Polycystic ovary symptoms
Mar 04, 2018
Polycystic ovary is a chronic symptom complex based on endocrine disorders, characterized by the formation of follicular cysts( spherical thin-walled formations filled with clear liquid) in both ovaries. Each ovary contains many structures known as follicles. Approximately once a month hormones stimulate one follicle, and it starts to grow and rise to the surface of the ovary, where it bursts and secrete an egg. At the same time, hormones from the follicles cause the uterine wall to thicken to provide support if the egg is fertilized. The egg leaves the ovary through the fallopian tube into the uterus. If fertilization does not occur, the thickened tissues lining the uterus are separated, and the oocyte, excess lining tissues and blood are excreted through the vagina during menstruation.
With polycystic ovaries, the follicle grows, but it is not able to burst. Instead of isolating the egg, the follicle forms a cyst right under the surface of the ovary. Normal menstruation can occur at the onset of puberty, but then they become rare or stop completely, as the ovaries begin to produce cysts instead of egg cells. Eventually, both ovaries are filled with tiny cysts. Insufficient ovulation leads to the cessation of menstruation, infertility and the production of the male sex hormone testosterone by the ovaries.
In the absence of treatment, the relative excess of estrogen compared with progesterone may increase the risk of endometrial hyperplasia and uterine cancer. However, the disease is often well treatable, which can eliminate infertility and other symptoms. The specificity of treatment depends on the individual needs of the patient, especially whether the woman wants to have children in the future.
• Abnormal growth of facial hair.
• Absence or irregularity of menstruation.
• The disease is often combined with obesity and insulin resistance.
There are 3 variants of polycystic ovary syndrome:
1) polycystic ovary syndrome with normal body weight;
2) Polycystic ovary syndrome with android obesity and concomitant disorders of carbohydrate metabolism: an increase in the insulin content in the blood and loss of tissue sensitivity to this hormone;
3) Polycystic ovary syndrome with obesity without loss of tissue sensitivity to insulin.
Obesity is observed in approximately 40% of women with polycystic ovary syndrome. Fatty tissue is the place of activation of the process of formation of estrogen( female sex hormone).The increased formation of this hormone contributes to the development of pathological processes in the endometrium( inner lining of the uterus) in the women with polycystic ovary syndrome and in the mammary glands.
For the lower type of obesity, the mild insensitivity of the body's tissues to insulin or its absence is more typical, a moderate increase in the content of male sex hormones in the blood serum, a normal blood lipid content, and a low risk of developing diabetes. In the domestic literature this form of the syndrome was called secondary polycystic ovary, or polycystic ovary syndrome of central genesis. When examined, these women are diagnosed with various disorders of the nervous system: vegetative-vascular dystonia( often hypertonic type), frequent headaches, increased appetite, sleep disorders, emotional disturbances( low mood, tearfulness, irritability), signs of increased intracranial pressure,signs of impaired function of certain structures of the brain. Often there is an arterial hypertension( increase of arterial pressure).Typically, the gradual progression of all manifestations of increased content of androgens( male sex hormones) and anovulation( lack of ovulation) against a background of weight gain.
Detection of the syndrome of polycystic ovaries is based on the appearance in a woman of all the characteristic manifestations of the disease, functional diagnostics tests for the detection of ovulation disorders, ultrasound, radiologic and other instrumental methods of examination. In addition, the content of hormones of the pituitary gland, adrenal glands and ovaries in the blood serum is determined. With excessive body weight, determine the body mass index, the ratio of the waist to the hip volume, and also conduct a study of carbohydrate metabolism: fasting blood glucose level, oral glucose tolerance test.
Reliable criteria for polycystic ovary syndrome are as follows:
1) chronic absence of ovulation;
2) skin lesion( male type of hair, dandruff, acne);
3) enlarged and / or penislike clitoris;
4) with ultrasound of internal genitalia, there is a bilateral increase in ovaries 2 times or more, absence of signs of ovulation against a background of multiple( more than 10) small cysts;
5) in 70% of cases there is a change in the hormonal background;
6) moderate increase in the level of free male sex hormones.
It is necessary to distinguish the polycystic ovary syndrome from all diseases accompanied by manifestations of excessive amounts of male sex hormones. Features of the signs of tumors of the ovaries and adrenal glands that lead to the appearance of men's traits in women are the sudden occurrence and rapid progression of all male manifestations. When hormonal research reveals the characteristic for each disease changes hormonal. For detection of tumors, ultrasound examination of the pelvic organs and computed tomography of the adrenal glands are used. The use of computed tomography in the study of pelvic organs has no advantages over ultrasound.
In case of doubtful or negative results of these studies in a surgical hospital, a catheter is inserted into the ovarian and adrenal veins to determine the hormone content in the blood that flows directly from the organs. However, despite the high information value of this method, due to its complexity and invasiveness, its use in clinical practice is limited.
Disease or Itzenko-Cushing syndrome can also be accompanied by the development of male-type hair, a violation of menstrual function, infertility, obesity. To exclude this disease, special tests are carried out with the subsequent determination of the quantitative content of hormones in the blood serum.
• The cause of the disease is unknown;it can be hereditary.
The causes of cyst development are not completely clear;probably, the imbalance between the production of two hormones of the pituitary gland, which usually stimulates the functioning of the ovaries: luteinizing and follicle-stimulating hormones, plays a role here. Polycystic ovary is observed in women during puberty.
• Medical history and pelvic examination. A gynecologist can detect an enlarged ovary during a bimanual examination.
• Blood tests to measure levels of luteinizing and follicle-stimulating hormones, testosterone and other hormones that are associated with ovarian function.
• Ultrasonic examination can be performed.
• Laparoscopic abdominal surgery( using tubes with light that are inserted into the abdomen through a small incision) can confirm the diagnosis.
• For those women who want to have children, clomiphene citrate, a drug from infertility, or hormones such as human gonadotropins and human chorionic gonadotropin can be prescribed to stimulate ovulation. Sometimes a laparoscopic operation is performed to reduce the size of the ovary( wedge resection or ovarian puncture) in order to create more favorable conditions for ovulation. Control of insulin resistance can contribute to success.
• Those who do not want to have children can be prescribed oral contraceptives or progestins such as medroxyprogesterone acetate to suppress ovulation and reduce the risk of intrauterine hyperplasia or uterine cancer later.
The basis of the modern approach to the treatment of polycystic ovary syndrome is the principle of restoring the impaired ovulatory function of the ovaries. There are two approaches to the treatment of the polycystic ovary syndrome - conservative and operative.
Before the beginning of specific treatment, it is necessary to carry out body mass correction, restoration of carbohydrate metabolism and normal activity of the cardiovascular system.
The following preparations are used for the treatment of polycystic ovary syndrome.
1. Gestagens( progesterone and its analogues - female sex hormones) are used to normalize the menstrual cycle and restore ovulation and fertility. Preference is given to the preparation of Duphaston( dydrogesterone), which, unlike other synthetic hormones, does not give such pronounced undesirable effects. This drug is used for moderately severe violations of menstrual and ovulatory functions. In addition, gestagens are used to prevent and treat endometrial hyperplasia( proliferation of the inner lining of the uterus).The effectiveness of treatment with only drugs of female sex hormones is 20-25%.
2. Combined female hormonal contraceptives( non-vellon, ovidone, ригевидон, etc.).These drugs are used for the same purpose as those discussed above. Their additional effect is stimulation of the formation in the body of a special protein that binds testosterone, which helps to reduce the level of free male sex hormones in the serum of a woman with polycystic ovary syndrome. On the background of treatment, regular menstrual-like discharges occur and the growth of the inner layer of the uterus is prevented, and the cessation of treatment( the duration of it should be at least 6 months) in 25-30% of women contributes to the restoration of the ovulatory function of the ovaries.
3. Antiandrogens. Such a drug, as cyproterone acetate( androkur), has the property of blocking the action of androgens( male sex hormones) cells of the body - antiandrogenic effect. It is used in combination with estrogen( female sex hormones) and is prescribed from the 5th to the 15th day of the menstrual cycle at 10-50-100 mg per day. In addition to anti-androgenic effect, this drug reduces the synthesis of the ovaries of male sex hormones, prevents the proliferation of the inner shell of the uterus, together with estrogen increases the synthesis in the liver of a special protein that binds testosterone( male sex hormone) and causes regular menstrual-like secretions. In addition, the drugs of this group are prescribed for women with polycystic ovary syndrome to reduce skin lesions: male type of hair, fatty dandruff, acne. Treatment is long - from 6 to 12 courses. With a view to longer use as a maintenance therapy, it is further expedient to take the combined drug "Diane-35", which includes the female sex hormone and antiandrogen. This drug is taken from the 5th to the 25th day of the menstrual cycle.
4. Veroshpiron( diuretic drug) also has an antiandrogenic effect. Use this drug, usually with increased intracranial pressure, premenstrual syndrome with edema before menstruation. It is prescribed for 200 mg per day in the second phase of the menstrual cycle in order to avoid breakthrough bleeding. The duration of treatment should be at least 6 months.
After 6 months of "preparation" combined hormonal preparations stimulate ovulation. For this, the drug clomiphenone( clomid, clostilbegite) is used. This drug increases the formation of a protein in the liver that binds male sex hormones( antiandrogenic effect), reduces the formation of male hormones in the ovaries, stimulates the formation of the yellow body and the female hormone of progesterone, blocks the proliferation of the inner shell of the uterus, normalizes the menstrual cycle. It is prescribed according to a certain scheme: 50-100-150 mg per day from the 5th to the 9th day of the cycle. As a result of treatment, ovulation is restored in 70% of cases, fertility - in 40%.In the absence of the effect of stimulation after 3-4 courses of clomiphene administration, its use is impractical.
Thus, for the conservative treatment of polycystic ovary syndrome used a whole arsenal of various hormonal drugs, but not always it is possible to achieve the restoration of ovulation and fertility. The absence of the effect of conservative therapy for 1 year is an indication for the conduct of surgical treatment. The main method of surgical treatment is bilateral partial removal of the ovaries( i.e., the organ is not removed completely, but a small part remains).In recent years, a less-traumatic laparoscopic method of surgical treatment, whereby the removal of the ovaries is made through a minimal incision, is increasingly used. Due to the fact that the ovary has a great ability to regenerate, it can take its former form and size without the formation of scar tissue and maintain its function even after the removal of 2 / 3-3 / 4 parts of its volume. With surgical treatment, the regular menstrual cycle is restored in almost 90% of cases, ovulation in 70%, fertility in 60% of cases.
• Contact your gynecologist if you have symptoms of polycystic ovary .
• There is no known way to prevent polycystic ovary.