Ультразвуковые особенности функциональной анатомии внутренних половых органов в период раннего постменархе

Истомина Н.Г., Раздрогина К.А., Баранов А.Н. Ультразвуковые особенности функциональной анатомии внутренних половых органов в период раннего постменархе. Гинекология. 2025;27(3):209–214. DOI: 10.26442/20795696.2025.3.203382

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Istomina NG, Razdrogina KA, Baranov AN. Ultrasound features of the internal genitalia functional anatomy in the early postmenarcheal period. A review. Gynecology. 2025;27(3): 209–214. DOI: 10.26442/20795696.2025.3.203382

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Аннотация

Раннее постменархе, период от первой менструации до окончания пубертата, представляет собой критический этап формирования репродуктивной функции, в течение которого происходит функциональная настройка оси «гипоталамус – гипофиз – яичники», обеспечивающая переход от ановуляторных к овуляторным менструальным циклам. Цель исследования – обобщить современные данные о физиологических механизмах становления овуляторной функции и нейроэндокринной регуляции менструального цикла, а также охарактеризовать эхографические особенности репродуктивных органов в этот период. В этом контексте акцент должен быть смещен с формальных признаков на индивидуальные траектории становления менструального цикла и овуляторной функции. Клинико-инструментальное наблюдение в этот период должно включать регулярную оценку характеристик менструального цикла, динамики объема и морфологии яичников, наличия доминантного фолликула, а также яичниково-маточного соотношения. Представленные сведения подчеркивают значимость раннего постменархе как чувствительного окна для диагностики и потенциальной коррекции нарушений репродуктивного развития.

Ключевые слова: подростки, раннее постменархе, ультразвуковая диагностика, пубертат

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Early postmenarche, the period from the first menstruation to the end of puberty, is a critical stage in the formation of reproductive function, during which the functional adjustment of the hypothalamus-pituitary-ovarian axis occurs, providing a transition from anovulatory to ovulatory menstrual cycles. The purpose of the study was to summarize current data on the physiological mechanisms of the formation of ovulatory function and neuroendocrine regulation of the menstrual cycle, as well as to characterize the ultrasound features of the reproductive organs during this period. In this context, the emphasis should shift from formal signs to individual trajectories of menstrual cycle development and ovulatory function. Clinical and instrumental observations during this period should include regular evaluation of menstrual cycle characteristics, changes in ovarian volume and morphology over time, the presence of a dominant follicle, as well as the ovarian/uterine ratio. The presented data emphasize the importance of the early postmenarcheal period as a sensitive window for the diagnosis and potential correction of reproductive development disorders.

Keywords: adolescents, early postmenarche, ultrasound diagnosis, puberty

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Список литературы

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1. De Sanctis V, Rigon F, Bernasconi S, et al. Age at Menarche and Menstrual Abnormalities in Adolescence: Does it Matter? The Evidence from a Large Survey among Italian Secondary Schoolgirls. Indian J Pediatr. 2019;86(Suppl. 1):34-41. DOI:10.1007/s12098-018-2822-x
2. Lacroix AE, Gondal H, Shumway KR, et al. Physiology, Menarche. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470216/ Accessed: 03.03.2025.
3. Glueck CJ, Woo JG, Khoury PR, et al. Adolescent oligomenorrhea (age 14–19) tracks into the third decade of life (age 20–28) and predicts increased cardiovascular risk factors and metabolic syndrome. Metabolism. 2015;64(4):539-53. DOI:10.1016/j.metabol.2015.01.005
4. Radivojevic UD, Lazovic GB, Kravic-Stevovic TK, et al. Differences in Anthropometric and Ultrasonographic Parameters between Adolescent Girls with Regular and Irregular Menstrual Cycles: A Case-Study of 835 Cases. J Pediatr Adolesc Gynecol. 2014;27(4):227-31. DOI:10.1016/j.jpag.2013.11.007
5. Hart R, Sloboda DM, Doherty DA, et al. Prenatal determinants of uterine volume and ovarian reserve in adolescence. J Clin Endocrinol Metab. 2009;94(12):4931-7. DOI:10.1210/jc.2009-1342
6. Cooper N, Meehan H, Linton-Reid K, et al. Clinical utility of ultrasonography in pediatric and adolescent gynecology: retrospective review of 1313 ultrasound examinations. Ultrasound Obstet Gynecol. 2025;65(2):226-34. DOI:10.1002/uog.29155
7. Ozerskaya IA, Shcheglova EA, Gavrilenko NB. Differential Ultrasound Diagnosis of Polycystic Ovaries and Multifollicular Ovaries in Girls 15–18 Years Old. Meditsinskaia Vizualizatsiia. 2015;4:116-30 (in Russian). EDN: UHRJXD
8. Volk J, Solntsava A. Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescents. Reproduktivnoe Zdorove. Vostochnaia Evropa. 2021;11(1):41-9 (in Russian). DOI:10.34883/PI.2021.11.1.014
9. Kamilova NM, Sultanova IA, Khalilova GM, Akhmedzade VA. Complex Ultrasound Diagnosis Of Pelvic Organs In Girls-Adolescents With Obesity. Permskii Meditsinskii Zhurnal. 2019;36(3):43-50 (in Russian). DOI:10.17816/pmj36343-50
10. Bumbuliene Z, Klimasenko J, Sragyte D, et al. Uterine size and ovarian size in adolescents with functional hypothalamic amenorrhoea. Arch Dis Child. 2015;100(10):948-51. DOI:10.1136/archdischild-2014-307504
11. Ziereisen F, Guissard G, Damry N, Avni EF. Sonographic imaging of the paediatric female pelvis. Eur Radiol. 2005;15(7):1296-309. DOI:10.1007/s00330-005-2648-6
12. Razzaghy-Azar M, Ghasemi F, Hallaji F, et al. Sonographic measurement of uterus and ovaries in premenarcheal healthy girls between 6 and 13 years old: correlation with age and pubertal status. J Clin Ultrasound. 2011;39(2):64-73. DOI:10.1002/jcu.20723
13. Gilligan LA, Trout AT, Schuster JG, et al. Normative values for ultrasound measurements of the female pelvic organs throughout childhood and adolescence. Pediatr Radiol. 2019;49(8):1042-50. DOI:10.1007/s00247-019-04419-z
14. Howard SR. Interpretation of reproductive hormones before, during and after the pubertal transition-identifying health and disordered puberty. Clin Endocrinol (Oxf). 2021;95(5):702-15. DOI:10.1111/cen.14578
15. Christian CA, Moenter SM. The neurobiology of preovulatory and estradiol-induced gonadotropin-releasing hormone surges. Endocr Rev. 2010;31(4):544-77. DOI:10.1210/er.2009-0023
16. Belova IS, Khashchenko EP, Uvarova EV, Andreeva VO. Psychoemotional Status and Eating Disorders in the Polycystic Ovary Syndrome Pathogenesis Among Adolescence. Reproduktivnoe Zdorove Detei i Podrostkov. 2021;17(3):82-93 (in Russian). DOI:10.33029/1816-2134-2021-17-3-82-93
17. Kauffman AS. Neuroendocrine mechanisms underlying estrogen positive feedback and the LH surge. Front Neurosci. 2022;16:953252. DOI:10.3389/fnins.2022.953252
18. Kelsey TW, Ginbey E, Chowdhury MM, et al. A Validated Normative Model for Human Uterine Volume from Birth to Age 40 Years. PLoS One. 2016;11(6):e0157375. DOI:10.1371/journal.pone.0157375
19. Porcu E. Imaging in pediatric and adolescent gynecology. Endocr Dev. 2004;7:9-22. DOI:10.1159/000077074
20. Rahman G, Urrutia MA, Salaberry MI, et al. The role of gynecologic sonography in sexual development assessment of girls and adolescents. Radiologia (Engl Ed). 2025;67(2):128-36. DOI:10.1016/j.rxeng.2023.08.006
21. Galvez MV, Salazar VPB, Adell MP, et al. Updated reference values in pelvic ultrasonography for a Spanish population of healthy girls between 6 and 12 years old. Endocrinol Diabetes Metab. 2021;4(3):e00233. DOI:10.1002/edm2.233
22. Salnikova IA, Uvarova EV, Khashchenko EP, Mamedova FSh. Management Of Uterine Bleeding In Adolescents: Treatment Options According To Clinical Recommendations. Reproduktivnoe Zdorove Detei i Podrostkov. 2023;19(3):62-73 (in Russian). DOI:10.33029/1816-2134-2023-19-3-62-73
23. Pecchioli Y, Oyewumi L, Allen LM, Kives S. The Utility of Routine Ultrasound in the Diagnosis and Management of Adolescents with Abnormal Uterine Bleeding. J Pediatr Adolesc Gynecol. 2017;30(2):239-42. DOI:10.1016/j.jpag.2016.09.012
24. Moore AM, Novak AG, Lehman MN. KNDy Neurons of the Hypothalamus and Their Role in GnRH Pulse Generation: an Update. Endocrinology. 2023;165(2):bqad194. DOI:10.1210/endocr/bqad194
25. Constantin S. Targeting KNDy neurons to control GnRH pulses. Curr Opin Pharmacol. 2022;67:102316. DOI:10.1016/j.coph.2022.102316
26. Mohr MA, Esparza LA, Steffen P, et al. Progesterone Receptors in AVPV Kisspeptin Neurons Are Sufficient for Positive Feedback Induction of the LH Surge. Endocrinology. 2021;162(11):bqab161. DOI:10.1210/endocr/bqab161
27. Starrett JR, Moenter SM. Hypothalamic kisspeptin neurons as potential mediators of estradiol negative and positive feedback. Peptides. 2023;163:170963. DOI:10.1016/j.peptides.2023.170963
28. Senaldi L, Gopi RP, Milla S, Shah B. Is ultrasound useful in the diagnosis of adolescents with polycystic ovary syndrome? J Pediatr Endocrinol Metab. 2015;28(5-6):605-12. DOI:10.1515/jpem-2014-0307
29. Khashchenko EP, Uvarova EV, Ivanets TYu, et al. Key diagnostic criteria for adolescent polycystic ovary syndrome adjusted for age-specific hormonal and metabolic status standards. Obstetrics and Gynecology. 2019;9:102-10 (in Russian). DOI:10.18565/aig.2019.9.102-110
30. Medeiros S, Medeiros A, Magalhaes LF, et al. Fundamentals to Diagnosing Polycystic Ovary Syndrome in Adolescents: A Critical Literature Review. J Gynecol Obstet. 2024;12:67-80. DOI:10.11648/j.jgo.20241204.12

Авторы

Н.Г. Истомина, К.А. Раздрогина, А.Н. Баранов*

ФГБОУ ВО «Северный государственный медицинский университет», Архангельск, Россия
*a.n.baranov2011@yandex.ru

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Natalya G. Istomina, Kseniia A. Razdrogina, Aleksei N. Baranov*

Northern State Medical University, Arkhangelsk, Russia
*a.n.baranov2011@yandex.ru

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