Polycystic ovary - symptoms, causes and treatment

Polycystic ovary syndrome is a syndrome whose morphological manifestation is numerous cystic masses in the sex glands.

Thus, the functioning of the female reproductive system is ensured by the coordinated work of the hypothalamus, pituitary, ovaries, adrenal glands and the thyroid gland. In the case of polycystic ovaries, this mechanism "knocks", leading, ultimately, to infertility.

The result of polycystic is the formation of numerous cysts on the surface and inside the ovary, which can be either single or merge into intricate "clusters."

The formation of such benign neoplasms on the body of the ovary leads to the fact that the dominant follicle does not mature in it, and as a result, anovulatory cycles predominate in the woman, which makes the occurrence of pregnancy impossible.

Causes

Why does polycystic ovary develop, and what is it? Polycystic ovary syndrome (PCOS) is a very common gynecological disease in which the following disorders occur in a woman's body:

  1. In the ovaries, egg maturation is impaired, as a result of which a woman may have considerable difficulty in conceiving a child.
  2. Multiple cysts (vesicles filled with fluid) can form in the ovaries.
  3. Monthly come rarely with long breaks or stop altogether.
  4. A large number of male sex hormones (androgens) are produced in a woman’s body.

Similarly, the reason is still under study. There are several theories trying to explain the mechanism of development of polycystic ovaries, but they do not have a sufficient evidence base, so we will not give them below.

It is believed that predisposing for the development of this state in the ovaries are such factors:

  • inflammation of the reproductive organs;
  • hereditary factors (if women in the family had such a pathology);
  • trauma to the genitals (especially the ovaries);
  • obesity;
  • frequent abortions;
  • complicated and difficult childbirth.

Also distinguish between primary polycystic ovary syndrome (Stein-Leventhal syndrome) and secondary polycystic ovary syndrome. Syndrome secondary polycystic ovaries develops on the background of adrenal hyperplasia, thyroid disease, diabetes, obesity.

Can I get pregnant with polycystic ovary

A hormonal disorder that causes polycystic ovary syndrome is observed in women of reproductive age. Due to the disruption of the natural maturation process of the follicles, the mature egg does not leave the ovary.

An additional "obstacle" is the thickened capsule of the ovary, which is formed during polycystic. Thus, ovulation occurs much less frequently than a healthy cycle implies (oligo-ovulation) or does not occur at all (anovulation). Outwardly, this is manifested by the absence or irregularity of menstruation and infertility. Often women will find out about polycystic ovarian syndrome, already starting treatment for infertility. Sometimes these patients manage to get pregnant, but often due to hormonal impairment, pregnancy ends early.

However, in most cases, after a course of treatment of polycystosis, it is possible to become pregnant and successfully bear and give birth to a healthy child. In most cases, polycystic prevents the conception of the child more than his carrying. If polycystosis has already been diagnosed in a pregnant woman, then a course of hormonal and drug therapy should be taken to maintain normal health and successfully bear the fetus.

First signs

Initial signs of polycystic ovary:

  1. Menstruation disorders;
  2. Overweight;
  3. Increase the amount of hair on the body.

The primary signs of polycystosis are difficult for doctors to identify. A significant role in the verification is assigned to a woman. In case of irregular or prolonged menstruation, consult a doctor immediately.

Symptoms of polycystic ovary

There are several characteristic symptoms of polycystic ovary, which can be observed in various combinations, have different severity:

  1. Irregular menstrual cycle: long breaks (more than 35 days) between menstrual periods are characteristic; occasionally pi polycystic ovarian vaginal bleeding occurs 2-3 times a month.
  2. Scanty (more often) or heavy (less often) cyclic bleeding.
  3. Duration of menstruation is different: from 2-3 to 7-10 days.
  4. The growth of noticeable dark hair on the face, chest, abdomen - hirsutism. A symptom occurs due to an excessive amount of androgens in the blood of a woman.
  5. Rough (male) voice.
  6. Obesity. The distribution of excess fatty tissue occurs in the male type (in the lower abdomen and in the abdominal cavity, while the arms and legs remain of normal size).
  7. Oily skin plus acne or body acne.
  8. Alopecia. Male-pattern baldness of the scalp is characteristic (balding on the forehead and on the crown).
  9. Fibrocystic mastopathy.
  10. Hyperinsulinemia. Increased blood insulin levels due to tissue insulin resistance.
  11. Infertility. It is explained by chronic anovulation or rare ovulation (during the rupture of the follicle and the release of the egg, it cannot break through the very dense membrane of the ovary).

As you can see, polycystic is manifested differently depending on the reasons that caused it. Most often, this disease is characterized by symptoms such as an increase in the size of the ovaries and an irregular menstrual cycle. A woman who takes care of herself should be alerted by long delays. This is already a serious reason to consult a doctor. It is worth paying attention to the basal temperature, which normally should increase in the second half of the cycle, and in case of polycystic it remains the same all the time.

Diagnostics

The diagnosis of polycystic ovary is made on the basis of ultrasound, but for the correct diagnosis is not enough. Polycystic ovaries give a peculiar characteristic picture on ultrasound, but sometimes a completely healthy woman can have the same picture. In this regard, it is wrong to diagnose polycystic diagnosis on the basis of ultrasound only.

Therefore, you need to pass a blood test for such hormones:

  • luteinizing (LH);
  • follicle-stimulating (FSH);
  • testosterone;
  • insulin;
  • cortisol;
  • 17-OH progesterone;
  • DEA sulfate;
  • thyroxin (T4);
  • triiodothyronine (T3);
  • thyrotropin (TSH).

The diagnosis of polycystic ovaries cannot be made until diseases that give exactly the same clinical picture are excluded:

  • Cushing's syndrome - an increased amount of cortisol;
  • androgenital syndrome - increased testosterone levels;
  • hyperprolactinemia - prolactin oversupply;
  • hypothyroidism - reduced thyroid function.

In general, the diagnosis of polycystic ovary will be reliable only if it is based on the results of laboratory and ultrasound studies and takes into account the whole complex of symptoms, that is, the clinical manifestations of the disease. Polycystic ovary syndrome is a combination of symptoms, including menstrual disorders, infertility and the manifestation of androgenic dermapathy.

Treatment of polycystic ovary

With a diagnosed polycystic ovary, treatment is a complex, multi-step process of consistently restoring the physiological parameters of the entire body. Polycystic ovarian disease is not only a gynecological disease, so treatment should also be aimed at eliminating those disorders that led to the development of ovarian pathology. The volume of therapeutic measures is determined by the intensity of the process and the desire of a woman to become pregnant.

Polycystic ovary treatment requires the following points:

  • regulation of metabolic processes in the brain (that is, therapy affecting the hypothalamic-pituitary system);
  • suppression of androgens excessively produced by the ovaries;
  • normalization of weight, the elimination of topical metabolic disorders;
  • therapy focused on the restoration of the menstrual cycle, as well as the elimination of infertility caused by polycystic cases.

How to treat? As for drugs, today the first-line drugs in the treatment of polycystic ovary are metformin and glitazone (pioglitazone, rosiglitazone). If necessary, antiandrogenic drugs (spironolactone, cyproterone acetate), estrogens (ethinyl estradiol as a separate drug or in birth control pills), progestins, small doses of dexamethasone (0.5-1 mg in the evening to suppress adrenal secretion of androgens) can be added to them. .

Treatment for excessive hair growth

Your health care provider may recommend birth control pills to reduce androgen production, or a drug called spironolactone (Aldactone), which blocks the action of androgens on the skin. However, spironolactone can cause birth defects, so when using this drug, effective contraception is necessary. Spironolactone is not recommended if you are pregnant or plan to become pregnant.

Eflornithine (Vaniqa) cream is another option for slowing facial hair growth in women. Possible options for hair removal without the use of drugs: it is electrolysis and laser hair removal. Laser hair removal works best on very dark hair and covers large areas.

Normalization of body weight

Women suffering from polycystic ovaries on the background of obesity, must combine physical activity with a certain diet and diet:

  • calorie restriction of food up to 1,500–1,800 kcal per day with 5–6 meals a day;
  • consumption of low-calorie foods (fruits, vegetables);
  • increased protein content in the diet (fish, seafood, meat, cottage cheese);
  • restriction of carbohydrate foods (baking, sugar, jam, honey, sugary drinks);
  • elimination of animal fats and their replacement with vegetable fats. Daily fat intake is not more than 80 g;
  • exclusion of spices, spices, sauces, smoked and pickled products;
  • complete elimination of alcohol;
  • fasting days 2-3 times a week (apple, kefir, cottage cheese, vegetable).

Particular attention should be paid to sweets, that is, to exclude it from your diet at all. Along with dieting, you need to exercise (gymnastics, swimming, jogging, yoga).

Regulation of menstrual function

For this purpose, COCs (combined oral contraceptives) are used that do not have an androgenic effect. For example, Marvelon, Janine and others. 1 tablet from 5 to 25 day of the cycle, for three months. Then break one month.

They effectively restore the cycle, and at the same time protect against the "accumulation" of non-sloughing endometrium. If the effect of androgens is expressed significantly, then it is better to use an antiandrogen (in combination with estrogen) instead of them - Diane-35.

Operation

In the case when hormonal therapy is ineffective for half a year, surgical intervention is indicated to the patient. It can also be prescribed at risk of developing endometriosis.

The most common are two types of surgery:

  1. Sphenoid resection - is to remove a certain part of the ovaries on both sides. This method has a high degree of efficiency - in 85% of cases, it is possible to achieve the onset of ovulation.
  2. Laparoscopic electrocoagulation of the ovaries - special notches are made in several places with the help of a needle electrode. Compared with resection, this method is much more gentle, since the probability of adhesions formation is minimized.

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.

Traditional methods of treatment of polycystic ovaries

Treatment of polycystic ovarian folk remedies is not recommended due to the low effectiveness of the latter. Given the number of hormonal disorders in the body of a woman with polycystic ovary syndrome, herbal treatment cannot bring the effect that occurs with proper hormonal or surgical treatment.

Treatment prognosis

It is impossible to completely cure PCOS, so the goal of therapy is to create favorable opportunities for conception. When planning a pregnancy, women diagnosed with polycystic ovary should be treated to restore and stimulate ovulation.

With age, polycystosis of the ovaries progresses, therefore, the issue of pregnancy should be resolved as soon as possible.

Watch the video: Understanding Polycystic Ovary Syndrome Video Brigham and Womens Hospital (January 2020).

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