According to statistics, the polycystic ovarian syndrome is diagnosed in 5-10% of women of reproductive age. The heyday of the disease is marked by the age of 30. Polycystic ovaries lead to failure of the menstrual cycle and seriously impairs the appearance of the women, but the most serious complication, perhaps, is the development of infertility.
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Polycystic ovarian syndrome: what is it
Healthy and polycystic ovaries Polycystic ovaries is called an endocrine disease that is characterized by structural and functional changes in ovaries, appearing on the background neuroendocrine disorders. The disease is called polycystic disease due to many cysts formed on the surface of the ovary as a result of anovulation, when the follicle comes out of the egg, and it remains fluid filled vesicle.
There are two forms of pathology. The first is the polycystic ovarian disease or primary polycystic ovaries, which is formed from the moment of the functioning of the ovaries, and consequently, clinical signs appear at puberty. Primary polycystic hereditary, that is, genetically determined disease. Synonymous with primary polycystic ovarian syndrome is Stein-Leventhal.
Secondary polycystic ovaries are the result of secondary violations in the sexual and gonads due to endocrine disorders or chronic inflammatory diseases of genital organs.
Causes and pathogenesis of the disease
Despite the fact that the disease is one of the most common hormonal disorders among women of childbearing age, the exact cause is still not established. In the pathogenesis of polycystic ovarian syndrome play the role of failures at any level in the system of the hypothalamus-pituitary-adrenals-ovaries. Not least is the functioning of the thyroid and pancreas.
The mechanism of development
It is established that almost all patients with the disease noted insulinorezistentnost, that is, the body is “bad” responds to insulin secreted by the pancreas and controls the glucose level in blood. As a result, blood accumulates and circulates in a large amount of insulin. An excess of insulin “pushes” the ovaries and they begin to produce androgens in amounts far exceeding the norm.
Androgens, in turn, inhibit ovulation, i.e., the dominant follicle does not burst and release of the egg it is not happening, and the second phase becomes inferior due to lack of progesterone (no ovulation yellow body is not formed, progesterone is not synthesized). The inhibitory effect of androgens on ovulation due to their ability to thicken the outer shell of the ovaries, which Mature follicles can not “break” to exit the egg. Not fulfilled its function, the follicle is filled with fluid and is converted into a cyst. In the next menstrual cycle history repeats itself, and ovaries covered with numerous small cysts, which explains their increased size.
The factors provoking the appearance of polycystic ovaries include:
- genetic predisposition;
- diabetes mellitus;
- catarrhal diseases;
- chronic stress;
- many abortions (lead to hormonal disorders);
- unfavorable ecological situation;
- diseases of endocrine organs (pituitary, thyroid, hypothalamus and adrenal glands);
- chronic inflammatory diseases;
- gynecological pathology (and hormonal, and inflammatory diseases).
Symptoms the clinical picture of the Symptoms of polycystic ovaries are very diverse. Most of the signs present in this disease, similar to other hormonal disorders.
Disorders of the menstrual cycle
The first sign that makes a woman worry are irregular menstruation. Disorders of the menstrual cycle are characterized by rare periods (3 to 6 months), poor (opalneria) or, on the contrary, profuse and prolonged menstruation, after a long delay. The cycle length is 35 days or more, and each year has about 8 menstrual bleeding or less. Menarche appear in time, but the cycle differs from the irregularity. Dysfunctional uterine bleeding is caused by the formation of hyperplastic process in the endometrium on the background of long-term absence of menstruation. In this regard, all patients with polycystic ovaries are included in the group of risk of occurrence of mastitis, uterine adenocarcinoma and breast cancer.
High levels of androgens is manifested by several symptoms:
Characterized by excessive hair growth in male pattern (on the face, nipple areas, thighs).
- Hypertrichosis is
Characterized by increase the growth of stem (rough and thick) hair on my chin, neck and around the nipples, around the hips. This symptom is always evidence of hyperandrogenism and the primary form of the disease.
Women have the male physique, body hair they have male pattern, is characterized by the increase of the clitoris, and hypoplasia of the mammary glands, low voice. There is often alopecia (baldness) male pattern and hair thinning.
The condition of the skin and hair
When polycystic ovaries skin is characterized by increased oiliness, enlarged pores with the presence of acne (acne). Characteristically, acne are not only on the face but on the neck, shoulders and back. It is also noted oily seborrhea and the hair is dirty quickly, even with careful care. Perhaps the emergence of dark-brown pigment spots on the skin of the inner thighs, in the folds of the elbows, in the armpits.
Obesity male pattern Change in body mass
The majority of patients are overweight or obese, and the distribution of the subcutaneous tissue occurs in the male in the abdominal area and thighs.
The most serious and dramatic symptom of the disease is infertility due to anovulation. It is because of the lack of pregnancies in women with this disorder often turn to the doctor. Approximately 85% of patients of primary infertility, pregnancy has never been.
As a result of increased content of insulin in the blood, a high probability of developing diabetes. Also there is often hypertension and hypercholesterolemia (high cholesterol in the blood), which in turn, triggers the development of hypertension and atherosclerosis.
In the process of establishing a diagnosis of “polycystic ovaries” are taken into account data of anamnesis, General and gynecological examination, performance of laboratory and instrumental methods of examination:
Anamnesis and clinical examination
When collecting history doctor takes into account the nature of the menstrual cycle and its formation, infection and hereditary diseases. During the examination, measured height and weight of the patient, calculated mesarosova coefficient is determined (if any) the degree of obesity and distribution of fat. In the process of gynecological examination palpable enlarged ovaries and dense, slightly painful when pressed. Estimated type body hair, the presence/absence of pigmentation in areas of friction (inguinal folds, inner thighs).
Determine the content of luteinizing and follicle stimulating hormone (increasing the ratio of LH/FSH), 17-ketosteroids, testosterone and prolactin. Also assigned to the tests for sugar and blood lipids, cholesterol, and insulin. Further assessed the content of thyroid hormones.
The importance in diagnosis of this disease is ultrasound of the pelvic organs. Ultrasound signs confirming the diagnosis: symmetric increase in ovarian volume (greater than 8 cubic cm), dense hyperechogenic stroma with increased blood flow and a well-developed vascular network, thick ovarian capsule, a large number of anechoic follicles (up to 1 cm in diameter, 10 or more). To confirm the diagnosis assigned to MHT (menopausal hormone therapy), excluding ovarian tumors and diagnostic laparoscopy.
Polycystic ovaries and pregnancy
It would seem that polycystic ovaries and pregnancy – two mutually exclusive concepts. A categorical “no” in this case does not say any doctor. The majority of patients care of can you get pregnant while polycystic ovarian syndrome. As already mentioned, the percentage of spontaneous pregnancies is very low, and their prosperous completion is even lower (3 to 5) without the lack of proper treatment. In addition to spontaneous abortion in the first trimester of pregnancy on the background of this disease also poses another complication is ectopic (usually tubal) localization of the ovum. The fact that increased and heavier ovaries dilate the fallopian tube, which leads to kinking and deformation. Accordingly, the fertilized egg goes the way of the modified pipe longer, which threatens its implantation in the tube or tubal pregnancy.
But even if “journey” ended successfully, and the egg got implanted in the uterus, this problem does not end there. The high androgen level interferes with normal grow and develop to an embryo, which is accompanied by the permanent threat of interrupts and often ends in miscarriage. Therefore, all expectant mothers with this diagnosis receive almost all the pregnancy-supporting hormonal therapy.
It often happens that neither conservative nor surgical treatment of the disease does not bring success, and to patients recommend IVF. In addition, the pregnancy on the background of this pathology is often complicated by the development of gestational diabetes, late toxemia, intrauterine growth retardation and premature birth.
How to cure polycystic ovaries? Therapy polycystic ovary is a lengthy process that requires patience from the patient and consists of several stages.
Diet is what you should start treatment of polycystic ovaries the First step in treatment is to normalize weight. Important to observe a low calorie diet under the polycystic ovarian syndrome. The first principle of the diet is the fractional meal, up to 5 – 6 times a day, and the portions should be small. Granularity of food can satisfy hunger. From the diet should exclude refractory fat (fatty meats, poultry, fish), carbohydrate (sweets, cakes, sweet fruits), as well as alcohol and Smoking. Eat preferably be steamed, boil, simmer (on a small amount of oil) or bake (no crust). Not allowed fried, spicy and fatty meals. The diet should contain a large amount of fiber (fresh fruits and vegetables). Also, the food included beans, brown rice, lean meats, fish, dairy products with low fat, nuts (source of vitamin E). Wheat bread need to replace the rye or bran, it is advisable to eat the yesterday’s baking. You should also observe the drinking regime. The consumption of free liquid should be at least 1.5 – 2 liters per day.
In addition, it is recommended that physical activity in the form of moderate sports and for the normalization of carbohydrate metabolism are often given oral Metformin, which regulates the level of glucose in the blood. This treatment lasts 3 to 6 months. Often already at the weight normalization of the menstrual cycle is restored.
Treatment of dishormonal disorders
After weight normalization proceeds to the next step – therapy hormonotherapy drugs that not only help to regulate the cycle, but also inhibit the action of androgens and related effects. With this purpose, assigned to combined oral contraceptives with low estrogen content, but possessing antiandrogenic activity (yasmin, Diane-35, Jess or Janine). The second phase of treatment is 6 – 12 months, during which restores menstrual cycle, normal menstrual blood loss and fade signs of hyperandrogenism. Also with the excessive synthesis of androgens helped taking spironolactone, but it is not recommended for pregnant women or planning pregnancy, as it can provoke birth defects in the fetus.
Hormonal combined oral contraceptives of new generation
Stimulation of ovulation
How to become pregnant with the polycystic ovaries? Related to this issue is the final stage of treatment, i.e. stimulation of ovulation. It is performed on clostilbegyt (clomifene) for 3 menstrual cycles. The drug is administered with 5 to 9 day cycle, starting at a dose of 50 mg/day. In the subsequent cycle in the absence of pregnancy the dosage is increased to 75, and in the third cycle to 100 mg. If the pregnancy did not occur, think women are resistant to the medication and recommend surgery. The long-awaited pregnancy after ovulation stimulation klomifenom occurs in 35% of cases.
In case of failure of conservative treatment and the patient wishes to become pregnant, surgery is indicated. The operation is performed by laparoscopy. The following methods of surgical intervention:
- wedge resection of ovary (excision of 2/3 of the volume of the ovaries) is in this case removed a large portion of the gonads, which spur production of androgens, and elimination of hyperandrogenism normal hormonal balance and ovulation occurs;
- decortication of the ovaries (excised dense tunica albuginea and follicles puncture needle);
- endothermically (spot burning) of the ovaries.
It should be noted that the possibility of occurrence independent of ovulation after surgery decreases with time. That is, up to 75% of patients become pregnant within the first 3 months after surgery, 50% within six months after laparoscopy, and about 25% or less within 9 months. In this regard, the patient is prescribed the stimulation of ovulation immediately after 3 months after surgery if pregnancy has not come.