Contents
Gynecological endocrinology plays an important role in the daily work of a gynecologist. Most of the complaints of patients at a gynecological appointment are 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 a gynecologist-endocrinologist
A gynecologist-endocrinologist is a specialist who deals with problems associated with disorders in the work of the endocrine system of a woman, the effect of sex hormones on the functions of other organs and systems. The work of this doctor is based on a detailed study of the hormones of the female body and their direct impact on health.
Hormones are biologically active substances that are produced by the 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 produced in the ovaries and adrenal glands. Regulates the function of the ovaries and adrenal glands of the 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 estrogens 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 vaginal secretion, good mood. Estrogens affect the exchange of calcium in the body, contributing to its retention in the bones, protect the cardiovascular system. When the level of estrogen drops significantly, a woman immediately feels it. She has hot flashes, her appearance worsens, she gains weight, cardiovascular diseases, osteoporosis appear. There is discomfort during sexual activity, urinary incontinence, and performance is significantly reduced. That’s when you need the help of a gynecologist-endocrinologist.
Progesterone is a hormone 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 helps to maintain pregnancy. This hormone is able to increase body temperature, which is often used at home to determine the correct functioning of the ovary and pregnancy planning. The lack of progesterone during pregnancy leads to its termination. The lack of this hormone contributes to the shortening of the menstrual cycle in older women, the development of bleeding. A gynecologist-endocrinologist deals with issues related to the regulation of the menstrual cycle, endocrine infertility.
Androgens (male sex hormones) are produced in the ovaries, adrenal cortex and peripheral tissues from precursor hormones. The main androgens are dehydroepiandrosterone (DHEA), androstenedione, testosterone, dihydrotestosterone. Androgens are of great importance for the female body. It depends on them sexual desire, endurance. They are the culprits of hirsutism (male-pattern hair growth), alopecia, acne, virilization (the appearance of male body features and male secondary sexual characteristics). Androgenization syndromes are the most common reason for consulting a gynecologist-endocrinologist for advice.
Thus, the scope of professional duties of this specialist includes solving all kinds of problems that are associated with impaired functions of the endocrine organs. Also, this doctor can choose hormonal contraceptives that will help to avoid not only unwanted pregnancy, but also maintain health, solve cosmetic problems, and rehabilitate after gynecological diseases.
Symptoms and diseases
In what situations should you think that there are violations in the work of the female endocrine system, and there is a reason to visit an endocrinologist-gynecologist:
- the absence of menstruation until the age of 16, despite normal growth and the timely appearance of secondary sexual characteristics;
- lack of sufficient growth and delay in the appearance of secondary sexual characteristics;
- absence of menstruation for three cycles in a row;
- the appearance of secondary sexual characteristics in girls under 10 years of age (growth of pubic hair, in the armpits, breast enlargement, the appearance of menarche (first menstruation);
- painful menstruation;
- uterine bleeding;
- premenstrual syndrome;
- signs of androgenization;
- climacteric manifestations;
- osteoporosis (diseases of the skeleton associated with a decrease in bone mass);
- infertility;
- 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
An appointment with a gynecologist-endocrinologist is not much different from a regular gynecological appointment and consists of a patient interview (anamnesis), a general examination, and a gynecological examination.
Ultrasound diagnostics is widely used. Usually, a 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 work of a doctor 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 the studies can be influenced by stress, medications taken by the patient, and dietary habits.
There are hormones that are taken 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 are usually taken on days 2-5 of the menstrual cycle, and are also repeated during the cycle. Functional endocrine tests are carried out using hormonal preparations. For example, with amenorrhea (absence of menstruation), a progestogen test is often used. The patient takes progesterone (usually duphaston or utrogestan) for 10-14 days, if spotting appears after 3-5 days, then the test is considered positive. This suggests that the ovaries are functioning, that the endometrium is influenced by its estrogens and additionally received gestagens. And if menstruation does not begin after progesterone, then the test is considered negative. This may indicate a low level of estradiol, dysfunction of the hypothalamic-pituitary system, or pathology of the uterus.
For functional tests, not only hormones are used, but also other substances. If you suspect a decrease in glucose tolerance or diabetes mellitus, a glucose test is performed. In addition to laboratory diagnostics, genetic analysis, CT, MRI, radiography, diagnostic laparoscopy, hysteroscopy and other methods are used.
Recommendations of gynecologists-endocrinologists
Every woman should understand that her health depends on genetics, lifestyle, environmental influences, the development of medicine in the region of her residence.
Genetics
Everything that is laid down by nature in a woman’s body determines the work of her reproductive system. It is important to know what ailed women in your family, especially on the maternal side. How they got pregnant and carried their pregnancies. At what age did they begin puberty, at what age did it begin and how did the menopause proceed. How did they menstruate? Focusing on these data, together with a gynecologist, you can carry out the prevention of certain diseases, plan the birth of children.
Life
70% of human health depends on lifestyle, including the work of the endocrine system. Nutrition should be balanced in terms of proteins, fats, carbohydrates, calories. In different periods of a woman’s life, it can be different. A young athlete and a woman of menopause cannot follow the same diet. But in self-selection of diets, one must be guided by the principles of moderation and prudence. For the reproductive system, both excess nutrition and inadequate low-calorie nutrition are dangerous. All this can eventually lead to menstrual irregularities and even infertility.
Active lifestyle
Insufficient physical activity has an extremely adverse effect on the work of all organs and systems, including the reproductive system. Even in childhood, parents should think about the formation of the correct skeleton in a girl who will give birth in the future. It is necessary to develop the muscles of the pelvic floor from childhood, so that later after childbirth and at an older age to avoid problems associated with the insufficiency of these muscles, learn how to use them and maintain tone throughout life. Physical exercise and sports should not be harmful, exhaust the body. The load should be regular, appropriate to individual capabilities and pleasant. It is advisable to learn how to perform the exercises correctly under the guidance of professionals. And it doesn’t matter what you do, skate or swim in the pool, play tennis or football, the main thing is to do it with pleasure.
Of exceptional importance for the endocrine system of a woman is the mode of work and rest. Some hormones are produced at night during sleep, for example, melatonin. There are hormones that increase during stress, such as adrenal hormones. Women often complain about changes in the nature of the menstrual cycle after family quarrels, conflicts at work, illness of loved ones, exams. Good sleep, the ability to distract from problems, relax during the time, switch to other pleasant activities, helps to maintain women’s health. Useful for women yoga, meditation. Sometimes only lifestyle changes, refusal to work with frequent night shifts or long journeys, organization of proper rest outside of work and study normalizes the endocrine system without additional treatment.
There is not always a gynecologist-endocrinologist in a small town or rural area. But every gynecologist daily at the reception deals with various hormonal disorders, this is part of his work. And in most cases it will help to solve women’s problems.