Gynecological endocrinology plays an important role in the daily work of the gynecologist. Most of the complaints of patients on gynecological admission due to violations of the endocrine organs. These are menstrual disorders, infertility, impaired sexual development, neuroendocrine syndromes. The issues of contraception and family planning are very significant in modern society. An increasing number of women do not want to put up with age-related changes that reduce the quality of life and performance. All these questions and many others can be solved by gynecological endocrinology.
The essence of the work of the gynecologist-endocrinologist
Gynecologist-endocrinologist is a specialist who deals with problems related to disruptions in the endocrine system of a woman, the influence of sex hormones on the functions of other organs and systems. The work of this doctor is built on a detailed study of the hormones of the female body and their direct effect on health.
Hormones are biologically active substances that produce endocrine glands (ovaries, adrenal glands, thyroid gland and others).
Most often, a gynecologist-endocrinologist deals with sex hormones. These hormones include estrogens, gestagens and androgens. They are formed in the ovaries and adrenal glands. Regulates the function of the ovaries and adrenal adenohypophysis. This is a gland that is located in the brain and produces gonadotropins: luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well as prolactin and other hormones.
Estrogens - female sex hormones are produced in the ovaries, are responsible for the development of the genital organs, the proliferation of the endometrium. The main effects of estrogen characterize the flowering of the female body: moisturized beautiful skin, good hair, a feminine figure due to the distribution of fat in the right places, sufficient secretion of the vagina, good mood. Estrogens affect the metabolism of calcium in the body, contributing to its retention in the bones, protect the cardiovascular system. When the level of estrogen decreases significantly, the woman immediately feels it. Her tides appear, her appearance deteriorates, she is gaining weight, cardiovascular diseases and osteoporosis appear. There is discomfort during sexual activity, urinary incontinence, significantly reduced performance. Then the help of the gynecologist-endocrinologist is necessary.
Progesterone is a hormone that is produced by the corpus luteum of the ovary, in a small amount by the adrenal glands and in pregnant women by the placenta. This hormone is responsible for preparing the uterus for pregnancy, it contributes to the preservation of pregnancy. This hormone is able to increase body temperature, which is often used at home to determine the proper operation of the ovary and pregnancy planning. Lack of progesterone during pregnancy leads to its interruption. The lack of this hormone contributes to the shortening of the menstrual cycle in older women, the development of bleeding. Gynecologist-endocrinologist deals with issues related to the regulation of the menstrual cycle, endocrine sterility.
Androgens (male sex hormones) are produced in the ovaries, adrenal cortex and peripheral tissues from progenitor hormones. The main androgens are dehydroepiandrosterone (DHEA), androstenedione, testosterone, dihydrotestosterone. Androgens are important for the female body. It depends on them sexual desire, endurance. They are the culprits of hirsutism (male-type hair growth), alopecia, acne, virilization (the appearance of male physique and male secondary sexual characteristics). Androgenization syndromes are the most common reason for consulting a gynecologist and endocrinologist for advice.
Thus, the sphere of professional duties of this specialist is the solution to all sorts of problems that are associated with dysfunction of the endocrine organs. Also, this doctor can pick up hormonal contraceptives that help to avoid not only unwanted pregnancy, but also to preserve health, solve cosmetic problems, rehabilitate after postponed gynecological diseases.
Symptoms and diseases
In what situations you need to think that there are irregularities in the work of the female endocrine system, and there is a reason to visit an endocrinologist-gynecologist:
- the absence of menstruation up to 16 years, despite the normal growth and timely appearance of secondary sexual characteristics;
- lack of sufficient growth and delay in the appearance of secondary sexual characteristics;
- absence of menstruation for three consecutive cycles;
- the appearance of secondary sexual characteristics in girls under 10 years of age (growth of pubic hair, in the armpits, an increase in the mammary gland, the appearance of menarche (first menstruation);
- painful menstruation;
- uterine bleeding;
- premenstrual syndrome;
- signs of androgenization;
- climacteric manifestations;
- osteoporosis (skeletal diseases associated with a decrease in bone mass);
- violation of sexual function;
- rapid weight gain or loss in the presence of menstrual irregularities or other endocrinological symptoms;
- pregnancy planning, especially if there were previously violations of sexual development, menstrual cycle, prolonged infertility, unsuccessful pregnancies.
Analyzes and diagnostic methods used
Reception of the gynecologist-endocrinologist is not much different from the usual gynecological reception and consists of a survey of the patient (history taking), a general examination, a gynecological examination.
Ultrasound diagnosis is widely used. Usually the gynecologist-endocrinologist prescribes not only ultrasound of the pelvic organs, but also the thyroid gland, adrenal glands, and mammary glands. The main tool in the doctor's work is laboratory diagnostics. It includes both the determination of individual hormones and the performance of endocrinological functional tests. It is often necessary to repeatedly determine the level of the hormone, since the results of research can be influenced by stress, medications taken by the patient, and dietary habits.
There are hormones that take once, for example, thyroid hormones, and on any day of the cycle. There are hormones that must be taken on certain days of the cycle, for example, sex hormones usually pass on the 2-5 day of the menstrual cycle, and also repeat during the cycle. Functional endocrine tests carried out with the use of hormonal drugs. For example, with amenorrhea (absence of menstruation), a gestagen test is often used. The patient takes progesterone (usually duphaston or utrozestan) within 10-14 days, if after 3-5 days there is bloody discharge, then the sample is considered positive. This suggests that the ovaries function, that the endometrium is influenced by its estrogens and additional progestogens. And if the monthly after progesterone does not start, then the sample is considered negative. This may indicate a low estradiol level, dysfunction of the hypothalamic-pituitary system, or uterine pathology.
For carrying out functional tests use not only hormones, but also other substances. If you suspect a decrease in glucose tolerance or diabetes mellitus, test with glucose. In addition to laboratory diagnostics, genetic analysis, CT, MRI, X-ray, diagnostic laparoscopy, hysteroscopy and other methods are used.
Recommendations of gynecologists and endocrinologists
Every woman should understand that her health depends on genetics, lifestyle, environmental influences, and the development of medicine in her region.
All that is inherent in nature in the body of a woman determines the work of its reproductive system. It is important to know what women in your family were ill with, especially on the maternal line. How they got pregnant and gested pregnancy. When did they start puberty, how many years did they begin and how did the menopause period go? How they went menstruation. Focusing on these data, it is possible, together with the gynecologist, to carry out the prevention of certain diseases, plan the birth of children.
At 70% of human health depends on lifestyle, including the work of the endocrine system. Meals should be balanced in protein, fat, carbohydrates, calories. In different periods of a woman’s life it can be different. A young athlete and a climacteric woman cannot keep to the same diet. But in the independent selection of diets should be guided by the principles of moderation and prudence. For the reproductive system, both excess nutrition and malnutrition with low calories are dangerous. All this as a result can lead to menstrual disorders and even infertility.
Lack of physical activity extremely adversely affects the work of all organs and systems, including the reproductive system. Even in childhood, parents need to think about the formation of the correct skeleton in a girl who will give birth in the future. It is necessary to develop the pelvic floor muscles from childhood, so that later after childbirth and in older age, avoid problems associated with the failure of these muscles, learn to use them and maintain tone throughout life. Exercise and sports should not be harmful, exhausting the body. The load should be regular, personalized and pleasant. It is advisable to learn how to do the exercises right under the guidance of professionals. And it does not matter what to do, skate or swim in the pool, play tennis or football, the main thing is to do it with pleasure.
Extremely important for the endocrine system of women is the mode of work and rest. Some hormones are produced at night during sleep, for example - melatonin. There are hormones whose production increases with stress, for example, adrenal hormones. Women often complain of changes in the nature of the menstrual cycle after family quarrels, conflicts at work, illness of relatives, exams. Good sleep, the ability to escape from problems, while relaxing, switch to other pleasant activities, helps to preserve women's health. Useful for women yoga, meditation. Sometimes only lifestyle changes, refusal to work with frequent night shifts or long journeys, the organization of proper rest outside work and school normalizes the work of the endocrine system without additional treatment.
There is not always a gynecologist-endocrinologist in a small town or countryside. But every gynecologist every day at the reception deals with various hormonal disorders, this is part of his work. And in most cases will help solve women's problems.
Specialty: gynecologist, pediatric gynecologist, gynecologist-endocrinologist.
Total experience: 25 years.
Education: 1987-1993, GrSMU, medical faculty.
Science degree:obstetrician-gynecologist of the first category.
- 2000 - "Actual issues of obstetrics and gynecology and the organization of gynecological care."
- 2005 - "Prenatal diagnosis: principles of organization, methods and effectiveness of prenatal diagnosis in the 2nd trimester. Ultrasound diagnosis of malformations."
- 2006 - "Management of pregnant risk groups".
- 2006 - "Therapeutic and prophylactic care for women with infertility."
- 2011 - "Ultrasound diagnosis in obstetrics and gynecology."
- 2016 - "Violations of menstrual and childbearing functions. Endoscopic methods of treatment."