Ovarian dysfunction is a disorder of the hormonal function of the ovaries due to an inflammatory process or endocrine disorders, manifested by a number of pathological conditions. It is characterized by disorders of the menstrual cycle: its excessive lengthening (more than 35 days), or shortening (less than 21 days), accompanied by subsequent dysfunctional uterine bleeding. It can also manifest as a symptom complex of premenstrual syndrome. It can lead to the development of endometriosis, uterine fibroids, mastopathy, breast cancer, infertility.
ICD 10
E28 Ovarian dysfunction
General information
Ovarian dysfunction is understood as a disorder of the hormone-forming function of the ovaries, leading to a lack of ovulation and menstrual cycle disorders. Manifestations of ovarian dysfunction are dysfunctional uterine bleeding, i.e. bleeding lasting more than 7 days after a delay in menstruation for longer than 35 days, or frequent, irregular, erratic menstruation, coming at different time intervals (but less than 21 days).
A normal menstrual cycle lasts from 21 to 35 days with menstrual bleeding lasting 3-7 days. The physiological norm of blood loss during menstruation usually does not exceed 100-150 ml. Therefore, any deviations in the rhythm, duration of the menstrual cycle and the volume of blood loss are regarded as a manifestation of ovarian dysfunction.
Symptoms
Regulation of ovarian activity is carried out by hormones of the anterior pituitary gland: luteinizing (LH), follicle-stimulating (FSH) and prolactin. A certain ratio of these hormones at each stage of the menstrual cycle ensures a normal ovarian cycle, during which ovulation occurs. Therefore, ovarian dysfunction is based on regulatory disorders of the hypothalamic-pituitary system, leading to anovulation (lack of ovulation) during the menstrual cycle.
With ovarian dysfunction, the absence of ovulation and the phase of the corpus luteum causes various menstrual disorders associated with insufficient progesterone levels and excess estrogen. Ovarian dysfunction may indicate:
- Irregular menstruation, their scarcity or, on the contrary, intensity, bleeding during intermenstrual periods;
- Miscarriage or infertility as a result of violation of the processes of egg maturation and ovulation;
- Pulling, cramping or dull pains in the lower abdomen and lower back on premenstrual and menstrual days, as well as on days of expected ovulation;
- Severe premenstrual syndrome, manifested by lethargy, tearfulness, apathy, or, on the contrary, irritability;
- Acyclic (dysfunctional) uterine bleeding: frequent (with a break of less than 21 days), rare (with a break of more than 35 days), abundant (with blood loss of more than 150 ml), prolonged (more than a week);
- Amenorrhea – non-occurrence of menstruation for more than 6 months.
Thus, each of the symptoms of ovarian dysfunction individually is a serious reason for consulting a gynecologist and examination, as it leads to infertility and miscarriage of the fetus. In addition, ovarian dysfunction may indicate malignant tumor diseases, ectopic pregnancy, and also serve as an impetus for the development, especially in women over 40 years of age, uterine fibroids, endometriosis, mastopathy, breast cancer.
Causes of ovarian dysfunction
The causes of ovarian dysfunction are factors leading to a violation of the hormonal function of the ovaries and the menstrual cycle:
- Inflammatory processes in the ovaries (oophoritis), appendages (salpingoophoritis) and uterus – (endometritis, cervicitis). These diseases can occur as a result of non-compliance with hygiene of the genitals, the introduction of pathogens with blood flow and lymph flow from other organs of the abdominal cavity and intestines, hypothermia, colds, violations of the correct technique of douching the vagina.
- Diseases of the ovaries and uterus (ovarian tumors, adenomyosis, endometriosis, uterine fibromyoma, cervical and uterine body cancer).
- The presence of concomitant endocrine disorders, both acquired and congenital: obesity, diabetes mellitus, thyroid and adrenal gland diseases. The hormonal imbalance caused in the body by these diseases also affects the reproductive sphere, causing ovarian dysfunction.
- Nervous overstrain and exhaustion as a result of stress, physical and psychological fatigue, irrational work and rest regime.
- Spontaneous and artificial termination of pregnancy. Medical abortion or mini-abortion is especially dangerous during the first pregnancy, when the restructuring of the body aimed at carrying pregnancy ends abruptly. This can cause persistent ovarian dysfunction, threatening infertility in the future.
- Incorrect location of the intrauterine device in the uterine cavity. The placement of the intrauterine device is carried out strictly in the absence of contraindications, followed by regular control examinations.
- External factors: climate change, excessive insolation, radiation damage, taking certain medications.
- Sometimes even a single violation of the menstrual cycle is enough to develop persistent ovarian dysfunction.
Diagnosis
Examination and treatment of ovarian dysfunction is carried out by a specialist gynecologist-endocrinologist. If ovarian dysfunction is suspected, the doctor, first of all, will exclude surgical pathology: ectopic pregnancy and tumor processes, will analyze a woman’s menstrual calendar, listen to complaints, conduct a gynecological examination and make a plan for further diagnosis. A set of diagnostic procedures aimed at identifying the causes of ovarian dysfunction may include:
- Ultrasound examinations of the pelvic organs, ultrasound of the adrenal glands and thyroid gland;
- Microscopy and bacposev of vaginal secretions on flora, PCR diagnostics to exclude sexual infections (candidiasis, ureaplasmosis, mycoplasmosis, chlamydia, trichomoniasis, etc.);
- Determination of the level of sex hormones (prolactin, follicle-stimulating and luteinizing hormones, progesterone, estrogens) in urine and blood;
- Blood test for the content of adrenal and thyroid hormones;
- X–ray examination of the skull, MRI and CT of the brain – to exclude pituitary lesions;
- EEG of the brain – to exclude local pathological changes in it;
- Hysteroscopy with targeted biopsy of the cervix or diagnostic curettage of the cervical cavity and canal for subsequent histological examination of endometrial pieces.
The examination scheme of a patient suffering from ovarian dysfunction is compiled individually in each specific situation and does not necessarily include all of the above procedures. The success of correction of ovarian dysfunction is largely determined by the severity of the disorders, so any menstrual cycle disorders should alert a woman and force her to undergo diagnosis. In order to avoid serious complications, patients with chronic ovarian dysfunction are recommended to have dynamic follow-up and examination by a gynecologist-endocrinologist at least 2-4 times a year, even in the absence of subjective changes in the condition.
Treatment
The complex of therapeutic measures for ovarian dysfunction pursues the following goals: correction of urgent conditions (stopping bleeding), elimination of the cause of ovarian dysfunction, restoration of hormonal function of the ovaries and normalization of the menstrual cycle. Treatment of ovarian dysfunction can be carried out inpatient or outpatient (with a mild course of ovarian dysfunction). At the stage of stopping bleeding, hormonal hemostatic therapy is prescribed, and in case of its ineffectiveness, separate curettage of the mucous membrane of the uterine cavity is performed for therapeutic and diagnostic purposes. Depending on the result of histological analysis, further treatment is prescribed.
Further treatment of ovarian dysfunction depends on the causes that caused the disease. If chronic inflammatory processes are detected, the infections that caused them, including sexually transmitted infections, are treated. Correction of endocrine disorders that caused ovarian dysfunction is carried out by the appointment of hormone therapy. To stimulate immunity in ovarian dysfunction, the appointment of vitamin complexes, homeopathic preparations, dietary supplements is indicated. An important role in the general treatment of ovarian dysfunction is given to the normalization of the regime and lifestyle, nutrition and physical activity, as well as physiotherapy, reflexology and psychotherapeutic assistance.
In order to further prevent recurrent uterine bleeding and restore the regular menstrual cycle with ovarian dysfunction, progesterone therapy is used from the 16th to the 26th day of the cycle. After this course, menstruation begins for seven days, and its beginning is regarded as the beginning of a new cycle. Subsequently, hormonal combined contraceptives are prescribed to normalize the menstrual cycle. For women who have previously experienced ovarian dysfunction, the installation of an intrauterine device (IUD) is contraindicated.
Pregnancy planning
Preparation and implementation of pregnancy with ovarian dysfunction should be carried out under the supervision and with the help of a gynecologist-endocrinologist. To do this, it is necessary to undergo a course of therapy aimed at restoring the ovulatory menstrual cycle. In case of ovarian dysfunction, hormonal treatment with chorionic gonadotropin, clomiphene, menotropin is prescribed for this purpose, which are used starting from day 5 of the menstrual cycle to day 9 inclusive.
During the course of taking the prescribed drug, the speed and degree of maturation of the follicle is recorded using ultrasound control. When the follicle reaches the required degree of maturity and the size of 18 mm and the thickness of the endometrium 8-10 mm, the patient is injected with human chorionic gonadotropin (hCG), which causes ovulation. Such stimulation therapy is usually carried out during three more subsequent menstrual cycles. Then progesterone preparations are used for three more cycles from the 16th to the 26th day of the menstrual cycle. The onset of ovulation is monitored by measuring the basal (rectal temperature) and control ultrasound examinations.
Methods of treatment of ovarian dysfunction, which are used by modern gynecology, in many cases allow to achieve the stabilization of the menstrual cycle and the regular onset of ovulation. Thanks to this, a woman can become pregnant and carry a child. If, despite the treatment, pregnancy does not occur, a consultation with a reproductologist is necessary to resolve the issue of the feasibility of artificial insemination with subsequent embryo insertion into the uterine cavity. According to the indications, a donor egg or a donor embryo can be used for IVF. Reproductive technologies also provide for cryopreservation of embryos that have not been transferred to the uterus, for their use if necessary, repeated IVF. In women with ovarian dysfunction, pregnancy management should be carried out from an early stage and with increased attention.
The female reproductive system is a mirror that reflects the overall health of the body, and it is the first to respond to emerging pathological conditions with a violation of menstrual and reproductive functions. The answer to the question: to treat or not to treat ovarian dysfunction in the event that the general well–being at the same time suffers slightly is unambiguous: to treat and as soon as possible! Ovarian dysfunction is sometimes terrible not so much by its manifestations as by its long-term consequences, among which the most frequent are infertility, mastopathy, uterine fibroids, malignant neoplasms of the reproductive system and mammary glands, severe endocrine lesions.
