Treatment of polycystic ovaries: nuances for those who plan to become pregnant. Polycystic ovaries: symptoms, causes and treatment What is polycystic ovary disease
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Alas, girls (as well as their adult relatives) do not always pay due attention to this! All these unpleasant phenomena are attributed to hormonal disruptions of the body, characteristic of puberty: they say, over time, everything will work out, it will pass by itself. In addition, a girl (which is quite natural) at this age is much more worried about excess weight, and greasy skin with an abundance of acne, rather than irregular menstruation. So she postpones an absolutely necessary visit to the doctor, but in vain.
How to treat polycystic ovaries, if it has already come to persistent infertility?
This is quite a difficult task. In most cases, you can not do without the appointment of special hormonal drugs, even taking into account their side effects. If the patient is overweight, it is necessary to correct it at the same time, for this, diets, physiotherapy exercises, etc. are used. At the same time, treatment is carried out that stimulates ovulation.
If all these measures do not give the expected result, that is, pregnancy does not occur, and the disease worsens, it is necessary to resort to surgery (by laparoscopy). To consolidate the effect achieved by surgery, hormonal therapy is usually prescribed again.
All about polycystic ovaries
A truly happy woman feels herself, having experienced the joy of motherhood. A gynecological disease such as polycystic ovaries, which is one of the most common endocrine disorders, can reduce the risk of pregnancy. To prevent serious consequences that threaten infertility, you need to know well what polycystic disease is and how to treat it.
Clinical picture of polycystic ovaries
Pathological changes in the hormonal background of women of childbearing age include polycystic ovaries. Violation of the production of hormones leads to the formation of multiple cysts filled with watery secretion, clotted blood or pus.
This pathology belongs to the endocrine and occurs in two forms: primary and secondary.
Primary (true) polycystosis is congenital or diagnosed in girls during puberty, occurring against the background of acute respiratory diseases, infectious tonsillitis, hereditary factors, early abortions. In adolescents, it is accompanied by painful heavy periods or their absence. It can be diagnosed in young women under 30 who are not obese and hyperglycemic. It has a severe course, poorly amenable to conservative and surgical treatment.
Secondary polycystic ovaries (Stein-Leventhal syndrome) is typical for women after 40 years of age with overweight and high blood glucose. Often diagnosed in menopause, accompanied by signs of extinction of the female glands. Well treated conservatively.
In the process of pathology development, liquid follicles are formed on the surface of the ovaries. The disease is accompanied by menstrual dysfunction, obesity, excessive hair growth, in 25% of cases leads to infertility.
Why is polycystic ovaries dangerous for pregnancy? Physiological changes in hormone levels during adolescence affect a woman's ability to become a mother in the future.
Hormonal imbalance is the main cause of diseases in gynecology, as a result of which the protein membrane of the paired female gonads thickens, leading to the cessation of ovulation. Since fertilization does not occur, a cyst is formed from the follicular fluid. Since this process occurs monthly, the ovary as a result takes the form of a ball filled with numerous cystic formations. Especially dangerous is the development of PCOS in girls who are just about to give birth. Having this disease, a woman reduces the likelihood of getting pregnant to almost zero.
Why ovarian pathology develops
Medicine has not yet established the exact factors for the formation of polycystic ovaries. The most common causes of pathology include:
- Dysfunction of organs that produce hormones. Disorders in the work of the pituitary gland, thyroid gland, hypothalamus, adrenal glands increase the level of androgen, which contributes to cystic neoplasms.
- Excess insulin production provokes an increase in testosterone, which affects ovulation.
- Extra pounds contribute to an increase in glucose, causing weight gain, and, as a result, polycystic ovaries.
- Hormone imbalance. Increased production of prolactin, testosterone, luteinizing hormone (LH); low concentration of globulin (SHGB).
- Chronic inflammation leads to excess cholesterol (atherosclerosis) and insulin resistance, causing heart and vascular disease. Any inflammatory processes occurring in the female body can cause pathology of the paired gonads.
- hereditary factors. The risk of developing polycystic ovary disease increases if the next of kin are carriers of the disease.
- Irregular development of the fetus. Gene expression (malfunctioning) leads to hyperglycemia and chronic inflammation, which can lead to PCOS.
The reasons for the failure of hormones include plastic containers. Scientists have found that drinking drinks from plastic bottles increases the concentration in the body of substances that affect sex hormones by 70%. Bisphenol A, contained in plastic products, acts like estrogen and can become the basis for the development of polycystic female gonads, uterine cancer, and lead to infertility.
What are the symptoms of pathology
At the end of the 20th century, at a conference dedicated to this problem, scientists decided that when diagnosing polycystic ovary syndrome (or PCOS), it is necessary to take into account the presence of the following mandatory features:
- Changed menstrual cycle. Signs of abnormal critical days are:
- menstruation with an interval of more than 35 days;
- absence of menstruation for more than 4 months;
- prolonged bleeding;
- irregular periods.
- Virilization - visual manifestations of a high concentration of androgens (male pattern baldness, skin rashes, hirsutism, voice changes, breast reduction). Since polycystic ovary symptoms are similar to other hormonal pathologies, the diagnosis is made with pronounced hyperandrogenism.
There are other signs of polycystic ovaries, expressed in different ways and combined with each other:
- External changes in the skin and hair, manifested:
- pigmentation, thickening and darkening of the epidermis in the inguinal, axillary, cervical and thoracic region;
- acne rash all over the body;
- dysfunction of the sebaceous glands.
- Changes in the paired female gonads, accompanied by
- increase in size;
- expansion of the glands due to multiple cysts;
- pain in the lower abdomen;
- bleeding between periods.
- Sharp weight gain (from 15 kg) and deposition of fat in the abdominal cavity (male type).
- Deterioration of general well-being due to diabetes, hypertension, high cholesterol.
- Reproductive disorders, expressed in the inability to become pregnant, bear and give birth to a baby.
The symptoms of polycystic ovaries and their severity are individual for each woman and increase significantly when gaining extra pounds (rational nutrition is very important). A complete medical examination is shown in the presence of a failure of menstruation and the appearance of signs of an excess of male hormones - hyperandrogenism.
Diagnosis of PCOS
Diagnostics, including objective, instrumental and laboratory studies, will help confirm the signs of polycystic ovary syndrome:
- general examination of the patient, assessing the constitution of the body, hairline, condition of the epidermis, peritoneum;
- reception of a gynecologist, including an examination to identify the condition of the female glands (compaction / increase);
- ultrasound examination of the small pelvis, noting bilateral changes in the paired gonads, the presence of multiple follicular cystic formations, an increase in vascular blood flow;
- laboratory examination for the concentration of hormone levels: FSH, LH, prolactin, progesterone, estradiol, testosterone, coritsol, DHEA-S, progesterone, thyroxine;
- MRI of the pelvis to exclude malignant tumors;
- study of lipid levels, sugar content, TSH (glucose tolerance testing);
- laparoscopy to confirm changes in the female gonads;
- mammography to detect polycystic breast disease.
A definitive diagnosis cannot be made without excluding diseases with similar symptoms:
- Cushing's syndrome, manifested by an increase in cortisol;
- androgenital syndrome, determined by an increased content of testosterone;
- hyperprolactinemia;
- decreased function of the endocrine gland.
Treatment of pathology of paired gonads
With a diagnosed polycystic ovary syndrome, therapy is prescribed according to the severity of clinical signs, in accordance with the patient's age, complaints, and is a multi-stage process of restoring reproductive abilities and other pathologies of the female body. Symptoms and treatment of the pathology of the paired gonads are directly interrelated. The number of therapeutic measures depends on the severity of the process and the woman's desire to become a mother.
How to cure polycystic ovaries? This is a rather complicated and lengthy procedure that requires patience and strong-willed efforts. The therapy is as follows:
- Body weight correction will improve hormonal levels and other health indicators (diabetes, high blood pressure, high cholesterol). Even a 5% weight loss corrects the balance of hormones, thereby increasing the chances of conception.
- Restoration and normalization of menstruation comes down to taking hormonal drugs - contraceptives containing a low dose of female hormones. They reduce the concentration of androgen, which reduces the risk of developing uterine cancer and normalizes blood flow. Alternatively, you can use progesterone monthly for a course of days. Metformin is often prescribed for polycystic ovaries, designed to lower insulin levels and improve ovulatory function, as well as normalize the menstrual cycle. In addition, with the help of metformin for polycystic disease, you can lose weight in combination with diet and exercise.
Combined female hormonal contraceptives are also used, for example, rigevidon. They stimulate the formation of a special protein that binds testosterone and helps reduce male hormones. Rigevidon normalizes menstrual flow and prevents the growth of the inner uterine layer. The course of treatment (at least six months) restores the ovulatory function of the paired female gonads.
- Stimulation of ovulation in polycystic ovaries. If you want to get pregnant, you need to take medications that cause ovulation. The drug Klostilbegit directly affects the sex glands, increasing the production of hormones and stimulating the maturation of the follicle. 1-2 pcs. take starting from the 3rd day of the cycle for 5 days. This scheme guarantees the onset of ovulation during the menstrual cycle. If necessary, the therapeutic course is repeated.
- Cessation of hair growth. Specialists often recommend contraception, which reduces the production of androgens, or spironolactone, which blocks the action of androgens on the epidermis. The drug is contraindicated in the planning and onset of pregnancy. Eflornithine cream will help slow down the growth of facial hair, as well as resorting to electrolysis or laser hair removal.
- Operational intervention. If pregnancy does not occur after conservative treatment, resort to surgical methods. An outpatient operation called a pelvic laparoscopy is scheduled. The surgeon uses a laser to perform electrocoagulation (incisions and cauterization) or resection of the ovaries for polycystic disease (removal of damaged areas), inducing ovulation.
The traditional question asked by patients faced with this problem: is it possible to cure polycystic ovaries? Doctors disagree, but many answer in the affirmative: a complete cure is possible, although difficult, but even after getting rid of the disease, it is worth visiting the gynecologist regularly to avoid relapse.
Diet for PCOS
One of the main causes of the disease of the paired gonads of a woman is obesity, so a diet for polycystic ovaries is important, which normalizes the hormonal background and reduces body weight. Rational nutrition requires the following changes in the daily menu:
- Include fiber-rich foods in the menu - fruits, nuts, vegetables will supply the body with useful vitamins.
- Replace foods high in animal fat (meat, milk, butter) with foods rich in vegetable or fish oil.
- Discard gaseous liquids.
- Minimize the use of confectionery and flour products.
- Do not drink strong tea and coffee.
The solution to the problem of how to lose weight with polycystic ovaries depends solely on the desire of the patient. Nutritionists and trainers recommend following their advice:
- create a healthy diet;
- add physical exercises (cardio loads are shown);
- keep track of your progress by recording them in the diary of achievements;
- Be patient and work hard towards the goal of fighting PCOS.
Folk recipes for ovarian pathology
An effective way to treat the problem of paired female gonads is herbal medicine. How to treat polycystic ovaries with alternative medicine?
Plants such as nettle, upland uterus, dandelion, sage and red brush are best dealt with this pathology. Infusions and decoctions from these natural healers are considered effective. The useful substances and trace elements contained in them even out the hormonal background, stabilize the menstrual cycle and prevent the formation of new cystic formations. Use simple and effective phytorecipes from the above herbal remedies:
- The upland uterus with polycystic ovaries is good as part of complex therapy. Most often, an alcohol infusion is prepared: 100 g of a dried plant is poured into 0.5 liters of alcohol and insisted for a week. Take every day for 1 tsp. before dinner throughout the year. It is even easier to make a decoction: 1 tbsp. l. herbs pour 1 cup boiling water. Drink the mixture infused for half an hour during the day in small portions.
- The red brush is no less effective for polycystic. The alcohol extract is prepared as follows: 100 g of vodka and 80 g of grass are infused for about 7 days and taken 0.5 tsp three times daily. Water decoction is prepared from 100 g of dried plant and 1 cup of hot water. Drink 1 tbsp. l. twice. To enhance the effect, it is taken simultaneously with the boron uterus.
- Sage tea is recommended not only for multiple ovarian cysts, but also during pregnancy planning. Brew 1 tbsp. l. sage with a glass of boiling water.
Similarly, decoctions and infusions are prepared from other natural remedies for polycystic ovaries. Treatment with folk remedies is long, but the effect will not keep you waiting, moreover, this method of therapy is absolutely safe.
Complications of polycystic ovary syndrome
In addition to impaired reproductive function in polycystic ovaries, the consequences of which are hazardous to health, serious diseases can develop:
- type 2 diabetes;
- peripheral vascular disease, vein thrombosis;
- myocardial infarction, stroke, coronary heart disease;
- mastopathy;
- endometriosis;
- breast and endometrial cancer;
- low levels of high-density lipoprotein (HDL);
- increased concentration of C-reactive protein;
- fatty hepatosis;
- metabolic disorder.
Timely treatment of PCOS and compliance with all medical measures is the guarantor of a favorable prognosis. However, if you want to get pregnant, women often face difficulties.
If the treatment of polycystic ovaries is ineffective or there are other reasons, pregnancy is possible with the help of in vitro fertilization. True, the probability of successful IVF with polycystic disease is lower than in other cases of infertility.
Polycystic ovaries is one of the most urgent problems in gynecology. To prevent the complications of PCOS, the following preventive procedures should be observed:
- systematic planned gynecological consultations;
- educational conversations with adolescent girls and interest in their health on the part of parents.
The main thing is to prevent the disease in time, therefore, at the first symptoms, do not postpone a visit to a specialist. The attending physician will prescribe competent treatment, which will help to avoid adverse consequences and enjoy the happiness of motherhood.
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The ABC of Women's Health
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Polycystic ovaries
One of the most common diagnoses of modern gynecology is polycystic ovaries; the causes and symptoms of the disease are associated with systemic hormonal imbalances and can develop infertility. To exclude this kind of complications, the choice of conservative therapy is carried out by the attending physician only after the diagnosis has been completed. In the worst case, women with endocrine infertility are not destined to experience the joy of motherhood, and they will have to be treated in one course.
What is polycystic ovaries
If ovarian metabolism is disturbed, abnormal changes in function and structure of the ovary occur. Steroidogenesis progresses, which violates the specificity and duration of menstrual cycles in the female body, reduces reproductive activity. Stein-Leventhal syndrome (another name for polycystic disease) contributes to secondary infertility, develops other chronic diseases in a female way.
Primary polycystosis is formed at the genetic level, and progresses only in the puberty. It is a serious disease, difficult to treat conservatively. Secondary polycystic disease is not an independent disease, a complex of unpleasant symptoms in practice is called "Polycystic Ovarian Syndrome" - PCOS in gynecology. The disease does not appear immediately, and relapse is due not only to the age of the patient, but also to the influence of a number of pathogenic factors.
Causes
Overweight women are more likely to suffer from polycystic disease than slender patients (with normal weight), so the first recommendation of a specialist is to control body weight, avoid obesity, regulate hormonal levels. It is important to understand that the pathological process is accompanied by excessive production of androgens - male hormones as a result of a jump, an excess of insulin in the blood. This leads not only to the disorder of the menstrual cycle, but also to a sharp decrease in the possibilities of reproductive functions.
The following pathogenic factors can lead to an imbalance of the hormone progesterone, intensive androgen synthesis and progressive polycystosis:
- nervous shocks;
- the presence of chronic infections;
- change in climatic conditions;
- bad heredity;
- irregular sex life;
- environmental factor;
- colds;
- a large number of abortions;
- pathology in the endocrine glands;
- chronic diseases inherent in the pituitary gland, hypothalamus, ovaries, thyroid gland.
Classification
Since pituitary hormones are produced in abnormal concentrations, additional hormonal preparations are necessary. Before starting intensive therapy, it is required to familiarize yourself in detail with the diagnosis of polycystic disease and study the classification associated with characteristic dysfunctions. So there are:
- Ovarian form. The ovaries are ignored if forced stimulation of ovulation predominates. This is explained by the permissible indicator and the ratio of sex hormones in the blood.
- Adrenal form. A characteristic symptom is hirsutism, a woman complains of sweating, weight gain, acne.
- diencephalic form. May prevail in multiple cysts, malignant tumors of the ovary. Dysfunctions of the endocrine system predominate at the diencephalic level.
What is dangerous
In the absence of timely diagnosis of polycystic disease, treatment may be useless - serious health complications progress. You can not expect a successful conception, the real chances of getting pregnant from immature eggs are completely excluded. The patient not only has problems with the arrival of menstruation, potential complications with women's health are presented below:
- predisposition to type 2 diabetes;
- the development of cardiovascular pathologies against the background of an increase in cholesterol in the blood;
- endometrial cancer, malignant tumors of the walls of the uterus;
- endometrial hyperplasia;
- hyperandrogenism with a noticeable hormonal imbalance.
Symptoms
Therapy of polycystic disease begins with clarifying the symptoms and features of the pathological process to which the ovarian capsules are subject. In addition to the lack of long-awaited fertilization, polycystic ovaries are manifested by such changes in general well-being:
- irregular menstrual cycle;
- soreness with planned uterine bleeding;
- signs of increased hair growth of the skin of a woman;
- dysfunction of the adrenal glands;
- acne and acne;
- problems with the functioning of the ovaries;
- increased blood pressure.
How to identify polycystic ovaries
The woman draws attention to the fact that with visible health for a long time she is not able to successfully conceive a child. When follicles are formed, you can find out by ultrasound of the uterus, while eliminating the risk of development and growth of pathogenic neoplasms. It is urgent to undergo an ultrasound diagnosis in order to correctly and timely differentiate the disease. With polycystic syndrome, an integrated approach is required, which includes a number of laboratory studies and therapeutic measures.
Analyzes
Determines the specifics of the clinical picture, a blood test for the detection of luteinizing, follicle-stimulating hormone (FSH), DEA-sulfate, cortisol. It is important to identify sensitivity to testosterone, thyroxine, estrogen, insulin, 17-OH-progesterone, triiodothyronine and thyrotropin. This laboratory test helps to exclude such diagnoses with similar symptoms, such as:
- Cushing's syndrome;
- adrenogenital syndrome;
- hyperprolactinemia;
- hypothyroidism.
Signs of PCOS on ultrasound
Ultrasound and laparoscopy of the ovaries are informative diagnostic methods, implemented in a hospital. On the screen you can see a smooth capsule up to 5 - 6 cm long and 4 cm wide. Rendered as a suspicious blackout. The density of the ovarian capsule can be judged by the number of follicles in its cavity. Signs of an increase in the size of the ovaries, other already noticeable symptoms are not excluded.
Treatment of polycystic ovaries
Since the pathology is accompanied by unstable insulin resistance, it is required to treat polycystic disease with the participation of replacement therapy. Unauthorized actions of the patient are strictly prohibited. The disease is subject to conservative and surgical treatment at the discretion of a specialist, since in the first case a complete recovery is guaranteed by 50%. So, the conservative method involves hormonal therapy with the participation of the drug Metformin and contraceptives. The operation involves the process of removing the part of the ovary that synthesizes androgen.
Preparations
To restore the function of the pituitary and hypothalamus, it is required to take oral contraceptives with antiandrogenic properties for 2 to 3 months in the absence of pregnancy planning. It can be Janine, Jess, Regulon, Yarina tablets. Representatives of other pharmacological groups are also needed:
- Preparations for stimulating ovulation if you want to get pregnant: Duphaston, Clomid, Utrozhestan, Clomiphene. Hormonal pills are supposed to be taken according to a certain scheme for up to 4 months.
- Antiandrogens to block male hormones in polycystic: Veroshpiron, Flutamide. Preparations in the form of tablets with a diuretic effect, it is supposed to take up to 3 pills per day.
- Drugs to increase insulin sensitivity in polycystic: Glucophage, Metfogamma, Bagomet.
Operation
If the positive dynamics of conservative treatment is completely absent throughout the year, the doctor resorts to surgical intervention. Previously, it was laparoscopy (resection of the ovaries), but in modern medicine this method is considered obsolete, and the gynecologist recommends wedge resection and electrocoagulation. In the first case, small cysts can be removed with a medical instrument, in the second case, the surgeon acts with a needle electrode.
Diet
In the daily diet after the diagnosis, radical changes are coming. For example, the calorie content of food should not exceed 1800 - 2000 Kcal, while it is supposed to eat up to 5 - 6 times. The norm of carbohydrates is 45% of the total calories, while the concentration of proteins is not normalized. The ratio of animal and vegetable fats should be 1:3. Below are the products allowed for ovarian pathologies:
- fruits and vegetables, fresh herbs;
- skimmed dairy products;
- lean meats and fish;
- mushrooms, legumes, cereals.
Prohibited for polycystic products are as follows:
- fast food;
- bakery products;
- sweets;
- potato;
- fast food products.
Folk remedies
Do not exclude the presence in a particular clinical picture of treatment with folk methods. However, such therapy can only be auxiliary, should be discussed with the attending physician beforehand. Here are effective and publicly available recipes:
- Pour 80 g of boron uterus with 500 ml of vodka, insist in a dark place for 2 weeks. Take the finished composition inside 0.5 tsp. three times a day for 2-4 weeks.
- 100 g of green peeled walnuts need to be filled with 800 g of sugar, pour the same amount of vodka. It is necessary to insist on the composition for 2 weeks, take 1 tsp orally. for 3 weeks.
- Decoctions of nettle or milk thistle, prepared according to the recipe on the package, also provide a positive trend in polycystic disease. It is allowed to be treated in this way up to 2 - 4 weeks.
Pregnancy with polycystic ovaries
Women with such a health problem are interested in the question of whether it is possible to get pregnant with polycystic ovaries. Over the past decade, this has become a reality with the use of oral contraceptives for treatment, long-term hormone therapy, and ovarian stimulation. The patient's chances of becoming a mother are 1:1, and if the answer is negative after the treatment, it is worth continuing substitution therapy. After a successful conception, a woman should remain under strict medical supervision.
Video
The information presented on the site is for informational purposes only. The materials of the site do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.
Symptoms, causes and treatment of polycystic ovaries
Polycystic ovaries is a disease that is characterized by the appearance of a large number of cystic neoplasms in both ovaries at once. The diagnosis of PCOS (polycystic ovary syndrome) is one of the main causes of infertility. In this article, we will take a closer look at what PCOS is and how to treat it.
Features of the disease
The reproductive system of a woman functions due to the proper functioning of the endocrine glands (thyroid and adrenal glands), hypothalamus, pituitary gland and ovaries. In the event of a dysfunction of any of the above systems, the activity of the entire reproductive system is disrupted. The woman's body becomes more sensitive to infections and inflammation. Thus, not only a simple cyst of the corpus luteum can occur, but also many small cysts - polycystic.
Numerous cysts on the ovary can be either solitary or form entire "clusters". As a result, the maturation of the follicle is disrupted, and ovulation does not occur. Accordingly, conception becomes impossible.
According to statistics, polycystic ovary syndrome occurs in 5-10% of women of reproductive age. There are cases when the symptoms of PCOS appear in a teenage girl after the start of the first menstruation. The peak of the disease is 30 years. It is in women of this age that the signs of PCOS are pronounced, the disease progresses rapidly and requires immediate treatment. After 50 years, polycystic ovary syndrome most often does not occur.
PCOS after childbirth is not uncommon. This is explained by the fact that during pregnancy a woman completely changes the hormonal background for bearing a child. And after childbirth, the restructuring and restoration of the body takes place. It is at this point that polycystic ovaries can begin to develop, which is facilitated by an increase / decrease in estrogen, progesterone, androgens and an imbalance of male and female hormones. Many patients are concerned about the question of how to cure polycystic ovaries and whether it is possible to become pregnant with this diagnosis. In both cases, the answer is yes. However, you must follow all the doctor's recommendations.
Timely diagnosis and the appointment of competent treatment of polycystic ovary syndrome helps not only to get rid of the disease, but also to prevent the development of complications.
Origin factors
The causes of polycystic ovaries are not fully understood. However, modern medicine identifies a number of factors that contribute to the development of the disease.
Causes of polycystic ovaries:
- infections and prolonged inflammation of the uterine appendages (ovaries and fallopian tubes);
- overweight, obesity;
- abortion;
- diabetes;
- disruption of the endocrine glands;
- heredity;
- heavy labor activity;
- incorrect installation of the intrauterine device;
- injuries of the pelvic organs;
- hormonal disorders.
Treatment of polycystic ovaries consists not only in the removal of cysts and the removal of painful symptoms, but also in the mandatory elimination of the root cause of the disease. So what are the symptoms of polycystic ovary syndrome, and when is urgent medical attention needed?
Signs of the disease
Every woman has different symptoms of PCOS. Some patients experience aching, sometimes sharp pain in the lower abdomen. Others don't care at all. However, the first manifestations of pathology are considered to be:
- violation of the menstrual cycle;
- causeless increase in body weight;
- the appearance of hair on the body according to the male pattern (chest, face, abdomen).
If any of the above symptoms appear, a woman should think about the proper functioning of the body and consult a doctor.
There are also such signs of polycystic ovaries:
- lack of ovulation;
- discharge between periods;
- "daub" in the middle of the cycle;
- different duration of menstruation;
- frequent delays;
- an increase in the size of the appendages;
- aching pain in the lower abdomen;
- oily skin and hair, acne on the neck, shoulders or back;
- swelling of the mammary glands, the appearance of fibrocystic mastopathy;
- increased levels of insulin in the blood;
- chronic anovulation;
- inability to conceive a child for more than one year.
Thus, the causes of polycystic ovaries are diverse and quite easy to confuse with the symptoms of another disease of the pelvic organs. However, first of all, a woman should be alerted by unusual discharge and regular delays in menstruation. You can also measure BBT (basal temperature), which should increase in the second phase of the menstrual cycle. In polycystic ovary syndrome (PCOS), basal temperature does not change.
An ultrasound picture of the ovaries with polycystic
How to identify the disease
It is impossible to make a diagnosis of polycystic ovaries based only on the results of an ultrasound. This is explained by the fact that the clinical picture of this disorder can also be observed in a healthy woman, that is, an error is possible. In addition, quite often, polycystic disease of the right ovary is determined on ultrasound, but in fact, affecting one appendage, cystic neoplasms soon affect the other. Diseases that give similar echoes should also be excluded. These include hypothyroidism, Cushing's syndrome, hyperprolactinemia. That is why the diagnosis of PCOS includes:
- Gynecological examination;
- Collecting an anamnesis and determining all symptoms;
- Ultrasound of the pelvic organs;
- General analysis of blood and urine;
- Blood test for hormones (LH, FSH, T4, TSH, T3, etc.);
- Laparoscopy.
Only a complete interpretation of the above analyzes and examinations makes it possible to see changes in the size, structure and shape of the ovaries, their functionality, confirm / refute the disease and the possible risk of complications.
Treatment
Treatment for polycystic ovaries is long and multi-stage. Unfortunately, it is impossible to completely cure it. The task of the gynecologist is not only to restore the normal function of the appendages, but also to eliminate all the disorders that provoked this disease.
Initially, the doctor prescribes painkillers to relieve the symptoms of polycystic ovaries and treat the hypothalamic-pituitary system. Then it is necessary to establish the production of androgens by the appendages, eliminate excess weight and restore the menstrual cycle.
Polycystic ovary syndrome is treated conservatively and surgically. Based on the results of the tests, the pain of the symptoms and the desire of the woman to become pregnant, the attending physician chooses the most appropriate method of treatment.
Medical treatment
How to treat polycystic ovaries with conservative methods? First of all, you need to improve nutrition and lifestyle. There is even a special diet for polycystic ovary syndrome (PCOS), which consists in the exclusion of alcohol, coffee, fatty, fried, smoked and spicy foods. It is also recommended to do fasting days. The total number of calories is per day. Five meals a day. Polycystic ovary syndrome also requires the mandatory use of vegetables, fruits, herbs, fish, cottage cheese, kefir. You should give up sweets, flour products, honey.
If you are overweight or obese, physical activity is essential. These should be light exercises that do not cause discomfort to the patient.
As for medicines, the doctor prescribes not only painkillers, but also hormonal drugs. Oral contraceptives (birth control pills) restore the menstrual cycle and the endocrine system, eliminate hyperandrogenism. Some of them stimulate ovulation and promote the proper release of the egg. Such drugs as Janine, Marvelon, Yarina, Jess have proven their effectiveness in PCOS.
Wedge resection for polycystic disease
Surgery
How to treat polycystic ovaries with surgical methods? There are two ways to do this:
- wedge resection. Damaged tissues are removed, including the capsule and stroma. Helps restore ovulation and reduce androgen production.
- Coagulation. The doctor makes notches on the ovarian capsule and cauterizes the cysts. This method is considered the most gentle.
The surgery is performed laparoscopically. The operation is performed only if conservative methods of treatment do not give the desired result or the patient begins to develop endometrial hyperplasia.
Alternative treatment
Unfortunately, many women do not trust modern medicine and current doctors in particular. Therefore, there are a lot of those who are interested in whether it is possible to cure polycystic ovaries with folk methods.
The ineffectiveness of folk remedies for PCOS has long been proven. However, women still continue to take herbal infusions and herbal teas. Yes, some herbs perfectly relieve painful symptoms, contribute to the reduction and self-resorption of a single cystic formation (for example, an ovarian corpus luteum cyst). These include the upland uterus and the red brush. But! With multiple cysts, folk methods are powerless, and in combination with hormonal therapy, they can even lead to irreparable consequences. That is why only a competent specialist will tell you how to treat polycystic ovaries and what kind of nutrition is needed.
What threatens PCOS?
If there is no proper treatment or a woman does not adhere to all doctor's prescriptions, the consequences of polycystic ovaries will not be long in coming. In addition to the appearance of body hair, oily skin, acne and weight gain, PCOS contributes to the development of a host of diseases.
Why is polycystic ovaries dangerous? First of all it is:
- infertility;
- adhesive processes in the pelvic organs;
- hypertension, stroke;
- endometriosis;
- endometrial cancer;
- cervical cancer;
- mastopathy and breast cancer.
If a polycystic transformation of the appendages is detected during pregnancy, the expectant mother is in danger of:
- severe pregnancy;
- spontaneous abortion (miscarriage) in the early stages;
- premature and difficult births (earlier weeks);
- late toxicosis;
- pregnancy diabetes.
Thus, it is important for a woman to know the manifestation of the disease, what it is and how to treat PCOS. Early diagnosis and proper treatment will help minimize possible complications and prevent infertility.
Polycystic ovaries is an endocrine disease that manifests itself in functional and structural lesions of the ovaries, leading to infertility in women. The mechanism of development of this syndrome is not fully understood. It is believed that there is a failure in a complex chain of neurohumoral processes from the hypothalamic-pituitary system to the peripheral endocrine glands.
Any cause that disturbs the pituitary-ovarian relationship leads to a breakdown in the biosynthesis of steroids in the ovary. The formation of estrogens slows down, the level of androgens rises. Hormonal imbalance prevents the maturation of the egg, the follicle does not burst, the egg does not come out of it, and ovulation does not occur. The egg dies, the follicle remaining on the surface of the ovary is filled with fluid. Over time, a cyst forms in its place.
With a long course of this process, the ovaries undergo significant structural changes. Under the influence of androgens, the ovarian membrane thickens, multiple cysts, foci of sclerosis in the medulla and cortical layer are found in the hypertrophied stroma. The ovaries are enlarged in size by 2-5 times compared to the norm.
Forms of polycystic ovaries
According to the 1997 classification, there are
Primary (true)
It manifests itself in girls in the puberty period after the onset of menarche (the first menstruation). The menstrual cycle is not established for a long time. Menstruation is characterized by acyclicity, occurs after 3-5 months. Duration varies or less than 3 days or more than a week. Often disturbed by pulling pains in the lower abdomen. The menstrual flow itself is scanty - oligomenorrhea, or occurs in the form of bleeding - hemorrhages, due to hyperplasia of the uterine endothelium.
The first signs go unnoticed, as it is mistakenly considered normal that the girl's menstrual cycle does not improve immediately. But as the girl grows older, the symptoms do not go away, but intensify. Characteristic signs: violation of the menstrual cycle, primary infertility (due to the lack of ovulation), hirsutism.
The transferred infectious diseases (ARVI, tonsillitis), stresses can provoke the disease. The hereditary factor also plays a role.
Secondary
A synonym for polycystic ovary syndrome is Stein-Leventhal syndrome, named after the doctors who first described it.
It is diagnosed in overweight women over 35 years of age, usually on the background of insulin resistance. Due to the reduced sensitivity of cells to insulin, which promotes the utilization of glucose, the level of glucose in the blood rises. The pancreas begins to produce even more insulin, which leads to hyperinsulinemia. Elevated levels of insulin in the blood activates the production of luteinizing hormone and androgens by the pituitary gland in the ovaries. The growth and development of the follicle is interrupted, ovulation does not occur.
As a result of androgen hypersecretion in women, hypertrichosis (excessive hair growth) is noted on the thighs, shins, inguinal region and hirsutism (hair growth in places uncharacteristic for women): "antennae", sideburns, on the mammary glands, on the white line of the abdomen. The sebaceous glands produce an increased amount of sebum. As a result, acne appears on the face, back, and arms. On the scalp - oily seborrhea. There is hyperpigmentation on the neck, under the breasts, on the elbows, in the groin area.
The emotional state of a woman changes from increased nervousness and irritability to apathy, depression.
The insidiousness of this disease lies in the fact that the symptoms increase gradually. Extra pounds, oily skin and "antennae" above the upper lip are regarded by a woman as an unfortunate defect in appearance. And it is possible to diagnose polycystic ovaries only with an unsuccessful attempt by a woman to conceive a child. A.
Causes of the development of polycystic ovaries
- Hypersecretion of androgens
- hereditary predisposition
- Obesity
- stress
- Chronic infections
- Pathology of pregnancy and childbirth
- Violations in the neurohumoral regulation of the hypothalamic-pituitary system
- insulin resistance
Treatment
The pathogenesis of polycystic ovaries is very complex. The process of ovulation of the egg is regulated by a dozen hormones and enzymes produced in the brain (in the hypothalamus and pituitary gland) and in the peripheral endocrine glands (in the ovaries, adrenal glands, pancreas). The answer to the question of how to cure polycystic ovaries is puzzled by medical scientists around the world. Polycystic ovaries is such a complex disease that it is treated by doctors of many specialties: gynecologists, endocrinologists, nutritionists, cosmetologists, surgeons.
How to treat polycystic ovaries, the doctor decides individually for each woman, depending on age, form of the disease, severity of symptoms, examination results.
Survey
Violation of the menstrual cycle, infertility, symptoms associated with hormonal imbalance, are also manifested in other diseases.
Differential diagnosis is carried out with tumors of the pituitary gland, ovaries, adrenal glands, hypothyroidism, adrenogenital syndrome.
The survey plan includes
1 Medical history. It is important to clarify the beginning of the menarche, the features of the menstrual cycle, the onset of sexual activity, the presence of pregnancies (how they ended), abortions, miscarriages. Information about past diseases and heredity (facts of diseases of the genital area in relatives along the female line), diseases of other endocrine organs are important. 2 Inspection. The appearance of the patient is assessed: the presence or absence of obesity, hypertrichosis, oily skin with acne, age spots under the breast, on the neck, in the groin. Measured weight, height, volume of the abdomen. The height-weight index is calculated. 3 During a gynecological examination, the doctor evaluates whether the external genitalia, the condition of the cervix, the nature of the vaginal discharge are properly developed, determines the pain on palpation of the enlarged ovaries. 4 Ultrasound examination of the pelvic organs. Now a special transvaginal sensor is used. This highly informative method allows you to identify structural changes in the ovaries, characteristic of polycystic disease - an increase in volume, thickening of the outer capsule, altered follicles (cysts). 5 If necessary, in case of combined pathology (tubal infertility, endometriosis), if a tumor of the uterus, ovaries is suspected, laparoscopy is used - the introduction of a telescopic tube into the abdominal cavity connected with a cable to a computer. On the monitor, the doctor sees the state of the pelvic organs. 6 If mastopathy is suspected, ultrasound of the mammary glands, mastography, thermography are performed.Blood for hormones: estrogen, testosterone, prolactin, follicle-stimulating hormone, luteinizing hormone, thyroid hormones.
Biochemical blood test: glucose, lipids (triglycerides, cholesterol).
8 In urine, the level of 17 ketosteroids (androgen metabolism products) is determined.The tactics of treatment is determined by the age, dominant symptoms and plans of the patient. For a teenage girl, the correction of the menstrual cycle, the fight against acne and excessive hair growth come to the fore. A woman with infertility to regain the ability to conceive.
Treatment objectives
- Weight normalization
- Restoration of the menstrual cycle
- Stimulation of ovulation
Doctors consider normalization of weight as a necessary component of treatment. Often, only by reducing body weight by 10-15% can a woman restore a normal menstrual cycle.
Principles of building a diet
A diet is not a temporary event, which, upon reaching the desired goal - the birth of a child, can be abandoned, but a way of life.
Nutrition should be low-calorie (up to 2000 calories per day), balanced in key nutrients: proteins, fats, carbohydrates, vitamins, macro-microelements.
Vegetable proteins account for two thirds, animal proteins one third.
Fats are also preferable to vegetable (sunflower, corn, olive oil). Animal fats are limited.
Eating fractional 5-6 times a day.
Boil food, bake, stew, steam.
The diet of patients with polycystic ovaries includes: lean meats, fish, cottage cheese, eggs, dairy products, cereals (oatmeal, buckwheat, pearl barley), vegetables (tomatoes, cucumbers, cabbage, peppers, zucchini, eggplant, radishes, beans, peas, onions, garlic, green crops), fruits (apples, pears, plums, cherries, pomegranates, cherry plums and others). Rye bread, whole grain bread, bran bread. From drinks, weak tea, coffee, dried fruit compotes, berry mousses without added sugar.
Smoked meats, sausages, all types of canned food, sweet pastries, sugar, cakes, ice cream, chocolate, sweet carbonated drinks, alcohol are prohibited. Limit consumption of spicy, salty foods.
Combine the diet with physical exercises - brisk walking, swimming, exercise bikes, fitness classes.
Medical treatment.
How to treat polycystic ovaries in women who are not planning a pregnancy? The goal of treatment is to normalize the menstrual cycle and reduce the risk of complications.
With an increased level of insulin in the blood, metformin hydrochloride is prescribed. The mechanism of hypoglycemic action consists in the processing of sugar in muscle tissue, a decrease in glucose absorption in the small intestine, and a decrease in appetite. Numerous studies have reliably shown the effectiveness of metformin not only for the correction of carbohydrate metabolism, but also for the restoration of reproductive function in women.
To normalize the hormonal background, estrogen-progestin preparations are used, which are part of the group of combined oral contraceptives. They contain synthetic hormones - estrogen and progesterone. The mechanism of action is reduced to the suppression of the formation of neurohormones in the hypothalamus, which in turn inhibit the gonadotropic function of the pituitary gland. At the same time, estrogen synthesis decreases in the ovaries. The result is a lack of ovulation. Commonly used drugs: zhanin, yarina, diane-35. Diane-35 contains an antiandrogenic component, which reduces the symptoms of hirsutism, acne, seborrhea.
The course is from 6 months to a year. To suppress the androgenic action, they resort to the appointment of veroshpiron, flutamide.
With the normalization of the menstrual cycle and the desire of a woman to conceive a child, they proceed to the main stage - ovulation stimulation. Assign a drug from the group of gonadotropin stimulants - clostilbegit. Various schemes are selected individually. Usually from days 5 to 9 of the cycle 50 mg per day. Acceptance for at least 3 months. In the absence of effect, the dose is increased to 200 mg per day. Ultrasound control after 5-7 days. If the dominant follicle reaches the required size, chorionic gonadotropin is prescribed, which contributes to the rupture of the follicle and the release of a mature egg from it. During this period, an active sex life is necessary for conception.
In the early stages, it is impossible to understand whether conception has occurred, therefore, progesterone, duphaston, and utrozhestan are used to maintain vital activity and the proper functioning of the corpus luteum. If after 2-3 weeks there are no signs of pregnancy on ultrasound, increase the dose of the drug that was used to stimulate or switch to others: gonal, menpur, menogon.
If conservative treatment fails, surgery is indicated.
Surgery
Wedge-shaped, subtotal resection of the ovaries, decortication of the ovaries and other surgical operations are now practically not used due to the development of postoperative complications in the form of adhesions in the small pelvis, which leads to infertility.
Polycystic ovaries are treated surgically with a minimally invasive technique using laparoscopy. Methods of influencing the ovaries with an electric current or a laser have been developed and successfully applied: electrocoagulation, thermovaporization, decapsulation of polycystic ovaries.
The goal of surgical treatment is to establish gonadotropic secretion by reducing the tissues of the polycystic ovary and incision of the thickened ovarian capsule, which interferes with the release of a mature egg.
The operation performed increases a woman's chance of becoming pregnant within 4-6 months. But this effect is short-lived, often surgery leads to a rapid fading of ovarian function.
Conclusion
To the question of how to treat polycystic ovaries, specialists involved in the study of this problem unequivocally answer - as early as possible. Unfortunately, it is impossible to completely get rid of this disease, but it is possible to restore a woman's reproductive function, normalize hormonal levels, and minimize appearance defects (obesity, excessive hair growth, oily skin).
The main thing is to prevent complications that may occur in the chronic and progressive course of the disease. Obesity insulin resistance can cause type 2 diabetes. Violations of lipid metabolism in the form of high levels of triglycerides and cholesterol in the blood lead to atherosclerosis, which increases the risk of heart attacks and strokes by several times.
- this is an increase in the gonads due to cystic atresia of the follicles. It is one of the signs of polycystic ovary syndrome and is often used as a synonym for this pathology. Other symptoms of the disease include menstrual and reproductive disorders, signs of virilization, and obesity. The diagnosis is based on anamnesis data, the results of a general and gynecological examination, ultrasonography, and hormonal analysis. Treatment is complex, including correction of metabolic and endocrine disorders, wedge resection or ovarian cauterization.
ICD-10
E28.2 Polycystic ovary syndrome
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General information
The term "polycystic ovaries" can be interpreted as an ultrasound sign, polycystic changes in the gonads, which are observed in the norm or in a number of pathologies, or as a specific disease - polycystic ovary syndrome (PCOS, PCOS, scleropolycystosis). Its historical name is Stein-Leventhal syndrome, after the Chicago gynecologists who most clearly described the symptoms of the classic form of the disease in 1935. Polycystic disease is detected by ultrasound at 16-30 years old, the incidence is up to 54% among women of childbearing age. Scleropolycystosis is registered in 5-20% of women.
Causes
Common causes of asymptomatic transient polycystic ovaries (multifollicular gonads), which is the norm, are stress, exercise, and taking hormonal contraceptives. The provoking factors of secondary polycystosis that have arisen against the background of known diseases are different and are associated with the mechanism of development of these pathologies. The etiology of PCOS is poorly understood. It is assumed that in 80% of the causes are congenital, in 20% - acquired. Possible risk factors:
- Exogenous: infectious and inflammatory diseases suffered in childhood and puberty (chronic tonsillitis, childhood infections, chronic inflammation of the internal genital organs), TBI (concussion, bruises, concussions), prolonged psycho-emotional stress (information stress, increased study load).
- Endogenous: adverse effects on the fetus (androgens, epigenetic factors, the consequences of the pathological course of pregnancy or childbirth), low birth weight, congenital genetically determined defect in the enzymatic systems of the gonads.
A special role is given to hereditary predisposition. There are cases of familial scleropolycystosis. There is a high probability of pathology in women whose mothers or sisters suffer from this disease. The genetic risk of having a daughter with a tendency to PCOS in a sick mother is aggravated due to another reason - the fetus develops with an excess of testosterone. A risk factor for male inheritance is early baldness in male blood relatives.
Pathogenesis
Polycystic ovaries are characterized by the accumulation of immature follicles due to anovulation. With random anovulatory cycles, such "cysts" resolve over time without consequences, with regular ones they provoke the development of pathology. The pathogenesis of PCOS has not yet been elucidated, and there are several theories on this subject. The primary defect in the feedback mechanism may come from the hypothalamic-pituitary system, ovaries, adrenal glands.
Desynchronization of the functions of the endocrine glands leads to an increased synthesis of androgens by the gonads without their further aromatization into estradiol, the absence of ovulation (as a result, to infertility), progesterone deficiency, polycystic changes in follicles, and thickening of the ovarian capsule. Androstenediol is aromatized by adipose tissue and adrenal glands to estrone, and relative hyperestrogenism occurs, leading to endometrial hyperplasia.
In the blood, the level of free testosterone rises, the result of hyperandrogenism is virilization. Hyperglycemia, which has developed as a result of insulin resistance, exacerbates the imbalance, contributing to increased synthesis of ovarian androgens, impaired testosterone binding, which further increases the level of this hormone and estrone.
Classification
By origin, polycystic ovaries are classified as primary (PCOS) and secondary (associated with known nosological forms). Scleropolycystosis is divided into two forms - with obesity and with normal or reduced body weight. In addition, there are 4 phenotypes of PCOS, which are based on symptoms that are diagnostic criteria (ESHRE / ASRM, 2007):
- Phenotype A (classic). The combination of hyperandrogenism with anovulation, polycystic. The frequency of occurrence is 54%.
- PhenotypeB(anovulatory). With hyperandrogenism, ovulatory dysfunction, without polycystic disease. The prevalence is 29%.
- PhenotypeC(ovulatory). Hyperandrogenism and polycystic. The frequency of occurrence is 9%.
- PhenotypeD(non-androgenic). Anovulation and polycystic. The occurrence is 8%.
Symptoms of polycystic ovaries
Transient cystic changes usually occur without external signs. With scleropolycystosis, symptoms can appear from menarche, less often against the background of an established cycle. In 85% of women, menstrual disorders are noted: first, proiomenorrhea alternates with opsomenorrhea, acyclic bleeding, hypo- and oligomenorrhea is recorded. Then the intervals between bleeding lengthen, hypomenstrual syndrome and amenorrhea develop.
A few years after the onset of menstruation, hirsutism occurs, skin symptoms of hyperandrogenism: seborrhea, acne. Obesity develops in 30-40% of patients. Persistent anovulation leads to infertility. In 10-15% of patients, spontaneous pregnancy may occur, which most often ends in miscarriage. There may be symptoms such as galactorrhea, psycho-emotional and vegetative-vascular disorders, similar to menopausal syndrome.
Complications
The most formidable complication of untreated scleropolycystosis is hormone-dependent endometrial cancer, which develops in 19-25% of patients. Other long-term effects include various types of cerebrovascular insufficiency (the risk increases by 2.8-3.4 times), glucose tolerance, which occurs in 40% of patients after 40 years and progresses in half of them to type 2 diabetes mellitus over six years .
For patients of reproductive age, obstetric complications are typical - gestational diabetes mellitus, preeclampsia, preterm birth (the risk of these pathologies increases threefold, fourfold and twofold, respectively). The risk of perinatal mortality increases threefold. Some methods of treating the disease often lead to complications: after the induction of ovulation, ovarian hyperstimulation syndrome develops, surgery entails tubal-peritoneal infertility.
Diagnostics
Polycystic ovaries as a morphological change is not a diagnosis, but a sign of a possible pathology. The diagnosis is established by a gynecologist with the participation of an ultrasound diagnostician, an endocrinologist. The following symptoms indicate PCOS (at least two are required): laboratory or visual signs of hyperandrogenism; oligo- or anovulation; polycystic changes. Diagnostic methods include:
- Clinical examination. During a conversation with the patient, a general examination, scleropolycystosis can be assumed by complaints of menstrual irregularities and infertility, the presence of PCOS in close relatives, an increased body mass index, virilization (hirsutism, hypertrichosis, oily, acne-prone skin). Gynecological examination - enlarged ovaries.
- Ultrasonography. With transvaginal ultrasound of the ovaries, polycystic disease is characterized by an increased (over 9-10 cubic cm) volume of the gonads; enlarged (2-10 mm) atretic follicles (more than 10) located under the thickened capsule without dominant; hyperplastic (up to a quarter of the total volume) stroma. Folliculometry detects less than 6 ovulations per year.
- Laboratory research. With androgenemia, hormone analysis confirms an increase in the level of luteinizing hormone and its ratio to follicle-stimulating hormone (more than 2.5), an increase in the free testosterone index. Concomitant insulin resistance is indirectly evidenced by the results of a biochemical blood test - an increase in triglycerides, a decrease in HDL, hyperglycemia.
Additionally, a biochemical blood test, hysteroscopy with endometrial biopsy, ultrasound of the adrenal glands, thyroid gland, radiography or MRI of the Turkish saddle are prescribed. Some clinicians recommend distinguishing polycystic ovaries on ultrasound from multifollicular ovaries, which are characterized by smaller "cysts", an unchanged capsule and stroma, normal volume, and an echogenic structure of the gonads. Such changes are often a variant of the norm.
Primary polycystic ovaries should be differentiated from secondary, the most common causes of which are congenital pathologies (adrenogenital syndrome, congenital adrenal hyperplasia), neuroexchange-endocrine syndrome, Itsenko-Cushing's disease, as well as virilizing tumors of the ovaries and adrenal glands. To exclude the tumor process, it may be necessary to consult an oncogynecologist, an oncourologist.
Treatment of polycystic ovaries
The choice of treatment tactics depends on the cause that caused this condition, and the existing symptoms. Polycystic ovaries, which does not manifest itself in any disorders, does not require treatment. In secondary polycystosis, a correction of disorders caused by the underlying disease is prescribed. Therapeutic measures for PCOS are determined by the clinical picture of the pathology.
Conservative therapy
Treatment of PCOS includes several stages, aimed at normalizing metabolic disorders, restoring the ovulatory cycle and generative function, eliminating endometrial hyperplastic processes and manifestations of hyperandrogenism. First of all, the metabolic syndrome and endometrial hyperplasia (if any) are treated, then, if the patient wants to have children, they begin to induce ovulation.
- Correction of metabolic disorders. All obese patients are recommended to modify their lifestyle - physical activity, a diet with a restriction of spicy and salty foods, liquids - up to 1.5 liters per day. The calorie content of the daily diet is up to 2,000 kcal, 52% of the calories should come from carbohydrates, 16% from proteins, 32% from fats, two-thirds of the latter are unsaturated. With insulin resistance, hyperinsulinemia, insulin sensitizers are prescribed.
- Therapy for endometrial hyperplasia. In case of obesity, recurrent hyperplastic processes, adenomyosis, the use of gestagens is preferable, with normal body weight and initially detected hyperplasia - estrogen-gestagens. Drugs can be administered in a cyclic or continuous regimen. Adenomyosis is also treated with GnRH analogues.
- Treatment of infertility. Not the most effective, but the safest method is the use of estrogen-progestin drugs (the “rebound effect” after their cancellation can lead to ovulation). With anovulatory infertility, ovulation induction is carried out with clomiphene, letrozole, in case of their inefficiency, with gonadotropic drugs. For the onset of pregnancy, IVF technologies can be used.
- Treatment of hirsutism and acne. To eliminate the external manifestations of hyperandrogenism, hormonal contraceptives (orally, in the form of patches or vaginal rings) spironolactone are used. Preference is given to combined hormonal preparations without androgenic action or with antiandrogenic effect. To increase the cosmetic effect, laser and photoepilation are used.
Surgery
In most cases, only surgical treatment can restore menstrual and reproductive function. Interventions on the ovaries are carried out by laparoscopic access, which minimizes the risk of adhesions. Surgical treatment for recurrent endometrial hyperplasia is also prescribed for women who do not plan pregnancy.
- Ovarian drilling. Destruction by a point electrode of hyperplastic stroma. It is used to stimulate ovulation with a slight increase in the gonads. Includes various techniques - electro-, laser-, diathermocauterization. The disadvantage of the method is the relative short duration of the therapeutic effect.
- wedge resection. Excision of the wedge-shaped area, including the cortical and medullar layers. It is performed to induce ovulation with a pronounced enlargement of the ovaries or to prevent recurrence of endometrial hyperplasia. The disadvantage is a decrease in ovarian reserve, early or premature menopause is possible.
The success of the surgical intervention is evidenced by the restoration of ovulatory function in the first weeks after the operation. If ovulation does not occur within two or three cycles, drug stimulation is performed. Pregnancy usually occurs within 6-12 months. The probability of a favorable outcome decreases in direct proportion to the time since the operation.
Relapse Prevention
Existing methods of treatment of polycystic ovary syndrome most often do not allow to achieve a stable cure. The reason is the impossibility of eliminating the main pathogenetic links of the disease. Symptoms and structural ovarian changes recur within five years of surgery, necessitating supportive care.
To regulate the menstrual cycle, prevent endometrial hyperplasia, hirsutism and hyperandrogenic dermatopathy on an ongoing basis until menopause, patients are prescribed combined hormonal contraceptives or gestagens in the second phase of the cycle. This tactic also contributes to the preservation of reproductive function in some patients.
Forecast and prevention
With polycystic ovaries, the prognosis for life is favorable in the absence of malignant transformation of the endometrium. The prognosis of the implementation of the reproductive function depends on how early the treatment was started, what reasons underlie the pathology. Thus, infertility treatment is most effective in the absence of viril and metabolic syndrome, pronounced hypothalamic-pituitary disorders.
Primary and secondary prevention of polycystic ovaries is to combat obesity, timely detection and correction of hypothalamic-pituitary, adrenal, ovarian dysfunction. Women suffering from PCOS are at high risk of developing uterine cancer, therefore they are subject to dispensary observation, including control studies (ultrasound, hysteroscopy, and, if necessary, therapeutic and diagnostic curettage of the endometrium).
What it is?
Polycystic ovaries is a violation of the normal functions of the ovaries in combination with cystic degeneration. The disease can be found under a different name - polycystic ovary syndrome - a more capacious definition, as it combines several symptoms that form this pathology.
In the medical literature, there are other definitions: ovarian sclerocystosis (due to sclerotic changes in the ovarian capsule) or Stein-Levintal syndrome (according to the names of the authors who first described this syndrome).
Causes of the development of polycystic ovaries
It is currently impossible to name the exact causes that contribute to the development of polycystic ovaries. The disease is a syndrome in which changes are found in several organs of the endocrine system: pancreas, adrenal glands, ovaries, pituitary gland and hypothalamus.
The main value is given to the hormone - insulin, produced by the pancreas. Often, women with polycystic ovaries have male-type obesity. Adipose tissue is insensitive to insulin and the pancreas is forced to produce the hormone in large volumes.
Insulin stimulates the ovaries to produce androgens, which leads to a violation of the main function of the ovaries - to produce an egg capable of fertilization.
Also, the development of polycystic ovaries can occur with disorders in the hypothalamic-pituitary system. This system regulates the production of follicle-stimulating and luteinizing hormones (FSH and LH), which promote the growth and development of follicles in the ovary and the onset of ovulation.
The concentration of hormones should be in a certain ratio, with an increase in the amount of LH, the ovaries produce male sex hormones, which inhibits ovulation.
During puberty, it can occur, then the girl's adrenal glands begin to produce more androgens than necessary. This inhibits the normal functioning of the ovaries.
Particular attention is paid to the hereditary factor. Although there is no 100% certainty in this, nevertheless, in families where close relatives of a woman suffered from polycystic disease, the risk of the disease is very high.
With aggravated heredity in the family, girls who have entered puberty should be carefully examined. With early diagnosis of the syndrome, the chances of recovery are much greater.
Signs and symptoms of polycystic ovaries
Symptoms of polycystic ovaries are very diverse and may resemble manifestations of other diseases. A feature is the fact that the presence of all the symptoms at once is not at all necessary for one woman.
Signs of polycystic ovaries may be invisible for many years. Most often, a woman learns about her diagnosis only at the moment when she plans to become a mother.
The main symptom of polycystic ovaries that makes you see a doctor is the inability to become pregnant.
The most common such causes and additional symptoms of polycystic ovaries:
1. The menstrual cycle is unstable. Violations begin to appear from the moment of the onset of menstruation: an irregular cycle with meager periods or vice versa, with prolonged bleeding.
Often, menstruation may be completely absent for several months. Due to hormonal imbalance, the endometrium of the uterus increases in thickness, but monthly rejection does not occur or occurs with a delay.
2. Pain in the abdomen. The pain symptom may be permanent. This is explained by an increase in the ovaries and pressure on the pelvic organs.
3. Increase in body weight. The sign is unstable, but is noted in many women. Obesity is typical of the "apple" type - the bulk of the fat is located in the abdomen and waist.
Obesity is associated with excessive production of insulin - insulin increases appetite, a constant feeling of hunger does not leave a woman. Due to a sharp increase in weight, stretch marks (stretch marks) appear on the skin of the body.
4. The appearance is changing. The appearance of acne on the skin is noted, the hair and skin are of a greasy type, oily dandruff is often detected. Girls and women find increased hairiness on the body in the genital area, on the legs.
Above the upper lip, the so-called female antennae make their way. On the head, on the contrary, focal hair loss (alopecia) can occur with the formation of bald patches. These changes indicate an increased production of male hormones.
5. It is marked by increased pigmentation of the skin on the back, in the armpits.
6. On the part of the nervous system, irritability, drowsiness, mood swings, i.e., signs resembling PMS, can be observed.
Can you get pregnant with polycystic ovaries?
Polycystic ovaries and pregnancy, at first glance, the phenomenon is not feasible. But it's not. With timely treatment and compliance with preventive measures, a long-awaited pregnancy can occur.
A woman needs to learn to be patient, not to violate the plan of action prescribed by the doctor. It may take months or even years, but the result is worth it.
The treatment is aimed at the maturation of a full-fledged egg and its exit towards spermatozoa for a long-awaited meeting and the birth of a new life.
Throughout pregnancy and at the time of childbirth, a woman is under the close attention of doctors. It should be remembered that the very fact of pregnancy is not the result. With polycystic ovaries, pregnancy can end unsuccessfully - the risk of miscarriages, fetal fading and premature birth in women with this diagnosis is several times higher.
There is also a high risk of exacerbation of extragenital diseases. Especially often in pregnant women with polycystic diabetes develops.
Diagnosis of polycystic ovary syndrome
Diagnosis of polycystic ovaries is a complex process. This is a whole complex of studies on the basis of which a diagnosis is made or refuted.
- The main criterion is infertility, due to rare ovulation or their complete absence. Women unsuccessfully attempt to get pregnant, years go by, but pregnancy does not occur.
- The second important indicator is the quantitative determination of female and male sex hormones in the blood serum. Clinically, signs of an increase in androgens may not always appear, while their increase may be detected in a laboratory study. It is also necessary to pass tests for glucose and cholesterol.
- With a two-handed examination, the gynecologist can feel the enlarged ovaries, dense to the touch.
- Ultrasound will help to see the structure of the ovaries. The doctor reveals the following ultrasound signs: the ovaries are enlarged, small follicles are visualized along the periphery of each, in an amount of more than 10 pieces.
- Sometimes a laparoscopy may be done. This examination is carried out using a laparoscope, which is inserted through a small hole in the abdominal wall. The laparoscope is able to examine the appearance of the ovaries: they are enlarged, their surface is covered with a white capsule, there are no signs of egg release on the surface of the capsule (point breaks). Laparoscopy allows you to take a piece of tissue for histological examination during the study, and is also one of the methods for treating polycystic ovaries.
The diagnosis is made only on a combination of several signs (infertility, an increase in androgens and associated symptoms are considered the main ones).
None of the signs in a single manifestation can confirm the disease.
Treatment of polycystic ovaries, drugs
Treatment of polycystic ovaries can take place with the involvement of several specialists at once: a gynecologist (or rather a narrow specialist gynecologist-endocrinologist), an endocrinologist and a nutritionist.
Conservative treatment methods:
- Hormonal contraceptives. Help restore the cycle and avoid the development of endometriosis. Some drugs have an antiandrogenic effect (they fight acne and excess body hair). This method is not suitable for women who dream of becoming pregnant.
- Drugs that stimulate ovulation.
- Antiandrogenic agents. This is a group of drugs that reduce the amount of male hormones.
- Drugs for the treatment of diabetes mellitus. Usually, this role is played by the drug metformin, which, in addition to regulating insulin production, contributes to weight loss.
- Diet. For some women, it is enough to lose weight so that insulin levels return to normal and ovulation occurs. Therefore, diet therapy plays an important role in the treatment of polycystic ovaries. The diet for polycystic ovaries is aimed at eliminating a large amount of fat and carbohydrates. Be sure to combine diet with exercise.
Operational treatment:
- Minimally invasive surgery - laparoscopy. With the help of a laparoscope, a thick capsule of the modified ovaries is incised to facilitate the release of eggs.
- Sometimes surgery is performed to remove part of the affected ovary. This is the most extreme measure and has recently been carried out less and less.
Complications of polycystic ovaries
In addition to the inability to conceive, PCOS has long-term complications.
- Uterine cancer. Irregular periods or prolonged absence contribute to the fact that the inner lining of the uterus (endometrium) gradually thickens, since its monthly desquamation does not occur. Endometrial cells first change their size and shape (), and then can degenerate into malignant ones.
- The development of obesity and diabetes mellitus due to insulin resistance of the body.
- Diseases of the heart and blood vessels due to high cholesterol levels (heart attacks and strokes).
Prevention
Prevention of recurrence of the disease is reduced to the constant maintenance of normal weight. Even after successful treatment, which ended in the birth of a child, it is necessary to maintain a diet for the rest of your life. At any time, polycystic ovaries can reappear.
- this is a severe chronic disease of the reproductive sphere, in which, due to pathological changes in the structure of the female gonads, it does not occur and occurs. However, the impossibility of conceiving a child is only the “tip of the iceberg”, polycystic ovaries entails serious hormonal and metabolic disorders, and also does not affect the appearance of a woman in the best way.
Polycystic ovaries: causes of development
Normally, 5-6 follicles with eggs grow in the ovary of a healthy woman every month, however, only the one that contains the most viable egg cell matures and bursts during ovulation. All other follicles under the influence of hormones are amenable to reverse development. If the hormonal balance is disturbed (androgens are also released in excess, but insufficiently synthesized), immature follicles, instead of being absorbed, are converted into. From cycle to cycle, the number of these cysts increases, so over time, the ovaries are almost completely covered with them. This is polycystic.
The exact cause of polycystic ovaries is currently unknown. However, scientists believe that the following factors play a role in this process:
- Decreased tissue sensitivity to insulin and compensatory hyperproduction of this hormone by the pancreas. Under the action of insulin, the female gonads begin to actively synthesize estrogens and androgens, which is manifested by a violation of ovulation.
- Failure in the hypothalamic-pituitary regulation of the functioning of the female reproductive system.
- Inflammatory.
- Dysfunction of the adrenal cortex, which synthesizes androgens.
Polycystic ovary syndrome occurs in both adolescent girls and adult women who have given birth. The impetus for the development of the disease can be a strong, severe infectious disease, an autoimmune process, a sharp change in climate.
Symptoms of polycystic ovaries
Due to the fact that numerous pathological changes occur in the body of a woman with polycystic ovaries, the clinical picture of the disease in question can be very different both in terms of the set of clinical signs and their severity. For example, some patients may not even be aware of their condition until they begin to actively search. In others, on the contrary, the symptoms are so pronounced that women seek medical help immediately after the first signs of the disease appear.
The main symptoms of polycystic ovaries include:
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In addition, in the course of laboratory and instrumental studies, signs characteristic of polycystic ovaries are also revealed:
- According to ultrasound - an increase in the sex glands in size by 2-3 times, visualization of cysts, thickening of the endometrium.
- According to laboratory tests - an increased concentration of androgens, estrogens, insulin, luteinizing hormone and other pathological changes
Consequences of polycystic ovaries
Polycystic ovaries is a very insidious disease, which, in addition to infertility, entails a lot of undesirable consequences for a woman's health. In particular, it has been proven that patients with polycystic disease are at an increased risk of developing the following conditions:
- Endometrial hyperplasia and uterine cancer.
- Cardiovascular diseases (,).
Diagnosis of polycystic ovaries
The plan for examining a woman with suspected PCOS should include:
![](https://i1.wp.com/okeydoc.ru/wp-content/uploads/2016/10/23028792-1-300x300.jpg)
The diagnosis of polycystic ovaries is based on the presence of at least two of the following criteria in a woman:
- Violation of the menstrual cycle and lack of ovulation (as a result, the inability to become pregnant).
- Clinical or laboratory evidence of overproduction of male sex hormones.
- Signs of polycystic ovarian changes obtained by ultrasound scanning.
Thus, ultrasound alone is not enough to make a diagnosis (unfortunately, many women are diagnosed with PCOS in this way). The ultrasound picture of the disease in question can be confused with the picture of multifollicular ovaries - an ailment that has significant differences from true polycystic disease.
Methods for the treatment of polycystic ovaries
It is almost impossible to completely cure polycystic ovaries. Gynecologists can only minimize the manifestations of the disease and thus help a woman achieve her main goal (this is, as a rule, the conception and birth of a healthy child). However, to get what you want, you can not delay a visit to the doctor. The sooner the diagnosis is made, the easier it will be to normalize the hormonal background and restore the proper functioning of the reproductive system.
Treatment of patients with polycystic ovaries begins with conservative methods - drug therapy, which involves the use of several groups of drugs at once:
- Hormones and their antagonists. The selection of hormonal agents is carried out in accordance with the identified hormonal disorders. Some patients are prescribed ovulation stimulants, others - progesterone, dexamethasone, antiandrogenic drugs, oral contraceptives or other hormonal drugs.
- Hypoglycemic drugs(usually metformin). The expediency of using these drugs is explained by the need to increase the sensitivity of tissues to insulin and thus achieve a decrease in the concentration of insulin in the blood and the termination of its stimulating effect on the ovaries.
- , which favorably affect the functioning of the gonads (in particular vitamins E, C and group B).
Complex drug therapy is prescribed for up to 6 months. If its result is unsatisfactory (pregnancy does not occur), gynecologists resort to surgical treatment. Modern laparoscopic equipment allows such interventions to be carried out with the least traumatism for a woman - already 3-4 days after the operation, the patient is discharged home, and only a few almost imperceptible scars remain on her body.
In polycystic ovaries, two surgical techniques are commonly used:
- Wedge resection - removal of the part of the ovary most affected by cysts.
- Cauterization - cauterization of cysts on the surface of the gonads.
As a result of such operations, ovulation and the production of sex hormones by the ovaries are normalized. However, the disease can return, so gynecologists recommend that patients try to conceive a child already in the first or second cycle after surgery.
Diet and physical activity in polycystic ovaries
Since excess weight creates serious obstacles to the normalization of hormonal levels, weight loss for patients with polycystic ovaries is no less important than medical or surgical treatment. Patients can help their body lose extra pounds and cope with the disease with the help of diet and physical activity (regular walking and jogging, fitness classes, etc.).
The diet for women with PCOS should be based on the following principles:
- food by reducing the intake of fast carbohydrates and fats.
- Fractional nutrition.
- Eating plenty of vegetables and fruits.
- Complete abstinence from alcohol.
- Restriction in the diet of fried, smoked, pickled, spicy foods.
Pregnancy and PCOS
Polycystic ovaries is by no means a sentence and not a reason to put an end to the desire to have children. Properly selected treatment in most cases helps a woman to conceive a child. However, after the onset of a long-awaited pregnancy, one should not forget about the disease. Such expectant mothers need medical support (mainly hormonal) and a very careful attitude to their condition, since there is a high risk of miscarriage. In addition, patients with polycystic ovaries should be under special medical supervision due to the possibility of developing gestational diabetes mellitus, high blood pressure and other pregnancy complications.