Anovulyatorny cycle – the monophase menstrual cycle which is characterized by lack of an ovulation and phase of development of a yellow body with preservation of a regularity and rhythm of uterine bleedings. In gynecology the states which are followed by a physiological anovulyation (during the periods of age reorganizations of an organism), and a pathological anovulyatorny cycle are allocated at infertility. In diagnostics of an anovulyatorny cycle physiological tests, transvaginal ultrasonography, an endometrium scrape research are used. At identification of an anovulyatorny cycle treatment is directed to elimination of functional infertility and suppression of excessive proliferation of endometrium. The forecast is caused by the reasons which caused a monophase cycle.
The Anovulyatorny cycle is single-phase as in it there is no consecutive change of phases characteristic of a normal menstrual cycle. Practically all anovulyatorny cycle is occupied by a phase of proliferation which is replaced by a deskvamation and regeneration of endometrium. At the same time absolutely there is no sekretorny phase which is usually coming after an ovulation in connection with development of a yellow body. Unlike dysfunctional anovulyatorny uterine bleedings the anovulyatorny cycle is characterized by cyclic menstrualnopodobny bleedings.
Reasons of an anovulyatorny cycle
At almost healthy women at reproductive age the anovulyatorny cycle is observed rather seldom (1-3%) and can alternate with an ovulyatorny cycle. Anovulyation is caused, for example, by change of climate when moving to other geographical region. Processes of age changes in a female body – puberty and fading of reproductive function are the most frequent physiological reasons of an anovulyatorny cycle (climax). As physiological process, an anovulyation in combination with amenorey it is characteristic of pregnancy and a postnatal lactation. In case of renewal of rhythmical bleedings at 40-50% of the feeding women the cycle has single-phase anovulyatorny character.
As the pathology demanding correction the gynecology considers an anovulyatorny cycle at the infertility or uterine bleedings caused by violation of a follikulogenez, lack of an ovulation and lyuteinovy phase. As a rule, violations of gipotalamo-hypophysial regulation of a menstrual cycle, and also yaichnikovy dysfunction are the reasons of a pathological anovulyatorny cycle. Violations of gipotalamo-hypophysial regulation are shown by insufficiency of development of FSG leading to not maturing of a follicle and its inability to an ovulation; insufficiency of LG; change of a ratio of sex hormones; sometimes - excess production of Prolactinum a hypophysis.
The Anovulyatorny cycle can be connected with an inflammation of ovaries or appendages (adneksit), violation of enzymatic transformation of sexual steroids in ovaries, functional violations in a thyroid gland or a cortical layer of adrenal glands, infections, psychological disorders, intoxication, avitaminosis or other violations of alimentary character. Quite often anovulyatorny cycle is observed at congenital defects of reproductive system, genetic pathology, violation of sexual development.
Pathogenesis of an anovulyatorny cycle
In the course of an anovulyatorny cycle in ovaries the periods of growth and return development of a follicle, various on character and duration, can be observed. The short-term rhythmic persistention of a mature follicle is followed by a giperestrogeniya; an atresia of not quite ripe follicle - a relative monotonous giperestrogeniya. The surplus of effect of estrogen which is not changed by influence of gestagenny hormone of progesterone is most typical for an anovulyatorny cycle. In some cases the anovulyatorny cycle proceeds with a gipoestrogeniya. Depending on the level of estrogenic influence changes of endometrium of various character – from a hypoplasia before excessive proliferation – giperplaziya and a polypose develop.
Development of menstrualnopodobny bleeding at an anovulyatorny cycle is, as a rule, caused by recession of the hormonal influence caused by an atresia of follicles. In a functional layer of endometrium the phenomena of a transsudation, hemorrhage, sites of a necrosis develop. Endometrium blankets partially break up that is followed by bleeding. In the absence of endometrium rejection bleeding develops owing to a diapedez of erythrocytes through walls of vessels. Sometimes recession of a giperestrogeniya does not happen, and the ekskretion of estrogen with urine remains rather stable all anovulyatorny cycle (from 13 to 30 mkg/days).
In a puberty when there is a formation of menstrual function, the anovulyatorny cycle is caused by lack of necessary level of lyuteiniziruyushchy and lyuteotropny hormones which synthesis reaches peak by 15 — 16 years. Similar changes, but upside-down, develop when fading reproductive function: violation of cyclic secretion and increase in gonadotropny influence is noted. Alternation of ovulyatorny and anovulyatorny cycles in the climacteric period is replaced by change of duration of a cycle and character of periods.
Manifestations of an anovulyatorny cycle
Clinically anovulyatorny cycle can be shown differently. The menstrualnopodobny bleeding arising at an anovulyatorny cycle can not differ from usual periods on a regularity and amount of the lost blood.
At a giperesterogeniye bleeding is followed by long and plentiful releases of blood as a menorragiya. In this case at a two-handled research the increased uterus of a plotnovaty consistence with the softened neck and the slightly opened internal pharynx is found. Plentiful bleedings as a result lead to development of anemia.
The shortened and poor menstrual bleedings, on the contrary, are characteristic of a gipoestrogeniya. At vaginal inspection the reduced uterus having a long conic neck, the closed internal pharynx, a narrow vagina is defined. The Anovulyatorny cycle at women of reproductive age is followed by impossibility of approach of pregnancy – hormonal infertility in this connection patients usually also address the gynecologist.
Diagnostics of an anovulyatorny cycle
The simplest method of differentiation of ovulyatorny and anovulyatorny cycles is determination of the rectal (basal) temperature (BT). Increase in BT in a progesteronovy phase is characteristic of a normal ovulyatorny cycle. At an anovulyatorny cycle single-phase temperature is defined.
The expressed estrogenic influence in case of an anovulyatorny cycle is found by functional tests (a positive phenomenon of a fern and a symptom of "pupil" during all cycle), kolpotsitologichesky data. A sign of an anovulyatsionny menstrual cycle at dynamic ultrasonography of ovaries is lack of a prepotent follicle.
As decisive criterion of definition of an anovulyatorny cycle serves carrying out a diagnostic scraping of a cavity of a uterus on the eve of periods with a histologic research of scrape. Absence in scrape of sekretorny changes of endometrium confirms existence of an anovulyatorny cycle.
For clarification of etiologichesky prerequisites of an anovulyatorny cycle the research of hormones of gipotalamo-hypophysial system, a thyroid gland, bark of adrenal glands is conducted; identification of inflammatory changes in the sexual sphere. Considering possible alternation of anovulyatorny and ovulyatorny cycles, for final diagnostics dynamic control within half a year is carried out.
Treatment of an anovulyatorny cycle
As the resistant anovulyatsionny cycle is followed by infertility and the expressed proliferative changes of endometrium, the main objective of treatment is stimulation of an ovulation and suppression of excessive proliferation. The gynecologist-endocrinologist is engaged in treatment of an anovulyatorny cycle.
Hormonal therapy of an anovulyatorny cycle is carried out by faltering cycles depending on degree of an estrogenic saturation. For postadiyny stimulation of the correct menstrual cycle after a preliminary scraping of endometrium medicines of gonadotropny influence are appointed ( to 3 — 6 months from 11 to 14 day). In 6-8 days prior to periods connect intramuscular injections of 1% of solution of progesterone; reception of a noretisteron. At the anovulyatorny cycle proceeding with giperestrogeniy and excessive proliferation during several cycles synthetic progestins are shown (from 5 to 25 day of a cycle).
At yaichnikovy insufficiency and a gipoestrogeniye estrogenic medicines in small doses are used (an estradiol or ; ), the stimulating transformations of a mucous uterus, function of ovaries, growth and development of a follicle. If chronically proceeding inflammation of appendages is the reason of an anovulyatorny cycle, complex treatment of an adneksit is carried out, the vitamin C participating in synthesis of steroids and promoting restoration of an ovulation is appointed.
For the purpose of induction of an ovulation at an anovulyatorny cycle indirect electrostimulation of gipotalamo-hypophysial area by an endonasal electrophoresis, electrostimulation of a neck of a uterus etc. is appointed. Hormonal stimulation is carried out by means of clomifene. At a giperprolaktinemiya appoint . Treatment of a physiological anovulyation during the periods of formation of periods, lactation, climax is not required.
Forecast and prevention of an anovulyatorny cycle
At correctly developed and carried out treatment of an anovulyatorny cycle pregnancy occurs at 30-40% of women. If women do not manage to achieve pregnancy, it is recommended to resort to auxiliary reproductive technologies for the EKO program. In case of absence at the patient of own mature ova artificial insemination is performed with a donor ovum then carry out replanting of an embryo to a uterus cavity. Use of a donor embryo is possible.
For prevention of an anovulyatorny cycle it is required to pay special attention to health of teenage girls, good nutrition, the rational mode of activity and rest, timely treatment of genital and ekstragenitalny pathology; the prevention of infections, toxic influence on production.