Resistant ovary syndrome

Resistant ovarian syndrome is a disease whose essence lies in the insensitivity of the ovaries to gonadotropic stimulation. This syndrome is characterized by amenorrhea and infertility in women under 35 years of age. Diagnosis of resistant ovarian syndrome is based on gynecological examination and anamnesis, hormonal studies and tests, ovarian biopsy, ultrasound. Resistant ovarian syndrome is treated by estrogen replacement hormone therapy. Quite often pregnancy is possible only with the help of ART techniques.

The content of the article:
What is it?
Causes of resistant ovarian syndrome
Symptoms of resistant ovary syndrome
Diagnosis of resistant ovarian syndrome
Treatment of resistant ovarian syndrome
Prevention of resistant ovarian syndrome
Resistant ovary syndrome
What is it?
Resistant ovarian syndrome is considered a little-studied pathology. Its main feature is amenorrhea and infertility, which occur with normally formed secondary sexual characteristics, high levels of gonadotropins and macro- and microscopically unchanged monads. It is worth noting that 1969 was a fateful year, because then for the first time the resistant ovarian syndrome was investigated and described. But even in our time, this topic is still insufficiently covered.

This syndrome accounts for 1.9-10% of cases among various forms of amenorrhea. Resistant ovarian syndrome is a follicular, specific type of ovarian insufficiency that differs from follicular amenorrhea. Resistant ovaries are characterized by the fact that each follicle moves very slowly. As a result of such sedentary activity, anovulation occurs, which further provokes infertility. The syndrome of resistant ovaries is also called Savage syndrome and the syndrome of “dumb”, resting, paralyzed, insensitive or refractory ovaries.

Causes of resistant ovarian syndrome
To date, the causes of the development of resistant ovarian syndrome have not been sufficiently studied. There is a high probability that its development is due to genetic defects in the receptor apparatus of the follicles.

There is also a large amount of data that indicates that this pathology has an autoimmune character. Resistant ovarian syndrome leads to the appearance of antibodies in the serum that block the sensitivity of FSH receptors in the ovaries. As practice shows, this syndrome often occurs in parallel with diseases such as Hashimoto’s thyroiditis, diabetes mellitus, hemolytic anemia, myasthenia gravis, hypoparathyroiditis, alopecia, platelet purpura, etc.

Iatrogenic factors have their influence on the development of resistant ovarian syndrome: the use of cytostatics and immunosuppressants, ovarian resection, radiorentgenotherapy. With tuberculosis, actinomycosis, sarcoidosis, mumps, ovarian tissue is affected, which can also provoke the development of a disease such as resistant ovarian syndrome.

Symptoms of resistant ovary syndrome
Violation of the menstrual cycle, and then the cessation of menstruation is a characteristic sign of resistant ovarian syndrome in women who are no more than 35 years old. Quite often, as practice shows, this pathology is hereditary in nature of menstrual and reproductive function disorders. In addition, the syndrome may occur after a severe viral infection, taking large dosages of sulfonamides, stress exposure, etc.

Quite often, resistant ovarian syndrome is accompanied by oligomenorrhea, which can last from 3 to 10 years. Another characteristic sign of pathology is the absence of vegetative vascular disorders (sweating, palpitations, hot flashes, etc.), which are typical for the syndrome of depleted ovaries and menopause.

Usually, a patient with a diagnosis of resistant ovaries has the correct female body type and well-developed secondary sexual characteristics. Every woman should be careful, because this pathology provokes the development of fibrocystic mastopathy.

Diagnosis of resistant ovarian syndrome
It should be understood that the diagnosis of resistant ovarian syndrome should necessarily include laboratory and instrumental studies. Only thanks to an integrated approach will it be possible to distinguish this syndrome from other diseases similar in symptoms.

Gynecological examination reveals signs of hypoestrogenism — hyperemia and thinning of the mucous membranes of the vagina and vulva. There is also a “pupil” symptom.

Ultrasound of the pelvis allows you to determine the size of the uterus, endometrium and ovaries. Ultrasound examination is perfect for examining a follicle up to 5-6 mm.

Diagnosis of resistant ovarian syndrome is impossible without conducting a hormone study, because this way you can see some kind of violation. Normally, blood plasma contains low levels of prolactin and estradiol. This disease is also characterized by an increase in the level of prostaglandin E2 by 3-4 times, testosterone by 3-10 times, cortisol by 2 times.

Hormone tests provide the most information for resistant ovarian syndrome. A gestagen test is carried out, the first result of which is almost always positive, and the next one is negative. This pathology is characterized by a positive result in a cyclic mode. This fact indicates that there are feedbacks between the ovary and the hypothalamic-pituitary region.

Diagnostic laparoscopy is ideal for seeing translucent follicles in the ovaries. In turn, biopsy and histological examination can reveal the presence of preantral and primordial follicles in the biopsy.

Treatment of resistant ovarian syndrome
Treatment of resistant ovarian syndrome is a complex and time—consuming process, since its etiopathogenesis in most cases remains unclear.

The first thing that is prescribed for this pathology is two- or three-phase HRT, which is designed to eliminate estrogen deficiency, normalize the menstrual cycle and reduce the level of gonadotropins. A young patient who is in contraception mode should take medications such as trisequence, klimen, femoston, klimonorm, premella cycle, etc. If a woman is over 50 years old, then in her case HRT is continuous (klimodien, cliogest, livial).

In the case of resistant ovaries syndrome, non-drug methods have been used to perform abdominal and intravaginal ultraphonophoresis and spa acupuncture, which acts exclusively on the receptor areas of the ovaries.

In the case when normal ovulatory function is not restored, the IVF method with a donor egg is used. Women over 40 years of age are recommended to undergo annual mammography, densitometry to exclude osteoporosis, pelvic ultrasound, as well as lipoprotein and blood cholesterol studies. Treatment should take place under the supervision of a gynecologist and other doctors. It is also important to follow all their recommendations and indications.

Prevention of resistant ovarian syndrome
To date, gynecology, due to the lack of knowledge and complexity of the process of developing resistant ovarian syndrome, cannot identify specific ways to prevent this disease. The only thing that is recommended is to exclude adverse iatrogenic effects: radiation, infections, drug intoxication.

In any case, if there are violations in the menstrual cycle, you should consult a doctor and undergo a full gynecological examination. Timely detection of resistant ovarian syndrome will prevent its development and minimize the negative impact on a woman’s reproductive health. Remember this, otherwise the state of health may deteriorate dramatically.

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