On the Strange Nature of the Ovaries
Dr. Nelson Soucasaux , Brazilian gynecologist
Due to the enormous histological, morphological and biochemical transformations
inherent in their physiology, the ovaries exhibit a high degree of "unquietness"
on the part of the cellular elements that constitute them. Their inner "agitation"
along the fertile years of women's lives is simply amazing. Nevertheless,
this fact becomes especially problematic because the ovarian follicles,
the basic functional structures of the female gonads, are neither renewable
nor able to give origin to new follicles. (Before starting its development
and growth, each ovarian follicle consists of an oocyte surrounded by a
layer of follicular cells. As these follicular cells proliferate and undergo
several morphological and functional changes, they produce the ovarian hormones.)
(Important: Regarding the recent discovery
of the formation of new follicles in the ovaries of adult mice, see
Notes 2 and 3 below the article.)
Considering that the ovarian follicles - the basic functional and reproductive
structures or "unities" of the ovaries - are neither renewable
nor capable of originating new follicles, all the physiological processes
that take place along each ovarian cycle inevitably lead to complete ovarian
depletion about the age of 50. The waste of follicles along women's lives
is enormous and the ovarian endocrine function is just the one that is more
harmed by that. It is possible that this continuous process of growth, transformation
and involution of functional structures may also be one of the causes for
the astonishing variety of existing ovarian pathologies, not only functional
and organic but also benign and malignant.
The very peculiar features of the female gonads deserve careful consideration
that must transcend the usual exclusive and restricted organism. We should
ask what might lie behind the way nature "programmed" the ovaries.
The histological structure which the ovaries are endowed with is too "unsophisticated"
to face the complexity and the importance of their function. It is also
possible that the kind of functional activity which the ovaries are subjected
to may cause "injuries" to their structure, slowly and gradually
harming them along life.
Throughout women's fertile years, the ovaries are continuously subjected
to: 1) processes of growth, transformation, involution, regression and disappearance
of functional structures; 2) processes of compression and distention resulting
from follicular growth and formation of the corpus luteum; 3) traumas on
their surface due to the ovulatory follicular rupture; 4) an infinitude
of highly complex hormonal and biochemical actions; 5) possible still unknown
neurovascular phenomena. The female gonads are, over and above all, organs
that are in constant histological and morphological transformation. The
degree of "unquietness" of the main structures that constitute
the ovaries is enormous. E.L. Potter remarks: "From early embryonic
life until well after the menopause, the ovary exhibits
a greater day-to-day variation pattern than any other structure of the body"
(quoted by Sylvany Filho, A., "O Ovário Humano do Nascimento
à Senescência Histofisiologia do Ovário" in: Tourinho;
Bastos; Moreira - "Ginecologia da Infância e da Adolescência,"
Byk-Procienx, Rio de Janeiro, 1977).
In my book "Novas Perspectivas em Ginecologia" ("New
Perspectives in Gynecology") (Imago Editora, Rio de Janeiro, 1990)
I observed that, sometimes, the very female nature seems to turn against
itself. This fact becomes especially remarkable in relation to the ovaries,
not only regarding their physiological "normal" destiny (that
unfortunately leads to their precocious depletion), but also concerning
the great number of pathologies that affect them. Botella Llusiá
observes that all the embryonic and physiological complexity of the ovaries,
associated with the great reproductive potentiality of their cells, contributes
to making the female gonads the organs that exhibit
the greatest number of pathologies in the body (Llusiá, B.,"Tratado
de Ginecologia, Tomo 3, Enfermedades del Aparato Genital Femenino,"
Editorial Científico-Médica, Barcelona, Madri, 1965).
Though discussing the astonishing diversity of ovarian pathologies is
not the purpose of this article, these observations by Botella Llusiá
confirm the intrinsic high degree of "unquietness" of the cellular
elements that constitute the female gonads. Such "unquietness,"
characterized by a somewhat "confused" pattern of proliferation
and atrophy of the cellular elements that constitute the non-renewable
basic functional structures of the ovaries, leads to the precocious
depletion of these organs and facilitates the appearance of innumerable
pathologies.
The capacity of proliferation and metamorphosis of the female gonads
is amazing, reaching a truly "frantic" pattern along women's fertile
years. Considering all of this, one more unusual and paradoxical feature
of the ovaries becomes evident through the fact that, despite the enormous
proliferative capacity of their cells, even so the female gonads are
absolutely incapable of multiplying their fundamental histo-functional unities,
the ovarian follicles. As a consequence, the self-renewal of the ovarian
endocrine-reproductive unities - the ovarian follicles - is entirely
impossible. Thus, the enormous cellular "agitation" characteristic
of the female gonads, physiologically - and paradoxically - contributes
to accelerating their depletion, due to the enormous waste of follicles
that are consumed during this process.
As a consequence, about the age of 50 women become deprived of the estrogens
they need so much. As Lauritzen remarked quite well, the
ovary is the first endocrine gland that ceases to function. (Lauritzen,
C; van Keep, P.A.: "Envelhecimento e Estrogênios" ["Aging
and Estrogens"] - Brazilian Edition, Medisa, São Paulo,
1975 ).
Note 2: As to the recent discovery of the formation of new oocytes in
the ovaries of adult mice, from the clinical and practical standpoint
it does not change the basic facts exposed in this article, which obviously
concerns women's ovaries. Regardless of the importance of the aforementioned
discovery for biology, I think it is too early for trying to draw conclusions
that may be applicable to women based on the results of these preliminary
experiments on mice. Though I do believe in the possibility of the
existence of stem cells able to originate new follicles in women's ovaries
and also do not doubt that, at least, some new follicles may be formed along
adult women's lives, the fact is that, in women, the entire ovarian follicular
population do deplete throughout life, culminating with menopause. This
means that even if some new follicles are formed throughout adult women's
lives, this formation would be so insignificant that these newly formed
follicles are also consumed by the events that characterize ovarian physiology
and, therefore, also disappear through the process of follicular atresia
(death).
Note 3: Nevertheless, in the face of the discovery mentioned above,
it is obvious that now we must search for the existence of these stem cells
able to give rise to new follicles in women's ovaries. If researchers can
demonstrate that such cells also exist in women, of course several new possibilities
arise for the future. Even so, in terms of safe and successful medical usage,
I think we must be very, very careful in our speculations on the subject.
The text above is an adapted excerpt from my book "Os Órgãos
Sexuais Femininos: Forma, Função, Símbolo e Arquétipo"
("The Female Sexual Organs: Shape, Function, Symbol and Archetype"),
published by Imago Editora, Rio de Janeiro, 1993. For information on the
book, see page http://www.nelsonginecologia.med.br/orgaos.htm,
at my Web site www.nelsonginecologia.med.br
Copyright Nelson Soucasaux 1993, 2004
__________________________________________________
Nelson Soucasaux is a gynecologist dedicated to clinical, preventive
and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina
da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several
articles published in medical journals and of the books "Novas Perspectivas
em Ginecologia" ("New Perspectives in Gynecology")
and "Os Órgãos Sexuais Femininos: Forma, Função,
Símbolo e Arquétipo" ("The Female Sexual Organs:
Shape, Function, Symbol and Archetype"), published by Imago Editora,
Rio de Janeiro, 1990, 1993. He has been working in his private clinic since
1975.
Web site (Portuguese-English): www.nelsonginecologia.med.br
Email: nelsons@nelsonginecologia.med.br