystic ovary syndrome is made. It can only be identified with the help of additional research. The first thing a gynecologist does is conduct a manual examination and take a smear. Determination of the inflammatory process obliges the woman to undergo treatment. Attention is drawn to the patient’s body mass index and her appearance: skin pigmentation, hair growth.

Before treating a patient with hormonal drugs, it is necessary to determine the level of FSH, LH, progesterone and androgen. Levels of these hormones can indicate polycystic disease even without an ultrasound scan. Additionally, blood is taken for sugar, insulin, prolactin and some thyroid hormones. For each woman, the gynecologist prescribes an individual range of tests.

If the diagnosis of PCOS is confirmed for the patient, and multifollicular ovaries are visible on ultrasound, treatment should be comprehensive. The woman is prescribed hormonal therapy to help “put to sleep” the gonads. For 3-6 months, the woman takes the recommended oral contraceptives, and doctors monitor the condition of the ovaries.

When the size of the antral vesicles decreases, the woman is prescribed ovulation stimulation. A popular drug used for this purpose is. Once ovulation occurs, it is a colossal step on the path to success. The second phase is supported with progesterone-based drugs.

The lack of positive results from drug treatment suggests surgical intervention. Laparoscopy is an effective and low-traumatic method of treating PCOS. During the operation, the gland is resected and incisions are made on it.

Is it possible to get pregnant with multifollicular ovaries?

Young patients are worried about how to get pregnant with multifollicular ovaries. If reproductive function is not impaired, menstruation is regular, and ovulation occurs about 10 cycles per year, then the likelihood of natural conception does not decrease. The process of egg release does not depend on the number of antral follicles. There may be many of them, but only one will release a gamete (less often, two or three). Pregnancy and multifollicular ovaries are not mutually exclusive. After childbirth, this condition may reappear. If a feature is discovered in a patient planning a pregnancy during ultrasound diagnostics, then the woman is prescribed hormone tests.

With polycystic disease, the likelihood of natural conception tends to zero. Only 15% of women can become pregnant spontaneously. Moreover, about 5% of them are not able to bear a child due to hormonal disorders. In 85% of patients with PCOS, absence of ovulation is diagnosed. When asked whether it is possible to become pregnant with polycystic disease without special treatment, gynecologists usually answer negatively.

Regardless of whether the multifollicular ovary is on the right or left, you can try to solve the problem using proven methods. An important point is diet and physical activity. This is especially true for overweight women. Nutrition should become less caloric, more vitamin-rich and healthy. Sufficient water consumption is a must.

Doctors do not recognize treatment with folk remedies. However, the use of herbs is popular among patients with PCOS: sage, red brush, boron uterus, licorice root, shepherd's purse.

Treatment of multifollicular ovaries is not necessary for all patients, but only for women with reproductive dysfunction, that is, with PCOS. For therapy, you should use drugs prescribed by your doctor in strict accordance with the dosage and regimen.

Consultation with an obstetrician-gynecologist

Obstetrician-gynecologist Elena Aryemeva answers patients’ questions.

— Will it be possible to get pregnant with multifollicular ovaries?

- If there is ovulation, then it will probably work out. To find out if it is there, you need to do folliculometry or buy ovulation tests. If it is, there is most likely nothing to worry about. If there is no ovulation, then in combination with other symptoms, PCOS can be assumed. To exclude this disease, you need to consult an endocrinologist (ideally a gynecologist-endocrinologist) and get tested for hormones.

— I am 21 years old, I have a long delay (a month), the test is negative. An ultrasound showed multifollicular ovaries.

— You need to get tested for hormones, including checking the level of luteinizing hormone. This condition may be temporary (for example, in the case of hormonal imbalance associated with sudden weight loss or gain). Or it may indicate the initial stage of polycystic disease. This is serious. Find a good doctor and follow all his orders.