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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