Polycystic ovaries symptoms
Polycystic ovaries - a chronic syndrome on the basis of endocrine disorders characterized by the formation of follicular cysts (spherical thin-walled structures, filled with clear fluid) in both ovaries.Each ovary contains many structures known as follicles.Approximately once a month hormones stimulate a follicle, and it starts to grow and rise to the surface of the ovary, where it ruptures and releases the egg.At the same time, the follicles of hormones cause the uterus to thicken the wall to provide support if the egg is fertilized.Egg released from the ovary through the fallopian tube into the uterus.If fertilization does not occur, the thickened tissue lining the uterus are separated, and the egg, extra lining tissue and blood are derived through the vagina during menstruation.
In polycystic ovarian follicle grows, but he is unable to break.Rather than select an egg follicle forms a cyst right under the surface of the ovary.Normal menstruation may occur at the beginning of puberty, but then they b
Untreated relative abundance compared to estrogen progesterone may increase the risk of endometrial hyperplasia and uterine cancer.However, the disease often responds well to treatment, which can eliminate infertility and other symptoms.The specifics of the treatment depends on the individual patient's needs, especially on whether the woman wants to have children in the future.
• Abnormal hair growth on the face.
• The absence or irregular menstruation.
• The disease is often associated with obesity and insulin resistance.
There are 3 types of polycystic ovary syndrome:
1) polycystic ovary syndrome with normal body weight;
2) polycystic ovary syndrome with android obesity and related disorders of carbohydrate metabolism: increase of insulin in the blood and the loss of sensitivity of tissues to this hormone;
3) polycystic ovary syndrome, obesity without loss of insulin sensitivity.
Obesity is observed in approximately 40% of women with polycystic ovary syndrome.Adipose tissue is the site of activation of estrogen formation process (female sex hormone).Increased production of the hormone promotes development in women with polycystic ovary syndrome pathological processes in the endometrium (the inner uterus) and in the mammary glands.
to lower the type of obesity are more common mild numbness of body tissues to insulin, or its absence, a moderate increase of male sex hormones in the blood serum of normal blood lipids, lower risk of developing diabetes.In the domestic literature, this form of the syndrome is called secondary polycystic ovaries or polycystic ovary syndrome of central origin.An examination of these women revealed various disorders of the nervous system: vegetative-vascular dystonia (usually of hypertensive type), frequent headaches, increased appetite, sleep disturbances, emotional disorders (depressed mood, tearfulness, irritability), signs of increased intracranial pressure,signs of dysfunction of certain brain structures.Often there is hypertension (high blood pressure).Characterized by a gradual progression of all manifestations of the increased content of androgens (male sex hormones) and anovulation (lack of ovulation) due to weight gain.
Identifying polycystic ovary syndrome based on the appearance of a woman has all the characteristic symptoms of the disease, functional diagnostic tests for the detection of ovulation disorders, ultrasound, X-ray and other instrumental methods of examination.In addition, the content is determined by the pituitary hormones, adrenal and ovarian serum.When overweight determine body mass index, the ratio of waist circumference to hip size, as well as conducting a study of carbohydrate metabolism: blood glucose level on an empty stomach, oral glucose tolerance test.
validity criteria polycystic ovary syndrome are as follows:
1) chronic lack of ovulation;
2) skin lesions (male pattern of body hair, oily dandruff, acne);
3) increased and (or) penisoobrazny clitoris;
4) at US internal genitalia revealed bilateral ovarian enlargement in 2 or more times, no signs of ovulation on a background of multiple (more than 10) small cysts;
5) in 70% of cases there is a change in hormonal levels;
6) a moderate increase in the level of free male sex hormones.
necessary to distinguish between polycystic ovary syndrome from all the diseases associated with manifestations of excessive amounts of the male sex hormones.Special features of tumors of the ovaries and the adrenal glands, leading to the appearance of male characteristics in women are the sudden onset and rapid progression of all male phenomena.When hormonal study reveal specific to each disease, hormonal changes background.To detect tumors used ultrasound pelvic examination and a CT scan of the adrenal glands.The use of computed tomography in the study of the pelvic organs is not superior to ultrasound method.
When questionable or negative results of these studies in a surgical hospital carried out the introduction of a catheter into the ovarian and adrenal veins to determine hormone levels in the blood, flowing directly from the authorities.However, although this method is highly informative, because of the complexity and invasiveness of its use in clinical practice is limited.
disease or Cushing's syndrome may also be accompanied by the development of male pattern body hair, menstrual dysfunction, infertility, obesity.To eliminate this disease carried out special tests with the subsequent quantitative determination of serum hormones.
• Cause of the disease is unknown;it can be hereditary.
Causes of cysts are not completely clear;probably plays a role of an imbalance between the generation of two pituitary hormones that normally stimulate functioning ovaries: luteinizing hormone and follicle.Polycystic ovary is observed in women at puberty.
• Medical history and examination of the pelvic organs.The gynecologist can detect an enlarged ovary during bimanual examination.
• Blood tests to measure levels of LH and follicle-stimulating hormone, testosterone and other hormones that are associated with the functioning ovaries.
• ultrasound examination can be performed.
• Laparoscopic surgery of the abdominal cavity (the use of tubes with light, which is inserted into the abdomen through a small incision) can confirm the diagnosis.
• Those women who want to have children, can be prescribed clomiphene citrate, a drug for infertility, or hormones, such as human gonadotropin and human chorionic gonadotropin to stimulate ovulation.Sometimes performed laparoscopic surgery to reduce the size of the ovary (wedge resection or ovarian puncture), to create a more favorable environment for ovulation.Control of insulin resistance may contribute to success.
• Those who do not want to have children may be prescribed oral contraceptives or progestins such as progesterone acetate medroksi to suppress ovulation and reduce the risk of endometrial hyperplasia or uterine cancer later on.
The basis of the modern approach to the treatment of polycystic ovary syndrome is the principle of recovery of impaired ovulatory function of the ovaries.There are two approaches to the treatment of polycystic ovary syndrome - the conservative and operative.
Before starting specific treatment is necessary to carry out the correction of body weight, recovery of carbohydrate metabolism and normal functioning of the cardiovascular system.
the treatment of polycystic ovary syndrome following drugs are used.
1. Gestagens (progesterone and its analogues - female sex hormones) are used to normalize the menstrual cycle and ovulation and restore fertility.Preference is given to preparation Duphaston (dydrogesterone), which, unlike other synthetic hormones do not provide much pronounced adverse effects.Use this drug with moderately severe menstrual disorders and ovulatory function.In addition, progestogens are used for prevention and treatment of endometrial hyperplasia (swelling of the inner lining of the uterus).The effectiveness of the treatment drugs only female sex hormones is 20-25%.
2. Combined hormonal contraceptives for women (non-ovlon, Ovidon, rigevidon et al.).These drugs are used for the same purpose as discussed above.Their additional effect is to stimulate the formation of a special protein in the body that binds testosterone, thereby reducing the level of free male sex hormones in the blood serum of women with polycystic ovary syndrome.The treatment occur regularly menstrualnopodobnye isolation and prevented growth of the inner layer of the uterus, and discontinuation of treatment (duration of it should be at least 6 months) in 25-30% of women helps to restore ovulatory function of the ovaries.
3. Anti-androgens.This drug is cyproterone acetate (androkur), has the property to block the action of androgens (male sex hormones), the cells of the body - anti-androgenic effect.It is used in combination with estrogens (female sex hormones) and is assigned to the 5 th to the 15 th day of the menstrual cycle 10-50-100 mg per day.In addition to the antiandrogenic effect, this drug reduces the synthesis of the ovaries of male sex hormones, prevents overgrowth of the uterine lining, together with estrogen increases synthesis of a particular protein in the liver, which binds testosterone (male sex hormone) and is scheduled menstrualnopodobnye selection.In addition, this group of drugs prescribed to women with PCOS to reduce the effects of skin lesions: male pattern body hair, oily dandruff, acne.Treatment long - from 6 to 12 courses.In order to better long-term use as maintenance therapy further appropriate to take a combined preparation "Diane-35", which is composed of the female sex hormone, and an anti-androgen.It is assumed this drug is 5 to 25-day menstrual cycle.
4. Veroshpiron (diuretics) also has anti-androgenic effect.Use this medication, usually with increased intracranial pressure, premenstrual syndrome with swelling before menstruation.It is assigned 200 mg per day in the second phase of the menstrual cycle to prevent breakthrough bleeding.Duration of treatment should be at least 6 months.
After 6 months of "training" combined hormonal therapy ovulation stimulation is performed.For this purpose klomifenon drug (Clomid, klostilbegit).This drug increases the formation of protein in the liver, binding the male sex hormones (anti-androgenic effect), reduces the formation of male hormones in the ovaries, stimulates the formation of the corpus luteum and the female hormone progesterone, blocking the growth of the uterine lining, and normalizes the menstrual cycle.He is appointed for a specific pattern: 50-100-150 mg per day from 5 th to 9 th day of the cycle.As a result of the treatment is recovered ovulation in 70% of cases, fertility - 40%.In the absence of stimulation effect after 3-4 courses of clomiphene its use is impractical.
Thus, for the conservative treatment of polycystic ovary syndrome used an arsenal of various hormones, but not always possible to achieve the restoration of ovulation and fertility.Lack of effect of conservative therapy for 1 year is an indication for surgical treatment.The main method of surgical treatment is bilateral partial removal of the ovaries (ie. E. Body is not completely removed, but remains a small part of it).increasing use is low-traumatic laparoscopic surgical method of treatment in recent years, in which the removal of the ovaries is performed through a minimal incision.Due to the fact that the ovary has high capacity for regeneration, it can take the original shape and size without the formation of scar tissue and to maintain its function even after removal of 2 / 3-3 / 4 part of its volume.When surgical treatment of a regular menstrual cycle is reduced almost 90% of cases, ovulation - 70%, fertility - in 60% of cases.
• Consult your gynecologist if you have any symptoms of polycystic ovarian .
• There is no known way to prevent polycystic ovaries.