GYNECOLOGICAL ENDOCRINOLOGY
it deals with disorders related to the endocrinology of the female reproductive system, in particular menstruation and fertility
the most common disorders are:
- amenorrhea, complete absence of period
- frequent menstruation occurring more often than normal
- poor menstruation: occurrence of the period at less frequent intervals
- polymenorrhea: menstruation accompanied by a large loss of blood or with a long duration
- oligomenorrhea: menstruation with little blood loss
- premenstrual syndrome
- dysmenorrhea: painful menstruation
menstrual cycle disorders can be caused by various factors involving the female reproductive organs hypothalamus-pituitary-ovaries-uterus
- detailed clinical examination
- thorough hormonal testing (AMH, FSH, LH, LH, PRG, TSH, PRL)
- thorough ultrasound screening at specific phases of the cycle
- hypothalamic amenorrhea
- significant weight loss and eating disorders
- intensive exercise
- emotional disorders (anxiety)
- menopause or premenopausal period
- menarche (the first few years after the start of cycles)
- taking medicines such as slimming pills, tranquilizers,
- hormonal disorders (e.g. thyroid gland disorders or polycystic ovary syndrome, hyperprolactinemia)
- breastfeeding
- contraceptive methods
what are the symptoms/criteria of the syndrome?
- menstrual disorders (oligo- or amenorrhea) due to ovarian dysfunction with the presence of anovulatory cycles
- clinical (acne, increased hair growth, etc.) and/or biochemical hyperandrogenism (increased testosterone and/or androstenedione concentrations, LH/FSH>1))
- polycystic ovarian morphology on ultrasound
what is polycystic ovary syndrome?
- the most common cause of menstrual disorders
- the occurrence of at least two of the above three criteria
in ½ of cases it is accompanied by increased insulin resistance and hyperinsulinemia
how is it treated in relation to infertility?
- taking appropriate medication to regulate the menstrual cycle
- reducing insulin resistance by recommending weight loss with a low glycaemic index diet and exercise and taking insulin sensitizers
- cycle monitoring and ovulation induction
- assisted reproduction methods (IVF)
it is the woman’s period after the cessation of the menstrual cycle for more than 1 year
it occurs at the age of 48-51 on average
it usually starts gradually with disturbances in the menstrual cycle in terms of duration and frequency that progressively leads to amenorrhea
accompanied by sleep disorders, mood disorders, weight gain, headaches, vaginal dryness, pain during sexual intercourse, fatigue, sweating
additional conditions: osteopenia/osteoporosis, increased cardiovascular risk
prevention and treatment of accompanying symptoms:
exercise
balanced diet
vitamins
psychological support
use of appropriate hormonal supplementation based on history
prolactin is the hormone secreted by the pituitary gland for breast development, initiation and maintenance of lactation
over-secretion of prolactin (hyperprolactinemia) can cause menstrual disorders such as amenorrhea and infertility
causes of hyperprolactinemia:
prolactinoma – benign pituitary tumour and other pituitary adenomas
stress
pregnancy
drugs
diagnosis:
- blood test for prolactin levels
in the case of high levels, the test may be repeated within a specified time to establish the over-secretion.
- brain MRI to rule out pituitary adenoma
how is it treated?
with appropriate medication and imaging monitoring
characterized by low levels of gonadotrophins and estrogens due to impaired impulse secretion of GnRH by the hypothalamus
it is the most common cause of primary and secondary amenorrhea
causes:
- food intake disorder (neurogenic anorexia)
- intense physical exercise
- stress
“athlete triad”
- disturbances of the energy balance
- menstrual disorder
- disorder of bone metabolism
diagnosis
- history and clinical examination
- hormonal profile
- characteristic ultrasound image of the ovaries
Treatment
- normalization of body weight
- physical exercise reduction
- psychological support – detecting the cause of stress and implementing stress reduction strategies
- hormonal replacement therapy
- calcium 1300mg and vitamin D 400 – 1000 IU
!!! systematic approach by a team of specialists including pediatricians, gynecologists, nutritionists and psychotherapists