The Pathogenetic Aspects of Menstrual Disorders in Women With Obesity (Review of Literature)
The problem of obesity and infertility is an important part of reproductive endocrinology. The problem of infertility at obesity is considered through the system of hypothalamus-pituitary-gonads and metabolic disorders. Besides increasing degree of obesity, the disease leads to the various types of menstrual function disorders from the time of menarche. The studies showed that obesity has an impact on the age of menarche, development of menstrual function and cycle activity of ovaries. Probably, the obesity causes the high incidence of infertility, the risk of polycystic ovary syndrome, and early menopause. The pathogenesis of reproductive disorders and their hormonal basis have not been study yet, and literature data on this question are contradictory. The increasing number of patients with obesity, especially women, which is combined with different reproductive disorders, determines the actuality of studying this problem. Furthermore, obesity as a medical and social problem remains understudied. For example, the causes explaining the mechanisms of development of reproductive disorders, especially in women, are not established. We have not guidelines for physicians and for patients with obesity regarding effective methods of treatment and prevention of this disease. It is known that in hypothalamus, mostly in the area of paraventricular nucleus, there is an integration of a lot of impulses from the brain cortex, subcortical structures, through the sympathetic and parasympathetic nervous system, hormonal and metabolic ones. The disorder of any part of this regulatory mechanism may lead to the changes of eating, lipid distribution in the body and to the development of obesity. It was showed, that hunger and satiation, as well as energy expenditure, depend on many regulatory mechanisms functioning by the rule of feedback between central and vegetative nervous system, endocrine organs and fatty tissue. More detail investigation of these regulatory mechanisms will make it possible to do develop new methods of obesity treatment. So, the risk of obesity development also depends on genetic mechanisms. The obesity is main active factor in the genesis of reproductive disorders and lead to the high incidence of primary and secondary infertility and amenorrhea. The development of reproductive disorders in fertile age women with obesity has some stages. In preserved reproductive function, there is hypergonadotropinemia in the first phase of menstrual cycle, which normalizes by the luteal phase of cycle and is associated with hyperandrogenemia (an increase of testosterone in the blood), hypercortisolemia, with the normal values of estradiol and progesterone, thus, this is the mechanism of feedback regulation of hypotalamo-pituitary-ovarial system on the whole. The first step of generative disorders in women with obesity are changes in peripheral link of regulation and reproductive function — metabolic type of gonadal hormone genesis (hyperandrogenemia, hypercortisolemia) on the basis of normal levels of estradiol and progesterone. Secondary stage in the development of reproductive disorders is the disorder of central regulation of reproductive function. It was found that main neurohormonal disorder is a violation of the rhythm of gonadotropin secretion with their progressive decrease as body mass index increases, which is determined by both hyperprolactinemia and, probably, decreased gonadoliberine secretion. It is believed that insulin resistance and hyperinsulinemia increase the synthesis of luteinizing hormone-dependent androgens in ovaries, which have an impact on the insulin-like growth factor 1 of ovarian theca-cells and activate the whole cascade of genetic disorders of reproduction. So, the central mechanism of regulation of the pituitary function, local ovaries factors and metabolic disorders nowadays are main factors of reproductive disorders in obesity. Besides increase in the degree of obesity, the disease leads to the development of various types of disorders of menstrual function from the time of menarche. In any type of obesity, the pathology of hypothalamic-pituitary system usually develops, which lead to the ovarian insufficiency. That is why, it is necessary to take a look on the problem of women infertility in terms of actual knowledge about obesity and its complications.
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Bessesen DG, Кushner R. Overweight and obesity: prevention, diagnostics and treatment. М.: ZAO Izdatel’stvo BINOM, 2004; 240 s. (Russian)
Beliakov NA, Мazurova VI. Оbesity. SPb., 2003; 520 s. (Russian)
Dedov II, Mel’nichenko GA. Obesity: ethiology, pathogenesis, clinical aspects. M., 2004; 456 s. (Russian)
Karpova EA. Biguanides in patients with policystosis ovarii syndrome. Obesity and Metabolism. 2004;1:30-33. (Russian)
Kurmachova NA. Experience of application of siofor (metformin) in women with abdominal obesity and sterility. Problemy reproduktsii. 2003;2:51-54 (Russian)
Kulakov VI, Korneeva IE. Modern going to diagnostics and treatment of woman sterility. Akusherstvo i ginekologia. 2002;2:56-59. (Russian)
Krapivina NA. Optimization of treatment of obesity in women of reproductive age. Avtoreferat diss. na soisk. uch. st. k.m.n. Tomsk, 2005;141 s. (Russian)
Manukhin IB, Tumilovich LG, Gevorkian MA. Clinical lectures on gynaecological endocrinology. M., 2001;247 s. (Russian)
Mgaloblishvili IB, Mgaloblishvili MB, Osidze КR et al. Different forms of policystosis ovaries. // Problemy reproduktsii. 2000;5:8-10. (Russian)
Mishieva NG, Nazarenko TA, Fanchenko NA. Influence of metformin on endocrine and reproductive function in women with the syndrome of policystosis ovaries. Problemy reproduktsii. 2001;7(3). (Russian)
Nazarenko TA, Durinian ER, Zyriaeva NA. Anovulatory sterility in women: methods and charts of induction of ovulation. Akusherstvo i ginekologia. 2002;4:58-61. (Russian)
Narimova GD. Sexual violations in women of reproductive age, suffering obesity. Diss. na soisk. uch. st. k.m.n. Tashkent, 2007;156 s. (Russian)
Serov VN, Prolepskaya VN, Pshenichnikova TN. et al. Gynaecological endocrinology. M., 1993;499 s. (Russian)
.Ozerskaya IA, Ageeva MI. Ultrasonic diagnostics of endocrine pathology of ovaries. Ul’trazvukovaya i funktsional’naya diagnostika. 2002;2:136-143. (Russian)
Calle EE, Rodriguez C, Walker-Thurmond K. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625-1638.
Cameron AJ, Spence AC, Laws R. A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity. Curr Obes Rep. 2015;4(3):350-62. doi: 10.1007/s13679-015-0168-5.
Hirofumi S, Masako Sh, Naoto N. Lifestyle, obesity, and insulin resistance. Diabetes Care. 2001;24(3):608.
Feakins RM. Obesity and metabolic syndrome: pathological effects on the gastrointestinal tract. Histopathology. 2015 Nov 24. doi: 10.1111/his.12907. [Epub ahead of print]
Mantzios M, Wilson JC. Mindfulness, Eating Behaviours, and Obesity: A Review and Reflection on Current Findings. Curr Obes Rep. 2015;4(1):141-6. doi: 10.1007/s13679-014-0131-x.
Patrick M, Christopher BD, Nicholas HC. Do different dimensions of the metabolic syndrome change together over time? Evidence supporting obesity as the central feature. J.Diabetes Care. 2001;24(10):1758-1763.
Sugimoto S, Nakajima H, Kosaka K. Review: Miglitol has potential as a therapeutic drug against obesity. Nutr Metab (Lond). 2015;12:51.
Shuldiner AR, Munir KM. Genetics of obesity: more complicated than initially thought. Lipids. 2003;38(2):97-101.
Shalitin S, Phillip M. Role of obesity and leptin in the pubertal process and pubertal growth. Int. J. Obesity. 2003;27(8):869-874.
Spahlholz J, Baer N, Konig HH. Obesity and discrimination – a systematic review and meta-analysis of observational studies. Obes Rev. 2015 Nov 24. doi: 10.1111/obr.12343. [Epub ahead of print]
Speakman JR. The 'Fat Mass and Obesity Related' (FTO) gene: Mechanisms of Impact on Obesity and Energy Balance. Curr Obes Rep. 2015;4(1):73-91. doi: 10.1007/s13679-015-0143-1.
Gertjan VD. The role of leptin in the regulation of energy balance and adipocity. J. Neuroendocrinol. 2001;13(10):913-921.
Williams EP, Mesidor M, Winters K. Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem. Curr Obes Rep. 2015;4(3):363-70. doi: 10.1007/s13679-015-0169-4.
WHO. Prevention and management of the global epidemic of obesity. Report of the WHO Consultation on Obesity (Geneva, 3-5 June, 1997). Geneva:WHO, 1997.
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