The main ideas about the pathogenesis of ovarian dysfunction in women with diabetes mellitus (DM) type 1 are presented. The role of increased opioid and dopaminergic tone in the pathogenesis of reducing the synthesis of the gonadotropin-releasing hormone by the hypothalamus in women with type 1 diabetes was analyzed. Presented the data of relationship between ovarian hormonal insufficiency in women with type 1 diabetes with possible damage of positive feedback mechanism of the ovaries and the pituitary gland, which intactness is necessary for the maturation of the dominant follicle and ovulation. The results of studies, suggested that the high doses of exogenously administered insulin in type 1 DM lead to stimulation of androgen synthesis in teca cells and ovarian stroma and the development of ovarian hyperandrogenemia, as well as polycystic ovary syndrome, are reduced. In addition to exogenous hyperinsulinemia, in the pathogenesis of ovarian dysfunction, the value of the deficiency of endogenous insulin, leading to a violation of steroidogenesis in the tissues of the ovary and anovulation, is proved. The role of insulin deficiency and hyperglycemia in the development of metabolic stress lead to ovarian dysfunction in patients with type 1 diabetes was analyzed.
■ Ключевые слова: сахарный диабет 1 типа; функция яичников; режим инсулинотерапии; компенсация диабета; микрососу-дис тые диабетические осложнения.
Hypothesis/aims of study. The adverse effects of type 1 diabetes mellitus on the female reproductive system have been proved by many studies. There is still conflicting literature on the impact of diabetes and other factor compensation on ovarian function in women with type 1 diabetes mellitus. Study design, materials and methods. The current analysis was undertaken to study the effects of diabetes compensation on ovarian function in women with type 1 diabetes mellitus. In order to this, 180 individuals aged 20 to 40 years were examined. The main group consisted of 112 diabetic patients with primary ovarian insufficiency, the comparison group included 68 women with type 1 diabetes mellitus and a normal ovulatory cycle. After 18–24 months following the therapy aimed to compensate diabetes, 63 patients with ovarian insufficiency were re-examined. The examination included determination of blood glucose, glycated hemoglobin (HbA1c), FSH, LH, prolactin, estradiol, total and free testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, dihydrotestosterone, progesterone, and sex hormone-binding globulin (SHBG) levels, as well as ultrasound examination in the first and second phases of the menstrual cycle. Results. Association of ovarian insufficiency with HbA1c level and the dose of insulin was found. Patients in the main group experienced a decrease in FSH and SHBG levels, an increase in the ovarian volume and the number of antral follicles compared to those in diabetic patients with a normal ovulatory cycle. In patients with decompensated diabetes and ovarian insufficiency, after the compensation of diabetes, the recovery of the ovulatory cycle was observed in 61.8 % of cases. Conclusion. Ovarian function in women with type 1 diabetes mellitus depends on HbA1c level and the dose of insulin. Diabetes compensation in women with type 1 diabetes mellitus contributes to the recovery of ovulation in 61.8 % of cases.
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