Polycystic ovarian disease (another name for the disease is Stein-Leventhal syndrome) is a polyendocrine disease in which ovarian function is impaired: they increase in size, fill with small bubbles of liquid and begin to produce large amounts of androgens - male sex hormones that are normally synthesized in female body in a small amount.
Violations can also affect the pancreas, resulting in insulin hypersecretion, adrenal cortex, resulting in excessive production of adrenal androgens, as well as the pituitary and hypothalamus.
What it is?
Polycystic ovary syndrome - polyendocrine syndrome, accompanied by impaired ovarian function (absence or irregularity of ovulation, increased secretion of androgens and estrogens), pancreas (insulin hypersecretion), adrenal cortex (adrenal androgen secretion, adrenal glands), adrenal glands (hypersecretion of adrenal androgens), adrenal glands (hypersecretion of insulin), adrenal gland (hypersecretion of adrenal androgens), adrenal glands (hypersecretion of insulin) and adrenal glands
Causes of PCOS
The basis of the development of polycystic ovaries are primarily polyendocrine disorders, manifested by a disorder of functions:
- ovaries (irregularity or lack of ovulation, increased estrogen secretion),
- pituitary and hypothalamus (dysregulation of the adrenal glands and ovaries),
- adrenal cortex (increased secretion of androgens),
- pancreas (increased insulin production when tissues are insensitive to it).
Disturbance of hormonal regulation leads to a suspension of the development and maturation of follicles, an increase in size and compaction of the ovarian capsule, under which multiple cystic growths begin to form from immature follicles. This entails a breakdown of ovulation, menstrual function and infertility. Against the background of obesity (and it occurs in women with PCOS in 40% of cases), these processes are even more pronounced.
Infectious diseases, stress and even climate change can provoke hormonal disorders.
Polycystic ovary and pregnancy
The diagnosis of "polycystic" is not a reason to abandon the idea of having a baby. Just for this you have to go a more difficult way than healthy women. In medicine, there are a lot of cases when women with such a diagnosis successfully become pregnant, bear and give birth to a child. During childbirth, supportive therapy is prescribed to the woman - Duphaston, Utrozhestan and other drugs that prevent miscarriage. Since pregnant patients have such a formidable diagnosis, they are heavily observed in the third trimester, when there is a threat of gestational diabetes, high blood pressure, weight gain. However, if you follow all the requirements of a doctor, pregnancy with polycystic is quite possible.
As a result of surgery, more than sixty percent of women manage to achieve a positive result - they successfully become pregnant and bear children. Doctors insist that couples decide on the continuation of the family as soon as possible after the operation, since the effect of the operation is not long - about three years. In order to support a woman during the conception of a child, she is prescribed drugs that stimulate the maturation of the egg. If you miss the time of remission, it will be harder to get pregnant in the future.
In some cases, the pregnancy itself can contribute to the cure of polycystic disease, since during the conception and gestation of the fetus in the female body there are enormous hormonal changes.
In women, the symptoms of polycystic ovaries are very diverse and may resemble manifestations of other diseases. A special feature is the fact that the presence of all the symptoms at once is not at all necessary for one woman.
The main symptom of polycystic ovary, forcing to see a doctor - the inability to get pregnant. The most common causes and additional symptoms of polycystic ovarian disease are:
- Oligomenorrhea, amenorrhea - irregular, rare menstruation or the complete absence of menstruation, those menstruation that still occur can be pathologically lean or, on the contrary, excessively abundant, as well as painful,
- Central obesity - “spider-like” or “apple-shaped” male-type obesity, in which the bulk of adipose tissue concentrates in the lower abdomen and in the abdominal cavity,
- Elevated blood levels of androgens (male hormones), especially the free fractions of testosterone, androstenedione, and dehydroepiandrosterone sulfate, which causes hirsutism and sometimes masculinization,
- Acne, oily skin, seborrhea,
- Androgenic alopecia (significant alopecia or male-type hair loss with bald areas on the sides of the forehead, at the crown, due to hormonal imbalance),
- Acrochordons (skin folds) - small folds and wrinkles of the skin,
- Acanthosis (dark pigmentation on the skin, from light beige to dark brown or black),
- Long periods of symptoms resembling the symptoms of premenstrual syndrome (edema, mood swings, pain in the lower abdomen, lower back, pain or swelling of the mammary glands),
- The appearance of stretch marks (stretch bands) on the skin of the abdomen, thighs, buttocks, as a result of a rapid increase in body weight against the background of hormonal imbalance,
- Depression, dysphoria (irritability, nervousness, aggressiveness), often drowsiness, lethargy, apathy, complaints of "fog in the head."
- Sleep apnea - respiratory standstill in sleep, leading to frequent night awakenings of the patient,
- Multiple ovarian cysts. Sonographically, they can look like a “pearl necklace,” a cluster of whitish bubbles or “fruit pits” scattered throughout the ovarian tissue,
- The increase in the size of the ovaries in 1,5-3 times due to the occurrence of many small cysts,
- Thickened, smooth, pearl-white outer surface (capsule) of the ovaries,
- The thickened, hyperplastic endometrium of the uterus is the result of a prolonged excess of estrogens, not balanced by adequate progesterone effects,
- Elevated LH or elevated LH / FSH ratio: when measured on the 3rd day of the menstrual cycle, the LH / FSH ratio is greater than 1: 1,
- Low level of globulin that binds sex steroids,
- Hyperinsulinemia (elevated level of insulin in the blood), impaired glucose tolerance, signs of tissue insulin resistance when tested according to the sugar curve method,
- Chronic pain in the lower abdomen or in the lower back, in the pelvic region, probably due to compression of the pelvic organs by the enlarged ovaries or due to prostaglandin hypersecretion in the ovaries and endometrium, the exact cause of chronic pain in polycystic ovaries is unknown.
Also, polycystic can be accompanied by signs of diabetes (weight gain, increased urination), chronic skin infections or thrush (vaginal candidiasis).
In addition to impaired reproductive function, polycystic ovarian disease may sooner or later provoke the development of gestational diabetes, arterial hypertension and lead to a significant increase in weight.
Women suffering from polycystic ovary syndrome increase the risk of developing coronary heart failure, peripheral vascular disease, clogged arteries and vein thrombosis, myocardial infarction and stroke. Those patients who are on long-term hormonal therapy should be wary of the development of mastopathy, endometriosis, breast cancer and cervical cancer.
Diagnosis of PCOS includes gynecological examination, ultrasound of the ovaries and hormonal examination, as well as other auxiliary methods.
- In the analysis of the blood for hormonal status, an increased concentration of androgens, follicle-stimulating and luteinizing hormones is noted (as well as their ratios). Also during the hormonal examination can be revealed impaired glucose tolerance and elevated insulin levels.
- Ultrasound scan. During this procedure, multiple small cysts are detected on the surface of the female genital glands. As a rule, the affected organs increase in size, their surface becomes bumpy, the capsule thickens. Due to the chronic excess of estrogen, the endometrial thickening (the inner layer of the uterus) is clearly visible on the ultrasound monitor.
- When conducting a glucose tolerance test, high blood sugar levels signal a violation of carbohydrate metabolism, that is, the development of hyperinsulinemia.
- In order to be able to "see" the ovaries affected by polycystic, a laparoscopic study is shown to patients. To date, ovarian laparoscopy is the most informative diagnostic technique. With the development of Stein-Leventhal syndrome, the capsule of the reproductive gland thickens and smoothes, the organ acquires pearl-whitish coloration, reaches a length of 5-6 and 4 cm wide.
- Patients with mastopathy are shown breast mast or thermography.
- To detect violations of metabolic processes, the lipid profile of the blood is determined. In case of polycystic ovaries, the concentration of low-density lipoproteins increases and the concentration of high-density lipoproteins decreases.
What does polycystic ovary look like? Photo of symptoms:
How to treat polycystic ovary?
Treatment of polycystic ovaries can be carried out with the involvement of several specialists at once: a gynecologist (or better a narrow specialist gynecologist-endocrinologist), an endocrinologist and a nutritionist.
Fully cure polycystic is almost impossible. Gynecologists can only minimize the manifestations of the disease and thus help the woman to achieve the main goal (this, as a rule, conception and birth of a healthy child). However, to get what you want, you can not pull a visit to the doctor. The earlier the diagnosis is made, the easier it will be to normalize the hormones and restore the correct functioning of the reproductive system.
The conservative treatment regimen is as follows:
- Drugs that stimulate ovulation.
- Antiandrogenic agents. This is a group of drugs that reduce the amount of male hormones.
- Drugs aimed at the treatment of diabetes. Usually this drug is metformin, which, in addition to regulating insulin production, contributes to weight loss.
- Hormonal contraceptives. Help restore the cycle and avoid the development of endometriosis. Some drugs have antiandrogenic effect (they fight acne and excess body hair). This method is not suitable for women who dream of getting pregnant.
- Diet. It is enough for some women to lose weight in order for insulin indicators to return to normal and ovulation occurs. Therefore, diet therapy plays an important role in the treatment of polycystic ovaries. Diet for polycystic ovaries is aimed at eliminating large amounts of fat and carbohydrates. Be sure to combine diet with exercise.
Comprehensive drug therapy is prescribed for up to 6 months. If her result is unsatisfactory (no pregnancy occurs), gynecologists resort to surgical treatment. Modern laparoscopic equipment allows such interventions with the least injury for a woman - 3-4 days after the operation, the patient is discharged home, and there are only a few almost imperceptible scars on her body.
The vast majority of patients with polycystic ovaries are overweight.
Adipose tissue has the ability to accumulate steroids, an excess of fat means an excess of steroids and hypothalamic dysfunction, which "directs" the menstrual cycle. Obesity leads to amenorrhea, infertility and many other serious consequences. For successful treatment of hormonal disorders, it is necessary to eliminate the negative effects of adipose tissue on the body, therefore, treatment of polycystic ovaries begins with weight correction.
As a result of monitoring the patients, we managed to find out which products are most useful for women with polycystic disease:
- vegetables - lettuce, broccoli, Bulgarian pepper (red and yellow), garlic, salad onions, zucchini, eggplants, cucumbers, carrots, asparagus, celery, garlic,
- fruits - plums, oranges, grapefruit, kiwi, apples, cherries, pears,
- greens - rosemary, parsley, dill, basil,
- cereals and legumes - beans, whole grain breads, beans, hard pasta, peanuts, soybeans, pumpkin, brown rice,
- vegetable oils - sesame oil, milk thistle oil, linseed oil, olive oil, pumpkin oil,
- dried fruits - raisins, prunes, figs, dried apricots,
- dairy products - cheese, cottage cheese, yogurt and low-fat milk,
- meat - chicken, quail, ostrich.
The diet for this category of patients is based on the following principles:
- reducing calorie intake to one thousand two hundred calories per day,
- transition to fractional frequent meals (about five or six times a day),
- In the diet should be more low-calorie foods - vegetables and fruits,
- increased protein intake (primarily from fish and seafood, cottage cheese, meat),
- carbohydrate restriction (sugar, fizzy drinks, pastries),
- the exclusion of animal fats and the transition to vegetable,
- exclusion of any doses of alcohol
- eating food without spices, seasonings, spices
- refusal of smoked, pickled products.
Once the body weight returns to normal, the number and range of products used can be expanded. However, if the patient returns to her previous diet, overweight will quickly return. In order to permanently get rid of obesity, it is necessary to use foods in such quantities that the body weight remains in a stable physiological state.
Physical activity (fitness, gymnastics) are a good addition to a balanced diet. In some patients, playing sports just two hours a week together with a diet gives a result similar to the use of special weight loss pills.
After the restoration of the menstrual cycle, they move to the main stage of therapy - stimulation of ovulation (for those patients who want to have children). For these purposes, drugs with pronounced anti-estrogenic properties - “Clomiphen” (“Clostilbegit”) are used.
After the abolition of these drugs, LH and FSH are synthesized, which by their action stimulate the maturation of the dominant follicle and the process of ovulation. The tool is prescribed from the 5th to the 9th day of the menstrual cycle, for a period of not more than 3 months at a dosage of 0.05 g. / Day. If the effect of therapy is absent, the dose is increased, bringing to 200 mg. “Klostilbegit” has one very unpleasant side effect - the risk of developing large functional cysts in the ovaries increases significantly. If therapy with this drug does not work within 3 months, the issue of surgery should be decided.
Surgical treatment of the disease is currently performed laparoscopically. Two surgical options are used: wedge-shaped resection of the ovaries and electrical coagulation of the brushes in the ovaries. The second method is more gentle, since it consists in applying notches on the capsule of the ovary and cauterizing multiple brushes. In the case of a wedge-shaped resection, the most modified areas of the ovaries (both the capsule and the stroma) are excised.
But it should be noted that the fertility of a woman is directly proportional to the statute of limitation of the operation, that is, the more time has passed after surgical treatment, the less likely to become pregnant. The maximum ability to conceive occurs in the first 3 months after surgery, and by the end of the year is significantly reduced. However, surgical treatment is indicated not only to patients with infertility, but also in the diagnosis of persistent endometrial hyperplastic processes.
IVF with polycystic ovaries
The IVF program for polycystic ovaries consists of 6 stages:
- follicle growth stimulation,
- puncture (invasively get eggs),
- fertilization and cultivation in an artificially created environment,
- embryo transfer
- support of the luteal phase of the cycle (progesterone),
- diagnosis of early pregnancy.
When the quality of sperm is unsatisfactory, IVF ICSI is performed. It is necessary to dwell in more detail on the fact that in the protocol of IVF with polycystic ovarian stimulation can lead to overstimulation syndrome. Therefore, cryopreservation of all received embryos can be made and replanting them in the next cycle.
Specific prevention of the disease today does not exist.
Given that the formation of polycystic ovary syndrome begins in girls during puberty, it is necessary to pay attention to menstrual disorders, as well as the development of obesity and manifestations of hyperandrogenism in such a cohort of children.
Features of the disease
Репродуктивная система женщины функционирует благодаря правильной работе эндокринных желез (щитовидки и надпочечникам), гипоталамуса, гипофиза и яичников. В случае возникновения дисфункции какой-либо из вышеперечисленных систем, нарушается деятельность всей половой системы. A woman's body becomes more susceptible to infections and inflammation. Thus, not only a simple cyst of the corpus luteum can arise, but also a multitude of small cysts - polycystic.
Numerous cysts on the ovary can be either single or form whole clusters. As a result, follicle maturation is disturbed, 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 symptoms of PCOS appear in a teenage girl after the onset of the first menses. The peak of the disease is 30 years. It is in women of this age that the symptoms 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 birth is not uncommon. This is explained by the fact that during pregnancy a woman's hormones change completely for carrying a child. And after childbirth there is a restructuring and restoration of the body. It is at this point that polycystic ovaries can develop, which is facilitated by an increase / decrease in estrogen, progesterone, androgen, and an imbalance of male and female hormones. Many patients are concerned about how to cure polycystic ovarian disease and whether they can become pregnant with this diagnosis. In both cases, the answer is yes. However, it is necessary to follow all the recommendations of the doctor.
A timely diagnosis and prescription of a competent treatment of polycystic ovary syndrome helps not only to get rid of the disease, but also to prevent the development of complications.
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 ovary:
- infections and prolonged inflammation of the uterus appendages (ovaries and fallopian tubes),
- overweight, obesity,
- endocrine gland malfunction
- heavy labor activity
- improper installation of the intrauterine device,
- pelvic trauma,
- hormonal disorders.
Treatment of polycystic ovary is not only to remove cysts and relieve painful symptoms, but also to eliminate the underlying cause of the disease. So what are the symptoms of polycystic ovary syndrome, and when urgent medical care is needed?
Signs of disease
Each woman has different polycystic symptoms. Some patients experience aching, sometimes acute pain in the lower abdomen. Others do not care. However, the first manifestations of pathology are considered to be:
- violation of the menstrual cycle,
- unreasonable weight gain,
- appearance of male body hair (chest, face, abdomen).
If any of the above symptoms occur, a woman should think about the correct activity of the body and consult a doctor.
Also distinguish such signs of polycystic ovary:
- lack of ovulation
- discharge between menstruation,
- "Daub" in the middle of the cycle,
- different duration of menstruation,
- frequent delays
- increase in the size of 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 insulin levels in the blood,
- chronic anovulation
- inability to conceive a child for more than one year.
Thus, the causes of polycystosis of the ovaries are varied and are fairly 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 menstruation delays. You can also measure BT (basal temperature), which should increase in the second phase of the menstrual cycle. In polycystic ovary syndrome (PCOS), the basal temperature does not change.
Ultrasound scan of ovaries with polycystic
How to identify the disease
It is impossible to diagnose "polycystic ovarian disease", considering only the results of ultrasound. This is explained by the fact that the clinical picture of this disorder can be observed in a healthy woman, that is, an error is possible. In addition, quite often the polycystic disease of the right ovary is determined by ultrasound, but in fact, affecting one appendage, cystic neoplasms soon hit the other. Diseases that give similar echo-signs should also be excluded. These include hypothyroidism, Cushing's syndrome, hyperprolactinemia. That is why the diagnosis of PCOS includes:
- Gynecological examination,
- History taking and determination of all symptoms
- Ultrasound of the pelvic organs,
- General analysis of blood and urine,
- Blood test for hormones (LH, FSH, T4, TSH, T3, etc),
Only a complete transcript of the above analyzes and examinations provides an opportunity to see the change in the size, structure and shape of the ovaries, their functionality, confirm / refute the disease and the possible risk of complications.
Treatment for polycystic ovaries is long and multi-stage. Unfortunately, it is impossible to completely cure him. 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 the disease.
Initially, the doctor prescribes painkillers to relieve symptoms of polycystic ovarian disease and treat the hypothalamic-pituitary system. Then it is necessary to adjust the production of androgen appendages, eliminate excess weight and restore the menstrual cycle.
Polycystic ovary syndrome is treated with a conservative and surgical method. Based on the results of the tests, the pain of symptoms and the desire of a woman to become pregnant, the attending physician chooses the most appropriate treatment method.
How to treat polycystic ovary conservative methods? First of all, you need to improve nutrition and lifestyle. There is even a special diet for polycystic ovary syndrome (spkya), which is to exclude alcohol, coffee, fatty, fried, smoked and spicy foods. It is also recommended to do fasting days. The total number of calories is 1200-1800 per day. Five meals a day. Polycystic ovary syndrome also requires the mandatory use of vegetables, fruits, herbs, fish, cottage cheese, kefir. It is necessary to refuse sweets, flour products, honey.
If you are overweight or obese, physical activity is required. 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 contribute to the proper release of the egg. Such drugs as Janine, Marvelon, Yarina, Jess proved their effectiveness in PCOS.
Sphenoid resection for polycystic
How to treat polycystic ovary surgery? To do this, use two methods of operation:
- Wedge resection. Damaged tissues are removed, including the capsule and stroma. Helps restore ovulation and reduce the production of androgens.
- Coagulation. The doctor makes notches on the capsule of the ovary and cauterizes the cysts. This method is considered the most benign.
Surgical intervention is laparoscopic. The operation is performed only if conservative methods of treatment do not give proper results or the patient begins to develop endometrial hyperplasia.
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 polycystic ovary can be cured by folk methods.
We strongly recommend that you do not self-medicate! Incorrect actions can only aggravate the situation.
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 remove painful symptoms, contribute to the reduction and self-resorption of a single cystic formation (for example, a cyst of the corpus luteum of the ovary). These include boron uterus and red brush. But! With multiple cysts, folk methods are powerless, and in combination with hormone therapy they can even lead to irreparable consequences. That is why only a competent specialist will tell you how to treat polycystic ovarian disease and what kind of food is needed.
What threatens PCOS?
If a competent treatment is absent or a woman does not adhere to all the prescription of a doctor, 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 many diseases.
What is dangerous polycystic ovaries? First of all it is:
- adhesions in the pelvic organs,
- hypertension, stroke,
- endometrial cancer,
- cervical cancer,
- mastopathy and breast cancer.
If the polycystic transformation of the appendages is found during pregnancy, the expectant mother faces such a danger:
- severe pregnancy,
- spontaneous abortion (miscarriage) in the early stages,
- premature and difficult labor (earlier 36-38 weeks),
- late toxicosis,
- diabetes pregnant.
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 potential complications and prevent infertility.
Polycystic ovary: what is it
There are two forms of pathology. The first is polycystic ovary disease or primary polycystic ovaries, which is formed from the moment of functioning of the ovaries, and accordingly, clinical signs appear during puberty. Primary polycystic hereditary, that is, a genetically determined disease. Stein-Leventhal syndrome is a synonym for primary polycystosis of the ovaries.
Secondary polycystic ovary is the result of secondary disorders in the genital gonads and is caused by chronic endocrine pathology or inflammatory diseases of the organs of the genital sphere.
Causes and pathogenesis of the disease
Despite the fact that the disease is one of the frequent hormonal disorders among women of childbearing age, the exact causes of its occurrence have not yet been established. In the pathogenesis of polycystic ovaries, malfunctions at any level in the hypothalamus-pituitary-adrenal-ovary system play a role. Not least, is the functioning of the thyroid and pancreas.
It has been established that almost all patients with this disease have insulin resistance, that is, the body reacts “badly” to insulin secreted by the pancreas and controlling the level of glucose in the blood. As a result, insulin accumulates and circulates in the blood in large quantities. Excess insulin "spurs" the ovaries and they begin to produce androgens in quantities far above normal.
Androgens, in turn, inhibit ovulation, that is, the dominant follicle does not break and the egg does not exit, and the second phase becomes incomplete due to lack of progesterone (no ovulation - the yellow body is not formed - progesterone is not synthesized). The inhibitory effect of androgens on ovulation is explained by their ability to thicken the outer lining of the ovaries, which a ripe follicle cannot “break through” to release an egg cell. The follicle that has not fulfilled its function is filled with fluid and converted into a cyst. In the next menstrual cycle, the history repeats and the ovaries become covered with many small cysts, which explains their increased size.
The factors provoking the occurrence of polycystic ovaries include:
- genetic predisposition
- catarrhal diseases
- chronic stress
- many abortions (leading to hormonal disorders),
- unfavorable ecological situation
- diseases of the endocrine organs (pituitary, thyroid, hypothalamus and adrenal glands),
- chronic inflammatory diseases,
- gynecological pathology (and hormonal and inflammatory diseases).
Symptoms, clinical picture
The first sign that makes a woman worry is irregular menstruation. Disorders of the menstrual cycle are characterized by rare periods (after 3 - 6 months), scanty (opsymenorrhea) or, on the contrary, copious and prolonged periods after a long delay. The cycle duration is 35 days or more, and there are about 8 menstrual bleeding or less per year. Menarche appear in time, but the cycle is immediately irregular. Dysfunctional uterine bleeding occurs as a result of the formation of a hyperplastic process in the endometrium on the background of a long absence of menstruation. In this regard, all patients with polycystic ovaries are included in the risk group for mastopathy, uterine adenocarcinoma, and breast cancer.
High levels of androgens are manifested by a number of symptoms:
Characterized by excessive hair growth on the male type (on the face, in the areola, shins).
It is characterized by an increase in the growth of pivotal (coarse and thick) hair on the chin, in the neck and around the nipples, in the hip area. This symptom always indicates hyperandrogenism and occurs in the primary form of the disease.
Women have a male physique, their male hair is characterized by an increase in the clitoris and hypoplasia of the mammary glands, low voice. Often there is alopecia (alopecia) for the male type and thinning hair.
The condition of the skin and hair
In case of polycystic ovary, the skin is characterized by high fat content, enlarged pores with the presence of acne. It is characteristic that acne is present not only on the face, but on the neck, shoulders and back. Oily seborrhea is also noted, and the hair itself is quickly contaminated, even with careful care. Perhaps the appearance of dark brown pigment spots on the skin of the inner surface of the thighs, in the elbows folds, in the armpits.
Male obesity Body weight change
Most patients are overweight or obese, and the distribution of subcutaneous tissue occurs in the male type, in the abdomen and thighs.
The most serious and cardinal sign of the disease is infertility due to anovulation. It is because of the absence of pregnancies that women with this pathology most often go to a doctor. Approximately 85% of patients have primary infertility, that is, there have never been pregnancies.
As a result of elevated blood insulin levels, the likelihood of developing diabetes is high. Arterial hypertension and hypercholesterolemia (high cholesterol in the blood) are also often observed, which, in turn, provokes the development of hypertension and atherosclerosis.
The clinical picture of polycystic ovaries
Pathological changes in the hormonal background of women of childbearing age include polycystic ovary. Disruption of the production of hormones leads to the formation of multiple cysts filled with watery secretions, coagulated blood or pus.
This pathology refers to the endocrine and proceeds in two forms: primary and secondary.
Primary (true) polycystic it is congenital or diagnosed in girls at puberty, arising on the background of acute respiratory diseases, infectious sore throats, hereditary factors, early abortions of pregnancy. In adolescents, accompanied by painful heavy menstruation or lack thereof. It can be diagnosed in young women under 30 years old who are not suffering from obesity and hyperglycemia. Has a severe course, poorly amenable to conservative and surgical treatment.
Secondary polycystic ovary (Stein-Leventhal syndrome) is characteristic of women over 40 years of age with overweight and elevated blood glucose levels. Often diagnosed in menopause, accompanied by signs of extinction of the female glands. It is well treated conservatively.
In the process of pathology development, liquid follicles form on the surface of the ovaries. The disease is accompanied by menstrual dysfunction, obesity, excessive hair growth, in 25% of cases leads to infertility.
What is dangerous polycystic ovary for pregnancy? The ability of a woman to become a mother in the future depends on physiological changes in the level of hormones in adolescence.
Hormonal imbalance is the main cause of diseases in gynecology, as a result of which the protein membrane of the paired female genital glands thickens, leading to the cessation of ovulation. Since fertilization does not occur, a cyst is formed from the follicular fluid. Так как этот процесс происходит ежемесячно, то яичник в результате принимает вид шара, наполненного многочисленными кистозными образованиями.Especially dangerous is the development of PCOS in girls who only have to give birth. With this disease, a woman practically reduces her chances of getting pregnant to zero.
Why ovarian pathology develops
Medicine has not established the exact factors for the formation of polycystic ovary. The causes of the pathology often include:
- Dysfunction of the organs that produce hormones. Disorders in the pituitary, thyroid, hypothalamus, adrenal glands increase the level of androgen, contributing to cystic neoplasms.
- Excess insulin production triggers an increase in testosterone, which affects ovulation.
- Extra kilos contribute to an increase in glucose, which causes weight gain, and, as a result, polycystic ovaries.
- Imbalance of hormones. Increased production of prolactin, testosterone, luteinizing hormone (LH), low concentration of globulin (SHGB).
- Chronic inflammation leads to excessive cholesterol (atherosclerosis) and insulin resistance, causing heart and vascular disease. Any inflammatory processes occurring in the female body, can cause the pathology of paired genital glands.
- Hereditary factors. The risk of developing a polycystic ovary disease is increased if the next of kin are carriers of the pathology.
- Improper development of the fetus. Gene expression (malfunctioning) leads to hyperglycemia and chronic inflammation, which can cause PCOS.
The reasons for the failure of hormones include plastic containers. Scientists have found that drinking beverages from plastic bottles by 70% increases the concentration in the body of substances that affect sex hormones. Bisphenol A, which is contained in plastic products, acts as an estrogen and can be the basis for the development of polycystic female genital glands, uterine cancer, and lead to infertility.
What are the symptoms of pathology
At the end of the 20th century, at a conference devoted 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:
- Modified menstrual cycle. Signs of abnormal critical days are:
- monthly 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, changes in voice, breast reduction). Since polycystic ovarian symptoms are similar to other hormonal pathologies, the diagnosis is made with pronounced hyperandrogenism.
There are other signs of polycystic ovary, which are expressed differently and are 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 regions,
- rash acne all over your body
- dysfunction of the sebaceous glands.
- Changes in the paired female genital glands, accompanied by
- increase in size,
- expansion of the glands due to multiple cysts,
- pain in the lower abdomen,
- discharge of blood between menstruation.
- Sharp weight gain (from 15 kg) and the deposition of fat in the abdominal cavity (male type).
- The deterioration of overall health due to diabetes, hypertension, high cholesterol.
- Reproductive disorders, expressed in the inability to get pregnant, bear and give birth to a baby.
The symptoms of polycystosis of the ovaries and their severity are individual for each woman and are greatly exacerbated when gaining extra pounds (rational nutrition is very important). A complete medical examination is shown in the presence of menstruation failure and the appearance of signs of excess male hormones - hyperandrogenism.
Treatment of the pathology of the paired genital glands
In a polycystic ovary syndrome diagnosed, therapy is prescribed according to the severity of clinical signs, in accordance with the patient's complaints, and is a multi-stage process of restoring reproductive abilities and other pathologies of the female body. The 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 desire of the woman to become a mother.
How to cure polycystic ovaries? This is a rather complicated and lengthy procedure that requires patience and willpower. Therapy is as follows:
- Correction of body weight will improve hormones 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.
- Recovery and normalization of menstruation is reduced to hormonal drugs - contraceptives containing a low dose of female hormones. They reduce the concentration of androgen, which reduces the risk of uterine cancer and normalizes blood flow. Alternatively, it is possible to use progesterone on a monthly basis for a course of 10-14 days. Metformin is often prescribed for polycystic ovarian disease, which is designed to lower the insulin level and help improve ovulatory function, as well as normalize the menstrual cycle. In addition, using metformin for polycystic can lose weight in combination with diet and exercise.
Apply and combined female hormonal contraceptives, for example, rigevidon. They stimulate the formation of a special protein that binds testosterone and helps reduce male hormones. Ripevidon 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 paired female genital glands.
- Stimulation of ovulation with polycystic ovaries. If you wish to become pregnant, there is a 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 pieces Take, starting from the 3rd day of the cycle for 5 days. This scheme guarantees the onset of ovulation on the 12-15 day of the menstrual cycle. If necessary, repeat the therapeutic course.
- Cessation of hair growth. Specialists often recommend contraceptives that reduce androgen production, or spironolactone, which blocks the action of androgens on the epidermis. The drug is contraindicated in the planning and the onset of pregnancy. Eflornithine cream will help to slow down the growth of facial hair, as well as having resorted to electrolysis or laser hair removal.
- Surgical intervention. If pregnancy after conservative treatment does not occur, resort to surgical methods. An outpatient surgery, called pelvic laparoscopy, is prescribed. The surgeon makes a laser electrocoagulation (incision and cauterization) or resection of the ovaries with polycystic (removal of damaged areas), prompting to ovulate.
The traditional question asked by patients faced with this problem is: can polycystic ovarian disease be cured? Doctors disagree, but many answer in the affirmative: full recovery is possible, though difficult, but even after getting rid of the illness it is worth regularly visiting a gynecologist to avoid recurrence.
Power Mode for PCOS
One of the main causes of the disease of the paired gonads of a woman is obesity; therefore, a diet with polycystic ovaries, which normalizes hormones and reduces body weight, is important. Nutrition requires the following changes to the daily menu:
- Include fiber-rich foods in the menu - fruits, nuts, vegetables provide the body with beneficial vitamins.
- Replace foods high in animal fat (meat, milk, butter) with foods rich in vegetable or fish oil.
- Discard the gas-containing liquid.
- Minimize the use of pastry and flour products.
- Do not drink strong tea and coffee.
Solving the problem of how to lose weight with polycystic ovaries depends solely on the desire of the patient. Nutritionists and trainers recommend sticking to their advice:
- create a healthy eating system,
- add exercise (showing cardio load),
- keep track of your progress by capturing them in the achievement diary,
- be patient and move steadily toward the goal of dealing with PCOS.
By adhering to these recommendations, you can be guaranteed success in treatment and reduce the risk of complications.
Folk recipes for ovarian pathology
An effective way to treat the problem of paired female gonads is herbal medicine. How to treat polycystic ovarian alternative medicine?
Plants such as nettle, boron womb, dandelion, sage and red brush work best with this pathology. Effective are considered infusions and decoctions of these natural healers. The beneficial substances and microelements contained in them level the hormonal balance, stabilize the menstrual cycle and prevent the formation of new cystic formations. Use the simple and effective fitorecept of the above herbal remedies:
- Borovaya uterus with polycystic ovaries is good as part of complex therapy. Most often, an alcoholic infusion is prepared: 100 g of a dried plant is filled with 0.5 liters of alcohol and drawn for a week. Take every day for 1 tsp. before dinner throughout the year. Even easier to make a decoction: 1 tbsp. l herbs pour 1 cup boiling water. Infused for half an hour to drink the mixture during the day in small portions.
- Red brush is no less effective for polycystic. Alcohol extract is prepared as follows: 100 g of vodka and 80 g of grass are drawn for about 7 days and they take 0.5 tsp daily three times. Water decoction is prepared from 100 g of dried plants and 1 cup of hot water. Drink 1 tbsp. l twice. To enhance the effect is taken simultaneously with the boron uterus.
- Sage tea is recommended to be taken 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 of folk remedies for a long time, but the effect does not take long, besides, this method of therapy is absolutely safe.
During the menstrual cycle, many follicles form in the healthy gonads. In the middle of the normal cycle, a mature follicle is ruptured, from which an egg cell (ovulation) enters the fallopian tube, while other follicles are absorbed. But ovulation does not occur with polycystic because the egg within the dominant follicle does not mature, and all follicles are filled with fluid, transforming into small cysts.
Pathology occurs in 5 - 10% of women of reproductive age and girls in the pubertal period (puberty) and often becomes the main cause of inability to conceive.
Types of polycystic
Two forms of polycystic ovary syndrome are distinguished:
- Primary polycystic ovary that occurs in younger girls during the stabilization of menstrual function. Another term is Stein-Leventhal syndrome or sclerocystic disease. This form is harder to respond to therapy and is often associated with heredity, but surgery also helps with this type of PCOS.
- Secondary polycystosis in girls develops after the established normal monthly cycle, in some cases - after the birth of children. Occurs due to inflammation of the reproductive organs or the development of endocrine pathologies, and more often in patients with obesity and insulinemia (an excess of insulin in the blood). Sometimes detected during menopause. The secondary form is more amenable to drug therapy.
Can only polycystosis of the left or right ovary develop? Most experts say that only polycystic cysts of both ovaries is possible, since the cause of this condition is systemic, that is, it affects the whole body, and pathological changes are characteristic of both sex glands. But the formation of a follicular cyst on the one hand is possible, and due to a more active blood supply to the right sexual gland, a cyst of the right ovary often develops. And this is a completely different disease.
In medical practice, one-sided formation of a set of cysts is recorded, and in this case a diagnosis is made of polycystic right ovary (or left).
Symptoms of the disease
The disease sometimes proceeds with little or no symptoms, and the symptoms of polycystic ovary can vary in severity. In some patients, individual manifestations associated with specific causes of polycystic PCOS (PCOS) are observed.
- Menstrual dysfunction due to disruption of the ovulation process in polycystic ovaries. Monthly with polycystic ovaries are irregular (or absent), the interval between two periods reaches 35 days or more, cyclical bleeding is recorded less than 8 times in 12 months.
- Sometimes a long delay of menstruation is replaced by abundant prolonged bleeding due to the pathological thickening of the uterine lining - endometrial hyperplasia.
- Pain in the lower abdomen, intermittent, pulling, with rebound (irradiation) in the sacrum, lower back.
- The appearance of striae (light or pink-purple stripes) on the skin of the mammary glands, abdomen and thighs.
- Increased fragility of the nails and hair.
- Overweight (increase in body weight by 10 - 15 kg). The deposition of fat is distributed evenly, or in the abdomen and shoulder girdle.
- Frequent recurrences of vaginal candidiasis (thrush), pustular skin infections.
- Constancy of temperature (rectal) throughout the full cycle. For the normal functioning of the sex glands is characterized by a temperature jump at the time of ovulation (from 36.7 - 37 C before ovulation and up to 37.2 - 37.3 after).
- Inability to conceive. In case of polycystic ovaries, due to disruption of the ovulation process, primary infertility is observed in 25% of patients.
- Excess male steroids - androgens, leading to the appearance of external male signs:
- active hair growth (hirsutism) on the face, along the chin line, on the neck, mammary glands, stomach, back, hips, arms (hirsutism),
- hair loss (alopecia),
- increased sebum production, seborrhea and acne (varying degrees of acne).
Features of the functioning of FSH and LH in polycystic
The disproportion in the production of hormones FSH and LH (follicle-stimulating and luteinizing) is one of the underlying causes leading to polycystic. With reduced FSH in the ovaries develops a lack of enzymes that accelerate the production of female sex hormones - estrogen. As a result, the accumulation of male androgens in the ovaries, which inhibit the process of maturation of follicles, causing their cystic degeneration.
At the same time, an abnormally high production of LH (luteotropin) activates the production of androgens, leading to a decrease in FSH and the production of estrogens.
Consequences of the syndrome
The consequences of polycystic ovaries in the long run without proper treatment are expressed in the following:
- In 45–60% of cases, the woman is not capable of conception, and in the case of pregnancy, the patient suffers from frequent miscarriages or does not don the fruit.
- Severe anemia due to massive uterine bleeding.
- Disturbances in the metabolism of fats and carbohydrates, initiating the gradual development of type 2 diabetes mellitus, which by the period of menopause (45-50 years) is diagnosed in half of the patients.
- When pregnancy develops gestational diabetes or preeclampsia (a threatening state of severe hypertension and destruction of the kidney tissue).
- The risk of developing atherosclerosis, stroke, heart disease, since elevated testosterone levels and the failure of the fat absorption process lead to an increase in triglycerides, "bad" cholesterol - LDL and decrease in "good" cholesterol - HDL.
- Severe inflammation - non-alcoholic steatohepatitis (due to fat accumulation in the liver).
- Malignancy or malignant degeneration of endometrial cells, triggered by, firstly, excessive growth of the endometrium due to the absence of monthly bleeding, which normally remove the dead cell layer, and secondly, due to elevated estrogen levels.
What is polycystic ovary
If the ovarian metabolism is disturbed, abnormal changes in the functions and structure of the ovary occur. Progressing steroidogenesis, which violates the specifics and duration of the menstrual cycles in the female body, reduces reproductive activity. Stein-Leventhal Syndrome (another name for polycystic) promotes secondary infertility, develops other chronic diseases in a female.
Primary polycystic is formed at the genetic level, and progresses only in the pubertal period. It is a serious disease, it is difficult to conservative treatment. Secondary polycystic is not an independent disease, the complex of unpleasant symptoms in practice has been called the "Polycystic Ovary Syndrome" - PCOS in gynecology. Болезнь проявляется не сразу, а рецидив обусловлен не только возрастом пациентки, но и воздействием ряда патогенных факторов.
Женщины с избыточным весом чаще страдают от поликистоза, чем стройные пациентки (с нормальным весом), поэтому первая рекомендация специалиста – контролировать массу тела, избегать ожирения, урегулировать гормональный фон. 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 breakdown of the menstrual cycle, but also to a sharp decrease in the possibilities of reproductive functions.
Pathogenic factors can lead to imbalance of the hormone progesterone, intensive androgen synthesis and progressive polycystic disease:
- Nervous shocks
- the presence of chronic infections
- climate change,
- bad heredity
- irregular sex life
- environmental factor
- a large number of perfect abortions,
- pathologies in the endocrine glands,
- chronic diseases inherent in the pituitary, hypothalamus, ovaries, thyroid.
Since the pituitary hormones are produced in abnormal concentrations, an additional dose of hormonal drugs is needed. Before you begin intensive therapy, you need to familiarize yourself with the diagnosis of polycystosis and study the classification associated with characteristic dysfunctions. So, there are:
- Ovarian form. The ovaries are ignored if forced stimulation of ovulation prevails. This is due to a valid indicator and the ratio of sex hormones in the blood.
- Adrenal form. A typical symptom is hirsutism, a woman has complaints of sweating, weight gain, acne.
- Diencephalic form. May predominate in multiple cysts, malignant ovarian tumors. Endocrine dysfunction prevails at the diencephalic level.
What is dangerous
In the absence of timely diagnosis of polycystosis, treatment may be useless - serious health complications are progressing. Successful conception can not wait, the real chances of getting pregnant from the immature eggs are completely excluded. The patient has not only problems with the arrival of menstruation, the potential complications with women's health are presented below:
- predisposition to type 2 diabetes,
- development of cardiovascular pathologies on the background of the growth of cholesterol in the blood,
- endometrial cancer, malignant tumors of the uterus,
- endometrial hyperplasia,
- hyperandrogenism with perceptible hormonal imbalance.
Therapy of polycystosis begins with the elucidation of the symptoms and features of the pathological process to which ovarian capsules are exposed. 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 pilosis of the skin of the woman,
- adrenal dysfunction,
- acne and acne,
- ovarian function problems
- high blood pressure.
How to determine polycystic ovary
The woman draws attention to the fact that with visible health for a long time 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 tumors. There is an urgent need to undergo ultrasound diagnosis in order to properly and timely differentiate the disease. Polycystosis requires an integrated approach that includes a number of laboratory tests and therapeutic interventions.
Defines the specificity of the clinical picture of a blood test to identify luteinizing, follicle-stimulating hormone (FSH), DEA sulfate, cortisol. It is important to identify sensitivity to testosterone, thyroxin, estrogen, insulin, 17-OH-progesterone, triiodothyronine and thyrotropin. This laboratory study helps to eliminate such diagnoses with similar symptoms, such as:
- Cushing's syndrome
- adrenogenital syndrome
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 ovaries in size, other already noticeable symptoms are not excluded.
Treatment of polycystic ovary
Since the pathology is accompanied by unstable insulin resistance, treatment of polycystic is required with the participation of substitution therapy. Unauthorized actions of the patient are strictly prohibited. The disease is subject to conservative and surgical treatment by the decision of a specialist, as in the first case, a full 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 removal of the part of the ovary that synthesizes androgen.
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 tablets Janine, Jess, Regulon, Yarin. Representatives of other pharmacological groups are also needed:
- Drugs to stimulate ovulation if you wish to become pregnant: Duphaston, Clomid, Utrogestan, Clomiphene. Hormonal pills are supposed to take a certain pattern of a course of up to 4 months.
- Antiandrogens for blocking male hormones in polycystic cases: Veroshpiron, Flutamide. Preparations in the form of tablets with a diuretic effect, put up to 3 pills per day.
- Preparations for increasing insulin sensitivity in polycystic cases: Glucophage, Metphogamma, Bagomet.
If the positive dynamics of conservative treatment is completely absent for a year, the doctor resorts to surgical intervention. Previously, it was laparoscopy (resection of the ovaries), but in modern medicine this method is considered outdated, and the gynecologist recommends wedge resection and electrocoagulation. In the first case, small cysts can be removed with a medical instrument, in the second, the surgeon operates with a needle electrode.
In the daily diet, after the diagnosis, radical changes are coming. For example, the caloric content of food should not exceed 1800 - 2000 Kcal, while it is necessary to eat up to 5 - 6 times. The carbohydrate rate is 45% of the total calories, while protein concentration is not normalized. The ratio of animal and vegetable fats should be 1: 3. The following are products that are approved for ovarian pathologies:
- fruits and vegetables, fresh greens,
- low fat dairy products,
- lean meats and fish,
- mushrooms, legumes, cereals.
Banned with polycystic products are as follows:
- fast food,
- bakery products,
- fast food.
It is not necessary to exclude the presence in the specific clinical picture of treatment with traditional methods. However, such therapy can only be ancillary, should be discussed with your doctor in advance. Here are effective and publicly available recipes:
- Pour 80 g of the uterus of the uterine 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 peeled green walnuts need to pour 800 g of sugar, pour the same amount of vodka. Infuse the composition laid 2 weeks, taken orally for 1 tsp. for 3 weeks.
- Broth nettle or milk Thistle, prepared according to the recipe on the package, also provide a positive dynamic polycystic. It is allowed to be treated in this way for 2 to 4 weeks.
Pregnancy with polycystic ovaries
Women with such a health problem are interested in the question of whether they can become pregnant with polycystic ovaries. Over the past decade, it has become a reality after taking oral contraceptives for treatment, long-term hormonal therapy and ovarian stimulation. The patient's chances of becoming a mother is 1: 1, and if the answer is negative, after the treatment, it is worth continuing the replacement therapy. After successful conception, a woman should remain under strict medical supervision.
Causes of polycystic ovary
The main causes of polycystic ovaries are due to the influence of several factors:
- Dysfunctions in the pancreas, leading to increased blood levels of insulin hormones. The very process of producing insulin provides the body's cells with glucose, to replenish its energy. When the body's resistance to insulin, the effectiveness of the use of hormones is impaired, forcing the gland to additional secretion. Excess insulin causes the development of hyperandrogenism (increased secretion of male hormones) and impaired ovarian function, which interferes with ovulation.
- The presence of non-specific inflammatory processes that stimulate androgen secretion.
- Genetic inheritance and gene disorders that increase the chance of disease manifestation.
Polycystic ovaries are classified according to two forms of manifestation.
Primary polycystic - due to congenital abnormalities. It develops in women with normal weight and in the absence of increased secretion of insulin hormones. Development begins at the age of puberty, in the period of formation of the continuation of the race. Polycystosis of this form is characterized by a severe clinical course of the disease, poorly amenable to drug therapy and surgical treatment.
Secondary form - develops as a result of congenital adrenal dysfunctions (hyper / hypocorticoidism), excessive fullness and insulinemia. Characterized by development during menopause, due to functional extinction of the ovaries. There are no problems in treatment. Perhaps stopping the disease by conservative techniques.
According to clinical manifestations, there are three types of PCH - ovarian, mixed (ovarian-adrenal) and central, occurring with signs of CNS damage. With symptoms of polycystic ovaries, causes and provocative factors are the main individual indicator when choosing a treatment strategy.
Signs and symptoms of polycystic ovary in a woman
Signs of polycystic ovary photo 3
Symptoms of polycystic ovary are diverse and may be common to many pathologies. And it is not at all necessary that at once all of them can manifest themselves in one woman.
Cases are known that for a long time no symptoms of polycystic disease manifest themselves, and treatment, as a rule, is delayed. Suspected the presence of a problem can prolonged absence of pregnancy, with regular unprotected sex. The most characteristic symptoms of PCO are manifested:
- Irregular cyclical menstruation. The discharge can be scanty, or long and abundant. Characterized by a long absence Reg. A hormonal imbalance causes a thickening of the uterine endometrium and its untimely rejection, or it passes with a delay.
- Soreness in the abdominal area, which may be permanent. The pain syndrome is due to the pressure of enlarged cystic ovaries on the adjacent organs.
- Quick weight gain. Symptoms are variable, but manifest in many patients. The main accumulation of fat is localized in the abdomen and in the lumbar region. A sharp increase in weight is reflected on the body with unpleasant stretch marks.
- Changes in appearance - greasy hair and dandruff, oily, pimply skin. On the legs, in the area of the groin and in the abdomen, a hairy "vegetation" appears, the "male antennae" adorn the upper lip. On the head is characterized by the manifestation of focal alopecia (pathological foci of alopecia). That clearly indicates the predominance of male hormones in the body.
- Increased skin pigmentation in the armpit and back.
- Premenstrual syndrome in the form of irritability, drowsiness, mood swings.
With timely, adequate treatment and compliance with all medical recommendations, to stop the development of pathology, or completely get rid of it as soon as possible.
In some cases, you may have problems planning a pregnancy. In its absence for more than a year and a half after the treatment of polycystic ovarian cancer, IVF can be an alternative to natural conception.
What blood tests to take and when
It is very important to donate blood for the study of hormonal status, lipid (fat) profile of blood, sugar and insulin.
Conduct a laboratory determination of the concentration of the following hormones:
- Androgen DHEA-S, which is produced only by the adrenal glands. For proper treatment it is important to establish what is the cause of hyperandrogenism (excessive secretion of male hormones) by the ovaries or adrenal glands. This indicator is necessary to identify the internal causes of such symptoms in polycystic as hirsutism, baldness, reproductive function disorders.
- Free Testosterone (T). If free testosterone in the blood is more than 1%, the woman will definitely show signs of hyperandrogenism.
- FSH and LH, analysis is needed to understand if there is a malfunction in the pituitary gland. The main function of FSH is the stimulation of the ovaries and the preparation of follicles for ovulation. If LH is higher than normal, and the LH / FSH ratio is increased, this means that there are disorders of the pituitary function in the regulation of the reproductive system.
- Estradiol. It is the most active estrogen and its low and elevated level indicates certain problems.
- Cortisol. The deviation of its content (more than 20 or less than 7 - 9 mg / dl) indicates severe stress, which can provoke the development of cytosis in the ovaries.
- Prolactin. The hormone is produced by the pituitary gland. Elevated levels of prolactin may be an indicator of a pituitary tumor, which activates excessive secretion of hormones. The high content of prolactin inhibits FSH and the ability to conceive. Its increase may indicate such causes of polycystic ovary, such as: hypothalamic tumors, pituitary, Turkish saddle area, hypothyroidism, Cushing's syndrome.
When polycystic depending on the cause-provocateurs in the blood plasma note:
- an increase in LH and LH / FSH ratios, which is over 2.5,
- a decrease in FSH and 17-OH progesterone (in the second phase of the cycle),
- increased estradiol levels (often)
- increased levels of free testosterone, DHEA-c, prolactin (optional).
Analysis of hormones for diagnosis should be carried out clearly in certain phases of the menstrual cycle (in the first, in the middle - during ovulation, at the end), otherwise the study will not be uninformative.
The analysis for LH, FSH and prolactin is given on days 3–5 of the monthly cycle, DHEA-s (DHEA-S) and free testosterone on days 8–10, 17-OH progesterone and estradiol on days 21–22 of the cycle. If the phases are not expressed, blood is donated after 7–10 days.
For the purpose of complex diagnostics, conduct research:
- Determining the concentration of low density lipoproteins (with PCOS increases) and high density (decreases) with polycystic ovary syndrome.
- The glucose tolerance test (insulin resistance), elevated insulin levels and high blood sugar indicate a violation of carbohydrate metabolism.
- Analyzes for thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH) to exclude hypo-or hyperthyroidism.
- Test with dexamethasone and test with ACTH (adrenocorticotropic hormone) to distinguish between different types of polycystic ovary.
- Laparoscopy for polycystic is performed for differential diagnosis. Usually during laparoscopy, it is determined that the ovaries are enlarged, their surface is knobby, and the follicular capsules have a characteristic whitish color. In addition, laparoscopy for polycystic is one of the most effective methods of sparing surgical treatment of the disease.
For more information about the treatment of polycystic folk and therapeutic methods, see our next article.
What is polycystic ovary
It is known that the ovaries are paired female sex glands, located on the sides of the uterus. The main functions of small organs, without which the pregnancy will never come - the production of female sex hormones and the production of follicles.
From the point of view of biology, the process of growth and maturation of the follicle is a rather complicated process, which can be influenced by a huge number of factors. The process starts in the first phase of the menstrual cycle (follicular) under the influence of estrogen hormones. At the same time about 7-8 follicles begin to grow, but in the end only one remains (in rare cases - 2), which is called dominant. It is from the dominant follicle that the ovum, which is ripe and ready for fertilization, eventually leaves, penetrating into the uterine cavity.
In 1935, two scientists, Stein and Leventhal, described a phenomenon in which a woman cannot become pregnant, and her ovaries are filled with multiple cysts, ranging in size from wheat grain to large cherry.
When scleropolystic ovulation does not occur, and multiple follicles that should have regressed, remain in the ovary and filled with liquid from the inside, thereby forming small cysts. Due to the numerous neoplasms, the ovary enlarges approximately 2 times, but sometimes it reaches a very impressive size, exceeding its norm by a maximum of 5 times.
Железа при СПКЯ покрыта тонкой жемчужно-белой капсулой и своим внешним видом напоминает виноградную гроздь. When performing a biopsy (excision of a piece of tissue for microscopic examination), no trace of the corpus luteum is found, which normally temporarily appears in place of the bursting follicle.
ICD code 10 for this pathology - E28.2
Causes of Polycystic Ovary
Girls with signs of primary polycystosis are born from mothers who have had infertility in the past, miscarriage, and other hormonal abnormalities. The hormonal “defect” is inherited from the mother and transformed into a polycystic ovary in her daughter. Other causes of primary polycystosis are infections that occurred in childhood, especially mumps (“mumps”).
Polycystic ovary syndrome occurs on the background of severe endocrine pathology, complications of the normal course of pregnancy and / or childbirth, serious brain injuries, stress, and intoxication.
In almost all (40-70%) women, polycystic ovarian disease develops against the background of a decrease in the body's insulin sensitivity (insulin resistance), the pancreatic hormone that controls blood sugar levels. As a result, a very large amount of insulin enters the bloodstream, and male sex hormones (androgens) begin to be synthesized in the ovaries in excess amounts. Against the background of hormonal dysfunction, destructive changes occur in the ovaries.
Under the influence of excess androgens, the outer membrane of the ovaries thickens. The ripe follicles present in it cannot collapse to release an egg cell, instead they expand and become filled with fluid, that is, turn into cysts. Polycystic ovaries contain a large number of cysts, due to which they increase in size.
Increasing the level of androgens can provoke not only excessive insulin production. At normal body weight and physiological norm of insulin in the blood, the normal functioning of the hypothalamus-pituitary-ovary system may occur. In this case, there is a decrease in the level of estrogen, increased production of growth hormone and increased concentration of androgens.
Polycystic ovaries can cause endocrine diseases (diabetes mellitus, adrenal pathology), obesity, hereditary predisposition.
Thus, hormonal imbalances are always the basis of polycystic ovaries.
Symptoms of polycystic ovary
The symptoms of polycystic is incredibly diverse, most of them are non-specific, as they can be present for any dishormonal disorder. They may appear with the first menstruation or a few years after a period of normal menstruation.
Adequate assessment of all obtained clinical, laboratory and instrumental data helps to make the correct diagnosis.
Diagnosis of polycystic ovaries starts with a general examination of the patient.
Frequent satellites of polycystic ovaries as external signs of hyperandrogenism are:
- Hypertrichosis - enhanced growth of individual rod hair in the chin, nipples, not the hips and neck. Always accompanied by primary lesion of the ovaries, indicates hyperandrogenism.
- Hirsutism - hair growth on the forearms, legs and face. It is marked with lesions of the adrenal glands or "hormonal" tumors.
- Virilism - male-type hair pattern, male physique, low timbre of voice. Accompanying violations of the gonadotropic function of the pituitary gland.
Almost all patients with polycystic ovaries are overweight (most fat on the abdomen). Women with primary polycystosis are distinguished by a correct physique, developed mammary glands and hypertrichosis. In patients with secondary polycystosis, there is underdevelopment of the mammary glands, narrow pelvis, and hirsutism.
Menstruation with polycystic ovaries come on time (12-13 years). The exception is polycystosis on the background of adrenal dysfunction. The nature of menstrual dysfunction depends on the form and causes of polycystosis, is represented by scanty (opsymenorrhea) or rare (oligomenorrhea) menstruation, acyclic uterine bleeding or amenorrhea.
The most common reason for going to a doctor is primary or secondary infertility, since without proper (not always effective) treatment, ovulation in polycystic ovaries is almost impossible.
During a pelvic exam, enlarged, dense ovaries are determined.
Laboratory diagnosis of polycystic ovary includes biochemical and complete blood count, determination of blood glucose and insulin sensitivity, cholesterol, study of blood lipid profile.
An important diagnostic value is the determination of the level of hormones in the blood and their ratio. Hormonal examination is carried out taking into account the phase of the cycle. An important criterion in the diagnosis of polycystic ovarian is an increase in the ratio of LH and FSH more than 2 - 2.5 (at a rate of 1 - 1.5). It is not always the usual one-time study of the hormonal status of the patient is sufficient for diagnosis, more often the study is conducted on the background of special hormonal tests (for example, the test with Dexamethasone).
Ultrasound examination (ultrasound) is very informative in relation to the diagnosis of polycystic ovary. Ultrasound - criteria for polycystic ovaries are:
- Symmetric (bilateral) significant enlargement of the ovaries.
- The size of the ovaries should be such that their volume was greater than 9 cm ³.
- Increased stromal density up to 25% by volume.
- Thick capsule (reliable sign of hyperandrogenism).
- On the periphery of the ovaries there are multiple neovulirovanny follicles (not less than 10) with a diameter of 8 - 10 mm.
The diagnosis of polycystic ovary, made only on the basis of ultrasound - signs, can not be reliable without the appropriate clinical manifestations. This is especially true in the case of examination of women with regular ovulatory cycles and the absence of characteristic symptoms. It is fair to talk about "ultrasound - signs of polycystosis," which implies the likelihood of the development of the disease in the future. After additional testing for this category of women, it is advisable to establish an observation.
An elevated level of insulin in the blood of patients suggests a combination of polycystic ovary with type 2 diabetes. Systemic abnormalities in polycystic ovary disease lead to the early development of vascular pathologies, such as hypertension and atherosclerosis.
The most alarming of all the consequences of polycystic ovarian disease is endometrial hyperplasia (19.5%), in 2.5% of cases provoking the development of a malignant disease (adenocarcinoma). In the presence of bleeding or persistent hyperestrogenism, diagnostic laparoscopy is performed in some cases.
Surgery for polycystic ovaries
The indication for surgical treatment of polycystic ovary is the lack of effect from conservative therapy. The method of operation is determined depending on the picture of the disease. In women with infertility, surgical treatment is analogous to hormonal stimulation of ovulation.
All surgical procedures are performed with the participation of a laparoscope under general anesthesia. Most commonly used are the following types of operations:
- A wedge-shaped resection of the ovary is performed with a significant increase in the volume of the ovaries. The overgrown ovarian tissue (sometimes up to 2/3 of its volume), which is responsible for the excessive production of androgens, is removed. Against the background of the elimination of hyperandrogenism, normal hormones are restored and ovulation occurs.
- Endothermocoagulation of the ovaries applies with a slight increase in the size of the ovaries. The operation is not as traumatic as resection, and takes less time. The essence of the method consists in a point “burning” of the ovarian tissue in order to eliminate the excessive production of androgens.
- Decortication of the ovary. Conducted in order to eliminate altered (sclerosed and thickened) ovarian tunica. It is removed with a scalpel, and the cystic changed follicles are punctured.
Sometimes the choice of method of operation occurs during diagnostic laparoscopy, which allows for surgical treatment directly after examining the ovaries. Another advantage of laparoscopic surgery is the ability to eliminate adhesions and / or restore the patency of the fallopian tubes.
After surgical treatment, ovulation usually recovers within 6 to 12 months. The onset of ovulation is controlled by laboratory and conducted hormonal tests (measurement of basal temperature). If during two to three normal cycles ovulation does not occur, it is stimulated with hormonal preparations. Lack of ovulation during the year after surgery is a bad sign, and further treatment of infertility does not seem appropriate.
Unfortunately, it is necessary to note that in some cases the restoration of ovulation is temporary, the relapse of the disease usually occurs five years after treatment. In order to prevent the recurrence of the disease, as well as to regulate the menstrual cycle, reduce hirsutism and prevent hyperplastic processes, COCs of a monophasic nature or gestagens are prescribed in the second phase of the cycle.
Diet for polycystic ovaries
The vast majority of patients with polycystic ovaries are overweight.
Adipose tissue has the ability to accumulate steroids, an excess of fat means an excess of steroids and hypothalamic dysfunction, which "directs" the menstrual cycle. Obesity leads to amenorrhea, infertility and many other serious consequences.
For successful treatment of hormonal disorders, it is necessary to eliminate the negative effects of adipose tissue on the body, therefore, treatment of polycystic ovaries begins with weight correction.
The dietary program is a nutritionist. The recommended amount of foods eaten depends on the degree of obesity, the growth of the patient, her profession, as well as the degree of physical activity.
There are many options for dietary obesity. All of them are based on the following basic principles:
- The body is easy to part with those extra pounds, if it lacks energy, that is, calories. If you reduce the calorie content of food and create an artificial lack of energy, the body will “burn” fat to replenish it. You can limit calories by eliminating fatty foods, sugar and alcohol from the diet. Instead of giving up any foods, you can reduce their consumption, based on their caloric content. There are many options for low-calorie diets that a nutritionist can recommend.
- To reduce the weight recommended limiting the consumption of carbohydrates: potatoes, sugar, chocolate, bread, cereals, pasta. Sources of carbohydrates should be vegetables, legumes, dietary breads, lightly sweet fruits and berries, buckwheat, oatmeal.
- The amount of protein in the diet of the patient should remain normal or elevated. It is necessary to include meat, lean fish and cottage cheese, eggs and seafood in food.
- Meals should not be rare. The optimal number of meals per day is 5-6 times. Between meals, raw vegetables and fruits are recommended for consumption. It is a mistake to believe that if there is little, you will certainly lose weight. For weight loss, it is not the amount of food eaten that is important, but its quality.
- The so-called fasting days with a limited list of permitted products are an integral part of clinical nutrition.
Once the body weight returns to normal, the number and range of products used can be expanded. However, if the patient returns to her previous diet, overweight will quickly return. In order to permanently get rid of obesity, it is necessary to use foods in such quantities that the body weight remains in a stable physiological state.
Physical activity (fitness, gymnastics) are a good addition to a balanced diet. In some patients, playing sports just two hours a week together with a diet gives a result similar to the use of special weight loss pills.
As in the case of diet, intensive exercise will help to quickly get rid of extra pounds, but the cessation of physical activity will return the excess weight. Just look at the former athletes to make sure of this opportunity. If a woman is not ready for constant physical exertion, it is better to choose the optimal mode of physical activity.
Tighter diets and increased physical exertion help to quickly reduce weight, but are not able to keep it. This problem can be successfully solved only by a correct lifestyle, not imposed from the outside, but consciously chosen by the woman herself.
Causes of Polycystic Ovary Syndrome
Unfortunately, like many other diseases of the gonads, the exact cause of PCOS has not yet been established, although work in this direction is very active. However, doctors identify factors that lead to the development of serious pathology:
- Excessive amounts of androgens (male sex hormones) produced in the ovaries of women with PCOS. In peripheral tissues (mainly in adipose tissue), androgens are transformed into female sex hormones — estrogens, which stimulate the production of luteinizing hormone (LH), but strongly inhibit follicle-stimulating (FSH). An excess of LH, in turn, causes an excessive formation of androgens in the ovaries, which leads to sad consequences.
- Pathology of the pituitary gland. The pituitary gland is an important organ involved in the production of hormones (FSH and LH) that affect the growth and maturation of follicles. When an endocrine gland located at the base of the brain fails, elevated levels of LH are often noted, leading to excessive formation of androgens in the sex glands. Also, LH enhances the production of growth hormone, which has a significant impact on the development of PCOS.
- Imbalance of active enzymes in the ovary. In the course of numerous studies, it was found that in the ovaries of sufferers of PCOS, the activity of some enzymes is too high, and vice versa - too low, in others. Such an imbalance for the body does not pass in vain, and in the end, the lack of balance invariably leads to an increase in the number of androgens.
- Insulin resistance. In almost all patients with PCOS and overweight, insulin immunity (resistance) is noted. When the body does not perceive this hormone, its amount in the blood inevitably increases, which leads to an increase in the level of LH and androgens. Due to the increased amount of insulin and androgens, premature aging of the eggs occurs - not one of them grows into a dominant follicle, but does not regress either.
There are factors that can give rise to breakdowns in the body, thereby increasing the risk of developing PCOS many times:
- overweight summer
- chronic inflammatory gynecological diseases,
- frequent abortions, especially those made surgically,
- bad ecology (which is especially important for residents of large cities),
- untreated chronic infectious diseases,
- endocrine pathologies (pancreas and thyroid, adrenal glands),
- frequent stress
- complicated pregnancy and childbirth.
Interesting fact: In the course of research in the field of PCOS, scientists from Harvard found out that the disease most often affects those women who often drink plastic bottles. The fact is that in the production of plastic containers, bisphenol A is used, which is a bit similar in its properties to the female hormone estrogen. It is especially dangerous to drink drinks from warm bottles (for example, so moms often warm the milk in the microwave for young children, or the tank has stood for a long time in direct sunlight). Heating plastic only increases the penetration of bisphenol into the body.
Good day. A couple of years ago, I had a two-chamber cyst of the left ovary, which burst and I was operated on. Yesterday I was on an ultrasound scan, and the doctor saw my multifollicular ovaries. I'm afraid, what if it's polycystic and I have to visit the surgeon again? What is the difference between them and what should I do? (Anna, 37 years old)
Hello Anna. It all depends on which day of the cycle you did the ultrasound. The fact is that for certain days such a picture as multifollicular ovaries is a normal variant, whereas polycystic is a pathology. If you are worried, redo the study again, 5-7 days after the first day of your period.
The doctor’s tactics in the treatment of polycystic ovary syndrome depends on the severity of the clinical manifestations and the woman’s desire in the future to realize her reproductive function.
Treatment usually begins with the normalization of body weight. Getting rid of excess weight with PCOS is not so easy. Lose weight will help proper nutrition, compiled by an experienced nutritionist. A strict adherence to the daily menu compiled by the doctor will lead to the normalization of fat and carbohydrate metabolism in the body.
Диета должна быть составлена таким образом, чтобы насыщенные жиры не превышали 1/3 суточного приёма пищи (есть рекомендуется не более 2000 ккал. в день). Результативны также «голодные» дни 1-2 раза в неделю, в течение которых женщина может есть только фрукты либо обезжиренные молочные продукты. Полное голодание не рекомендуется при СПКЯ, чтобы не допустить повышенного расхода белка. Together with a diet, fat patients need to play sports according to a program drawn up by a doctor taking into account her individual characteristics.
When planning a pregnancy, treatment regimens to increase the chances for a woman to become a mother can vary, because each person is unique and requires an individual approach to herself. Specialist actions may include:
- The appointment of antiandrogenic drugs ("Veroshpiron", "Androkur", "Tsiproteron", etc.)
- Treatment of elevated glucose (often used for these purposes, the drug "Siofor", "Metformin" or "Glucophage", usually used to reduce the concentration of glucose in people with type II diabetes).
- Stimulation of ovulation. If a couple tries unsuccessfully to conceive a baby for more than 1 year and other causes of infertility other than PCOS, the woman is not identified, and the man is healthy, the doctor conducts the patient to stimulate ovulation. With the help of gestagens and estrogens, artificial hormones are created, then substances are added that are able to “grow” the dominant follicle with a mature egg cell. To achieve such effects, the following drugs are used: Duphaston, Utrogestan, Clomiphene, Divigel, Proginova.
- Laparoscopy. During surgery, the surgeon excises part of the ovary (resection). As a result of his actions, sex glands get "stress", which leads to increased hormone production and natural stimulation of ovulation. A drainage is also often installed in the abdominal cavity, which is removed a couple of days after surgery. You can get pregnant after such manipulation in about 3-6 months. Very often, after laparoscopy, the doctor additionally conducts his patient's drug-induced stimulation of ovulation in order to increase the woman’s chances of pregnancy. If conception did not occur within 6-7 months, it is better not to delay time and proceed to the next stage.
- ECO. Unfortunately, even IVF can not always help a woman conceive a long-awaited child. Polycystic ovaries may be resistant to treatment, and doctors simply will not be able to collect eggs from damaged glands. Therefore, quite often eggs are borrowed from donors - surrogate mothers.
It should be borne in mind that pregnancy with polycystic ovary syndrome can occur on its own, without hormones and operations. However, the chance of a natural conception is too small, and the results can be known for years. Some doctors recommend taking some time oral contraceptives, and then, having canceled them, begin to live an open sex life without contraception. Indeed, abrupt cancellation increases the likelihood of a full follicle maturing.
If the patient does not want to become a mother, it is still necessary to treat the pathology, since ignoring the problem can lead to disastrous consequences. Drug treatment of the disease involves the reception of:
- Antiandrogenic drugs and treatment of elevated glucose levels.
- Hormonal contraceptives designed to suppress the excessive production of androgens and restore normal hormonal levels (Yarin, Diane 35, Jess, etc.).
- Synthetic hormone progesterone. Most often, the choice of doctors falls on the tablets "Duphaston.", Because it has the greatest effectiveness when taken orally, and also does not have androgen-like, corticosteroid and estrogen-like action. After treatment, "Duphaston" in patients creates the effect of false menstruation, but without the release of an egg cell there is no full menstrual cycle.
- Drugs designed to gently stimulate the ovaries. Usually it is “Folic acid”, “Remens” or “Cyclodinone”.
In the case of ineffectiveness or complete ineffectiveness of non-drug therapy for 6 months, further treatment without surgery, alas, becomes impossible. Minimally invasive surgery can be performed in two versions:
- electric coagulation of cysts. This method is considered more secure. Incisions are made on the sex gland, and small cystic formations are cauterized,
- wedge-shaped resection of the ovaries - removal of androgenic formations.
The operation is only a temporary salvation of the female body, because polycystic is almost impossible to cure completely without removing the affected organs. In every second case, the disease recurs approximately 5 years after surgery.
Polycystic ovarian forms
- Primary (true) PC.
- Secondary PCO (Stein-Leventhal syndrome).
True polycystic ovarian disease is a pathological process that occurs in women who have normal body weight, and during its development no increase in the level of insulin in the blood is observed. For primary polycystosis, a more severe course is characteristic and it is poorly amenable to conservative and surgical treatment. As a rule, the development of the disease begins in puberty (10-12 years).
Secondary polycystic is most often found in middle-aged women suffering from overweight and insulinemia. At the same time, this form of pathology can develop against the background of ovarian extinction (during menopause). It is much easier to treat and can often be eliminated with the help of conservative methods.
Many experts believe that polycystic ovary syndrome and polycystic ovarian syndrome are the same pathology, and therefore they recommend treatment aimed at normalizing hormonal balance without taking into account the cause of the disease. However, there is a big difference between these pathological forms. It should be noted that polycystic ovary syndrome is a pathological condition that occurs in 5-10% of women and is considered the most common cause of malfunctioning of the reproductive system.
To date, the classification of Stein-Leventhal syndrome has been adopted in clinical practice. It highlights:
- Ovarian (typical) form,
- Ovarian-adrenal (mixed) form,
- The central form, occurring with a lesion of the central nervous system.
Polycystic ovarian disease: etiology and pathogenesis
Science learned about polycystic ovaries more than 100 years ago, but so far, due to the fact that this manifestation is characterized by multiple manifestations, its etiology and pathogenesis are still not fully understood.
The main causes of PCL are usually attributed to:
- Increased secretion of androgens.
- Insulin resistance.
- Overweight and obesity.
- Hormonal disruptions in a single neurohumoral integration system.
- Constant stress.
- Increased prostaglandins.
- Transferred infectious and inflammatory diseases.
- Climatic aspects.
The theory of the central origin of PCL.
To date, the focus is on the central theory of polycystic development, which associates the occurrence of the pathological process with damage to the hypothalamic centers and impaired production of gonadotropins LH and FSH.
With insufficient production of FSH, ovarian enzyme deficiency develops (we are talking about enzymes catalyzing the process of estrogen production). As a result, androgens accumulate in the female genital glands, which suppress the growth and maturation of follicles and provoke their cystic regeneration.
However, the increased production of luteotropin increases the secretion of androgens, which, in turn, leads to a decrease in the secretion of follicle-stimulating hormone and the production of estrogen.
According to many authors, the development of the pathological state provokes a violation of the secretion of neurotransmitters, which leads to failures in a single integration neurohumoral system (hypothalamus - pituitary - ovaries - adrenal glands). However, to this day, the root cause of such violations has not been thoroughly studied.
Also, the pituitary melatonin production (hypermelatoninemia), increased secretion of serotonin and prolactin and reduced production of thyroid hormones also indicate the central origin of PCL.
Note: in some cases, a malfunction of the thyroid gland can trigger the development of polycystic ovary.
Along with this, morphological changes in the sex glands can occur against the background of menopause, after inflammatory diseases, and also due to the primary defect of the enzyme system. As a result, the production of androgens increases, or the growth and maturation of follicles are disrupted, which leads to malfunctioning of the regulatory mechanisms of the female reproductive system.
At the same time, genetic, perinatal, psychogenic and endocrine and unfavorable production factors (poisoning with salts of heavy metals, benzene, etc.), as well as long-term administration of oral contraceptives can provoke the development of PCL.
According to experts, 40 different genes can provoke an increase in the secretion of androgens (polygenic nature of inheritance). Most often prone to the development of the disease are women in whom the immediate family suffered from malignant and benign tumors of the ovaries and uterus. PSC is also detected in those patients who had a high incidence of gestosis during pregnancy, those suffering from obesity, hirsutism, type 2 diabetes mellitus and various menstrual disorders. However, many authors draw attention to the existing relationship between the age of the patient's parents. So, the older the parents, the higher the influence of various adverse factors on the body of the fetus.
Decreased glucose tolerance
Numerous studies have shown that PCOS is a disease that is associated with increased insulin production. Somehow, the increased secretion of this hormone is associated with an increase in the secretion of male sex hormones. Most experts argue that women suffering from obesity, triggered by increased production and insulin resistance, form a chain of pathological changes, leading to menstrual disorders, hirsutism, lack of menstruation and infertility.
In 40-60% of women diagnosed with polycystic ovary syndrome, insulin resistance is detected at the same time, often accompanied by obesity. And sometimes with diabetes of the second type, a decrease in glucose tolerance can be observed even in the absence of obesity.
The role of infectious pathogens
Many experts in the development of polycystic ovaries do not exclude the role of infectious pathogen. For example, a history of patients with PCA of central origin may have chronic upper respiratory tract diseases (65%) or childhood infections. Since the ovaries are very closely associated with the tonsils, tonsillitis or ARVI can trigger the development of the pathological process.
Symptoms of true polycystic ovary
The main symptom of this form of pathology is a violation of the menstrual cycle. As a rule, this condition is observed in adolescent girls after the onset of menarche (first menstruation). With the development of the pathological process on the face, back and neck acne appears (acne). Due to the hyperfunction of the sebaceous glands, skin and hair are quickly contaminated, and therefore, even with the most careful care, they constantly shine and look oily. Gradually, hirsutism (excessive hair growth) begins to progress. It appears on the legs, arms, groin and even in the chest area. Then the body mass begins to increase (up to 10-15 kg) and menstrual bleeding is delayed (from one month to six months). Patients complain of nagging pain in the lower abdomen, the female sex glands increase in size, infertility develops.
Symptoms of Polycystic Ovary Syndrome
In almost all forms of Stein-Leventhal syndrome, the menstrual cycle fails, leading to impaired female reproductive function.
For a typical (ovarian) form of polycystic is characterized by oligomenorrhea (short duration of menstruation), or secondary amenorrhea (absence of menstruation for six months or more). Most often, this form of pathology is detected in adolescent girls after the onset of menarche.
The mixed form of Stein-Leventhal syndrome is characterized by a later onset of menarche. In this case, menstrual disorders take the form of secondary amenorrhea and lead to the development of infertility.
With the central form of the pathological process, the first menstrual periods in girls begin at the age of 12-13 years, however, the menstrual cycle is very unstable, which leads to the development of oligomenorrhea or amenorrhea. As a result, reproductive function is impaired, spontaneous abortions occur on small periods of pregnancy, or secondary infertility develops.
Note: brain trauma, stress, and even the first sexual intercourse (defloration) can provoke the development of this gynecological pathology.
The main symptom of polycystic ovary syndrome is hirsutism (overgrowth of terminal hair of a male type). As a rule, such a symptom is detected in 50-100% of patients, and is often the only complaint with which they turn to a specialist. Overweight hair develops gradually, after the onset of the first menstruation. Most often there is a growth of hair above the upper lip, on the chin and in the area of the white line of the abdomen. However, pronounced hirsuitism is not characteristic of this form of the disease.
In the mixed form of Stein-Leventhal syndrome, increased body hair is observed in 100% of cases. In this, hair begins to grow on the face, on the legs and on the hips.
In 60-90% of episodes, hirsutism develops in the central form of polycystic ovaries (3-5 years after the onset of menstruation). The most pronounced symptoms observed in women of reproductive age. During this period, stretch marks appear on the chest, abdomen and thighs, nails and hair begin to break down strongly.
In patients with polycystic ovary syndrome developed on the background of obesity, there is an uneven distribution of adipose tissue (on the hips and in the shoulder girdle area).
Diseases that can mimic polycystic
- Pathological processes associated with hypothyroidism,
- Tumors of the ovaries and adrenal glands,
- Increased secretion of prolactin (pituitary hyperprolactinemia).
I would like to emphasize that in the above diseases, the symptoms are very similar to the signs of PCO, and therefore much attention should be paid to the diagnosis of the pathological process.
Polycystic ovary: is it possible to get pregnant?
Most experts say that getting pregnant with PCOS is quite possible. In clinical practice, there are many cases of successful childbearing by patients suffering from polycystic disease. However, for this throughout the pregnancy, they are recommended supportive drug therapy.
However, pregnant women diagnosed with polycystic ovarian disease are at risk of miscarriage or fetal death, and premature labor is also possible.