He worked at the Military Medical Academy from 2009 to 2018 in the Endocrinology Clinic. For 5 years, he practiced in the reception office of "Tokuda" hospital in Sofia, as well as in other medical facilities in outpatient medical care. He has taken numerous postgraduate qualifications and specializations in the field of metabolic diseases.
Which endocrine diseases and disorders affect reproductive function? In response to this reader's question, we talk to endocrinologist Dr. Krasimir Hadjilazov.
Dr. Hadjilazov, what is the relationship between endocrine diseases and reproductive disorders?
- Endocrinology is a speci alty of internal medicine, which has many points of contact and interconnections not only with them, but also with other organs and systems. Since endocrinology studies the endocrine glands, that is, the endocrine glands, it is closely related to obstetrics and gynecology and especially to reproductive medicine.
Ovaries and testes are also endocrine glands in that they produce not only hormones, but also cells - eggs and sperm. But their production - of both eggs and sperm - is directly related to hormonal indicators - estrogens, progesterone. Therefore, our collaboration with obstetricians and gynecologists is extremely frequent and very close, and this is proof that when there is a problem from the point of view of the reproductive system, it is common to both endocrinology and obstetrics and gynecology.
Just two days ago, three young women with reproductive problems as a leading point visited my office, referred directly by obstetrician-gynecologists.
Which endocrine diseases affect reproductive function?
- First of all, endocrine diseases of the thyroid gland. When a woman intends to get pregnant, but does not get pregnant for several months, and if elevated values of the main thyroid hormone TSH are found above the age-specific, globally accepted criteria, then a problem with the thyroid gland can be sought as a reason.
Very often fellow gynecologists refer such patients to us. I mean, this is the easiest and fastest way to solve a reproductive problem if the TSH value is above the age limit. Because it is enough for the woman to take FT4 (levothyroxine), which accordingly lowers TSH levels
It is believed that women of reproductive age according to accepted standards should have a level of this hormone below 2.5, even below 2. This is a prerequisite for normal reproductive function. I open a parenthesis to note that reproductive issues are not limited to the thyroid.
What do you mean?
- Reproductive problems can be related to insulin values, and I clarify right away that it is not a question of whether the patient has diabetes or not. Hyperinsulinemia already at the level of the ovaries leads to possible changes in the balance of hormones that are synthesized into sex hormones in the woman's ovary.
It is believed that a part of the cells in the ovaries, which are also related to the synthesis of testosterone in the woman, when there are increased levels of insulin at the level of the ovaries, the production of testosterone is stimulated accordingly. However, in certain amounts, it disrupts this fine balance between estrogen, progesterone and testosterone, and accordingly the possibility of obtaining an egg ready for fertilization.
Here comes the turn of us, the endocrinologists, to intervene. We resort to tests to tell us if a person has hyperinsulinemia despite otherwise normal blood sugar levels. And if such problems are proven, according to the world standard, metformin is most often used, and maybe more modern medications. This is our job, accordingly we observe the patient for 3 months and the situation is controlled if it has not changed. This type of medication is supposed to improve ovarian function, i.e. a woman's reproductive abilities.
What else directly affects the reproductive system?
- The other hormone that can link endocrinology to reproductive issues is prolactin, which is released by the pituitary gland. This hormone has been found to be necessary and when a woman becomes pregnant, it is normal for its levels to rise in order to block the menstrual cycle and prepare the mammary glands for breastfeeding. But this is under normal conditions.
However, when prolactin is elevated, which is almost always due to a benign process in the pituitary gland affecting prolactin-producing cells, this adenoma causes disruption in the reproductive system. Depending on the values of its rise in the circulation, a woman may have menstruation, but ovulation is blocked.
With higher prolactin values, the entire menstrual cycle can now be blocked. And here everything depends on the size of the tumor formation, which we prove with double tests. The woman should be calm, not take contraceptive, stimulating or sleep-inducing drugs. We explain all these and other requirements to women in great detail, as one worry can raise the levels of the stress hormone prolactin.
Then we go to a stage to see the cause of this, next level is to study the pituitary gland by MRI if it will visualize a formation in the pituitary region. Most often, small formations under one centimeter are found, the so-called. microcarcinomas. Initially, medication is started, and usually most carcinomas quickly respond to suppression of prolactin secretion. That is, their levels rapidly decrease within a month-two-three.
In some cases, the volume of the tumor can be reduced and even disappear. After all, entering the reference limits in prolactin values guarantees the restoration of a woman's reproductive abilities. It is considered desirable to discontinue these medications after pregnancy.
A very rare link between reproductive medicine and endocrinology also focuses on the adrenal glands. There is a complex secretion of hormones from different areas of the otherwise small adrenal gland. There, on the one hand, glucocorticoid hormones (cortisol), aldosterone, and sex hormones are released, which, however, have nothing to do with reproductive abilities.
And to what extent do endocrine disorders affect reproductive opportunities in men?
- I have already indicated that if there is a problem in the adrenal glands in men, it affects the male gender accordingly. Men would also be affected by the increased prolactin level, although it is less common. Diseases associated with changes in thyroid hormones are even less common. But when there are elevated prolactin values in them, they are much higher than in the female sex. The unpleasant thing is that in a part of the cases the tumors are malignant. By sometimes resorting to operative intervention.
Otherwise, the type of treatment is the same as for the female gender regarding the thyroid gland, although the cases are much rarer. In addition, such a direct connection between thyroid hormones and their influence on the male reproductive system has not been proven. At the next level is the examination of the testicles, where the levels of testosterone and its derivatives are monitored.
And depending on their levels (there is already another visual research method here - a spermogram), an analysis is made to come to the conclusion where the violation is, what it is, and the appropriate treatment is undertaken. If prolactin is the cause, everything that is female is taken. If testosterone production is reduced due to congenital or acquired disorders, it is given in the form of tablets or injections. And thus the violations are corrected.