TREATMENT OF AUTOIMUNNE OVARIAN DAMAGE

Abstract

Introduction. To investigate levels of antiovarian autoantibodies in girls and young women with disturbances of menstrual cycle before and during treatment with hormonal therapy. To explain morphological changes in ovarian structure in these patients. Menopause usually occurs approximately at the age of 50. Premature ovarian failure (POF) is a disorder defined as a pathologic termination of menstrual cycle after puberty and before the age of 40. Frequency of this disorder is approximately 1%. Hormonal levels show hypergonadotrophic hypoestrism (FSH more than 40 lU/l). The onset of the disease may be very slow. Menarche and regular menstrual cycles may be followed by menstrual cycle disorders - oligomenorrhoea or secondary amenorrhoea. Sterility or infertility at the reproductive age could be manifestations of the early stage of the disease. One of the possible causes of premature ovarian failure could be an autoimmune process beginning at any time during the reproductive period. Autoimmune damage of the ovarian hormonal production places this disease between the autoimmune endocrinopathies, characterized by direct destruction of the target cells, such as thyroiditis, insulin dependent diabetes and Addison’s disease. Animal models proved that the manifestation of the disease is preceded by complex process that is influenced by genetic, immunologic and environmental factors. Material and methods. Studied group included 39 patients. 18 patients were treated for primary amenorrhoea, 21 for menstrual cycle disorders. Patients included in the study were repeatedly examined at the beginning of the study and after six months during which they were treated by estrogen and gestagen. In all patients we have tested FSH, LH and FSH/LH ratio, presence of antiovarian antibodies. Results were compared with those obtained in control women. 21 antiovarian antibodies positive patients were indicated for laparoscopic biopsy. Bioptic sample was examined using light and electron microscopy. Results. Our treatment with hormonal therapy lead to the reduction of ovarian antigens. In 85% of the cases marked decrease of antiovarian autoantibodies levels was observed, while in 28% of the cases the levels were undetectable. From morphological changes of the bioptic sample enhanced atresia of follicules at different developmental stages was frequently observed. It evoked marked reduction of follicular apparatus up to its complete disappearing. Conclusion. The results of our study and mapping of the antiovarian antibodies positivity support our hypothesis that the antiovarian antibodies positivity corresponds with the clinical symptoms. Appropriate treatment with hormonal replacement therapy minimizes ovarian destruction, preserves ovarian hormonal functions and saves healthy ovarian tissue.