Weight gain, obesity. polycystic ovary syndrome

I have long wanted to write about polycystic ovary syndrome (PCOS). The topic is extensive, there are a lot of letters and I had to answer them in different places on the blog. And so that there is no further confusion, everything will be in a separate topic. Four more posts with ideas to follow natural treatment from western physician Lara Briden, depending on the underlying causes of PCOS, identifying which will increase your body's chances of healing.

PCOS is an extremely common diagnosis and, according to statistics, is detected in 20% of women of reproductive age. This is a very frustrating fact to face as PCOS can be one of the most challenging health issues for women of our time.

Polycystic ovary syndrome is not one disease, but a complex of metabolic and endocrine disorders characterized by a set of symptoms. The key primary symptom is the inability to ovulate regularly, resulting in cystic changes in the ovaries and menstrual irregularities. Secondary symptoms of PCOS include various manifestations associated with increased levels of androgens (male sex hormones) - excessive growth of hair on the face, abdomen (hirsutism), acne, oily skin, hair loss, as well as obesity and infertility.

PCOS is difficult to diagnose due to its varied symptoms and manifestations over time, and is rare in its full form. Some women have ovarian cysts but no other symptoms. Some women are thin, have acne and hirsutism, but don't have cysts. All different.
Since PCOS cannot be diagnosed with just one test and symptoms vary from woman to woman, PCOS has been known as the "Silent Killer". Early diagnosis is critical because it is associated with an increased risk of several health problems: infertility, insulin resistance, type 2 diabetes, high cholesterol, endometrial hyperplasia due to high estrogen levels, abnormal liver enzymes, high blood pressure, and heart failure. vascular diseases.

Signs and symptoms of polycystic ovaries

Ovulation and menstrual disorders

Menstrual cycles become irregular due to the lack of ovulation. Attempts to get pregnant end in failure.

In women with PCOS, the hypothalamus releases GnRH (gonadotropin-releasing hormone) at a higher than normal pulsatile rate. This allows you to increase LH and reduce FSH, which, in turn, leads to excessive production of androgens - androstenedione and testosterone. This results in the follicle not reaching full maturity to release the egg. At the same time, estrogens continue to increase. As a result, high levels of androgens and estrogens create a chronic state of very low progesterone and anovulatory cycles.

A woman notices that menstruation becomes painful and plentiful, or vice versa, scarce. And they can be accompanied by severe PMS - with pulling pains in the lower abdomen, swelling, breast engorgement, nervousness, depression.

Decreased fertility, hormonal imbalance.

Irregular ovulation leads to reduced fertility. Women with PCOS are not always able to get the desired pregnancy and bear a child. At the same time, doctors, without going into details of the real reasons for this, prescribe OK according to the standard scheme, which aggravate the course of the disease.

Doctors sometimes point to the cause of infertility endometrial hyperplasia(thickened endometrium in the uterus), which is formed during the long-term predominance of estrogen, insufficiently compensated by progesterone.

But endometrial hyperplasia is only a consequence and cannot be the cause of infertility or miscarriage. Hyperplasia can be the cause of profuse painful menstruation, which is accompanied by large blood loss.

Every third woman can be found fibrocystic mastopathy, which developed against the background of chronic anovulation and hyperestrogenism.

Curettage of the uterine cavity and the appointment of synthetic hormones only temporarily provide relief, without solving the main problem - violation of the synthesis of hormones in the ovaries and metabolic disorders in the body.

Polycystic ovaries

Polycystic ovaries(small cysts - non-ovulated follicles up to 10 mm, scattered throughout the ovarian tissue, which look like a strand of pearls on ultrasound) are the main symptom of women with PCOS. It is believed that these cysts are the result of a hormonal imbalance and chronic anovulation, the eggs do not go through the normal sequence of maturation. Over time, another obstacle to normal ovulation is added - the outer shell of the ovaries thickens under the influence of androgens and the follicle cannot “break” it for the release of the egg and its participation in the fertilization process. So unexploded the follicle fills with fluid and turns into a cyst. The good news is that these cysts are benign and not dangerous, which means they do not require surgical removal and are not associated with an increased risk of ovarian cancer.

Large ovarian cysts are different from polycystic ovaries. There are big functional cysts(most common), which can grow to 5 cm or more and sometimes require surgery. There are also pathological ovarian cysts such as dermoid, hemorrhagic and chocolate cysts of endometriosis. These are completely different types of problems that do not affect the topic of PCOS.

Over time, the ovaries may increase in size (their volume is > 9 cm3) and become covered with a thickened connective tissue stroma. They become tense and can cause pain in the abdomen and legs. But enlarged ovaries do not occur in all women with PCOS and are not an absolute sign, like all the symptoms listed here.

High androgen levels in PCOS

Androgens include testosterone, DHEA and androstenedione. In small amounts, some androgens are beneficial to health. You need them for mood, libido and bone health. Too many androgens cause acne, hair loss and hirsutism.

Increased androgen synthesis in the body (hyperandrogenism) very often is the first symptom to suspect polycystic ovary syndrome. Usually a woman struggles with this only by cosmetic means and does not even think about getting an examination. And only when problems with conceiving a baby begin, she begins to look for the cause.

Hyperandrogenism manifests itself as excessive growth of male-pattern body hair (hirsutism), acne, hyperandrogenic alopecia (male-pattern baldness), or simply increased hair loss.

Big trouble for a woman skin problems: acne (acne, inflammation of the sebaceous glands), age spots (acanthosis), seborrhea, oily skin and increased greasiness of hair, wrinkles, stretch marks.

Weight gain, obesity

Metabolic disorders manifest themselves in a variety of ways. For example, 50% of women are overweight, with fat usually deposited in the abdomen and thighs - this is called "central obesity" or "apple-shaped obesity."

If you notice cycle disorders against the background of weight gain, then the first thing to start with is to try to lose weight. Perhaps this will be enough to start the cycle.

Obesity itself is a problem and contributes to metabolic disorders. In addition, androgens are synthesized in adipose tissue, which further complicates the course of polycystic ovaries.

When weight gain occurs quickly, striae may appear - stretch marks on the skin of the chest, hips and abdomen.

Elevated insulin

One of The main cause of all PCOS symptoms is increased insulin secretion, impaired glucose tolerance, the formation of insulin resistance in tissues and organs. These characteristic features occur in 60% to 70% of women diagnosed with PCOS.
The development of type 2 diabetes mellitus later in life may be due to insulin resistance and hyperinsulinemia.
Scientists believe that this is the main cause of metabolic and hormonal disorders in the body.

Emotional instability, fatigue

Depression, apathy, constant fatigue, mood lability, nervousness, aggressiveness, sleep problems - indicate a violation of the hypothalamus, pituitary gland, adrenal glands. They are also a sign of deep exhaustion of the body and chronic stress.

What is PCOS often confused with?

Polycystic ovary syndrome in its symptoms resembles several diseases:

• Itsenko-Cushing syndrome (congenital hyperplasia of the adrenal cortex)
• Adrenogenital syndrome (congenital adrenal dysfunction (ACHD) or acquired)
• Hyperprolactinemia
• Diseases of the thyroid gland (hypothyroidism, hyperthyroidism).

And at the same time, it has many differences.

Tests to Diagnose PCOS

The diagnosis of "Polycystic Ovarian Syndrome" has recently been made without due diligence, as a fashion trend. It cannot be diagnosed by ultrasound alone, simply by seeing enlarged and cystic changes in the ovaries. They are only a "victim" of metabolic and endocrine disorders in a woman's body.

To make a correct diagnosis, a woman must undergo a thorough examination. First of all, you need to take blood tests for:

• LH, FSH, estradiol, prolactin - on days 3-5 of the menstrual cycle
• Free testosterone, sex hormone-binding globulin (SHBG), DHEA-c - on day 8-10 of the m cycle
• 17-OH progesterone - 3-5 days of m cycle.
• Insulin resistance assessment (HOMA-IR)

Next, undergo transvaginal ultrasound of the pelvic organs three times during the cycle. A single ultrasound, not confirmed by analyzes, is not informative.
Get a competent assessment of all symptoms and test results from a gynecologist-endocrinologist, as well as exclude other diseases that could cause excessive androgen activity.
And most importantly, find out the main reason that caused these metabolic changes in your body.

The diagnosis of PCOS is made if any two of the three criteria are present simultaneously:

• High androgens in the blood or symptoms of androgen excess such as hirsutism, acne. At the same time, other causes of hyperandrogenism were excluded: adrenogenital syndrome, Itsenko-Cushing's syndrome, hyperprolactinemia, androgen-producing tumor;
• Irregular or absent ovulation;
• Polycystic ovaries on pelvic ultrasound.

Conventional treatment for PCOS

Hormonal contraceptives

The traditional treatment for PCOS is to suppress ovulation with birth control pills. This is a strange approach, considering that the problem itself is the lack of ovulation. OK also suppresses androgens, which is more beneficial. Unfortunately, OK is valid only for the time you accept. Once you stop them, your androgens will rise even higher than they were before.
The main problem with OCs (as a treatment for PCOS) is that they worsen the underlying cause of PCOS, deepen all violations. After them, it is more difficult to restore hair and skin, establish a cycle, lose weight, restore libido and get out of depression.

Spironolactone (veroshpiron)

Spironolactone (trade name Aldactone) is the same progestin drug used in Yasmin oral contraceptives. Taken on its own, spironolactone appears to be a safer, milder treatment, but spironolactone is not safe. Like OK, it interferes with ovulation, estrogen metabolism, and adrenal function. Like OK, he causes loss of libido, menstrual irregularities and depression. It is also the risk of breast cancer. Not a very good choice.

Metformin

If your doctor is more forward-thinking, she may have suggested you a diabetes drug called metformin. This is a better approach than OCs or spironolactone because at least it works to correct the underlying underlying cause of PCOS (insulin resistance). The main problem with metformin is that it causes digestive problems and depletes the body of vitamin B12 and other nutrients.

The role of genetics and prenatal factors in PCOS

Researchers suggest that PCOS is influenced by genes and possibly also exposure to androgens or environmental toxins in utero. This is a depressing thought because it could mean you were born with PCOS. It doesn't work like that. Being genetically inclined towards PCOS does not mean that you will always suffer from its symptoms. You can change your genetic expression through diet, lifestyle, and other natural treatments. Lara Braden's experience with thousands of patients is that PCOS can be reversed (although you will always have a genetic predisposition).

Natural Approach to PCOS

Lara Breeden - naturopathic doctor, having 20 years of experience in the field of women's health, can say with great confidence that polycystic syndrome responds very well to natural treatment. In many cases PCOS can be completely reversed with natural treatments.

Right now, I could give you a simple list of what works for PCOS by reading the back and forth of her book, but it's not that simple. To get results from natural medicine, you must first go deep and understand what is causing your PCOS.

I like Lara Breeden's approach in that she ignores the PCOS label and instead looks at each individual patient. Why isn't she ovulating? Why does she have high androgen levels?

The causes of PCOS break polycystic syndrome into five types:

And knowing what type of PCOS you have is key to understanding the right treatment protocol for you.

Visual flowchart for diagnosing 4 types of PCOS

If, after the tests you have passed, you are still undecided on the type of PCOS, I invite you to walk through the flowchart that will help you do this:

Some women may have a combination of these types of PCOS as the underlying cause of her PCOS changes and develops over time. Therefore, treatment regimens can be combined.

It takes at least 6-12 months of consistent lifestyle changes, diet, and natural therapies to bring about real change in the body before letting go of your PCOS diagnosis.

Polycystic ovary syndrome is a common problem faced by many women. The formation and growth of multiple cysts is usually associated with hormonal disorders. If untreated, the disease leads to infertility. That is why it is worth learning more about this pathology.

Why does polycystic ovary syndrome occur? How to treat such a pathology? What symptoms should not be ignored? Is it possible to get pregnant with such a disease? The answers to these questions are of interest to many women.

What is a disease?

What information about pathology does the ICD contain? Is polycystic ovary syndrome dangerous? What symptoms are accompanied? This information is sought by many patients.

So, polycystic ovary syndrome (ICD-10 assigned pathology code E28.2) is a disease in which multiple small cysts form in the tissues of the ovaries. As a rule, the disease is associated with hormonal problems.

What is the mechanism of development of polycystic ovary syndrome? The pathogenesis of the disease is well understood. Increased secretion of insulin leads to disruption of the growth and maturation of eggs. Cystic structures begin to form from immature follicles.

The neoplasms themselves are small, with a dense shell and liquid contents inside. In most cases, cysts appear in both ovaries. The presence of such structures in about 25% of patients leads to infertility.

Depending on the origin, two forms of pathology are distinguished.

• Primary polycystic ovary syndrome is the result of congenital anomalies. This form can also occur in girls during the formation of menstrual function.
• The secondary form of the disease develops in adulthood and, as a rule, is associated with acquired pathologies of the endocrine glands or previously transferred inflammatory lesions of the organs of the reproductive system.

Polycystic ovary syndrome: causes

Unfortunately, this is a very common pathology. Why does polycystic ovary syndrome develop in women? In fact, the reasons may be different.

• Often the disease develops against the background of pathologies of the hypothalamic-pituitary system. The fact is that follicle-stimulating and luteinizing hormones are synthesized in the pituitary gland, which are responsible for the growth and development of follicles, the processes of ovulation. Against the background of an increase in the level of these hormones, hyperproduction of androgens in the tissues of the ovary is observed, which leads to the appearance and development of cysts.
• Polycystic ovary syndrome may be associated with cell resistance to insulin. An increase in insulin levels affects the entire endocrine system. In particular, the amount of synthesized androgens and luteinizing hormone increases. Such changes lead to the active growth of follicles. However, none of these structures mature - premature aging of the follicles occurs, which increases the likelihood of multiple cysts.
• Risk factors also include an excess of male sex hormones, which also disrupts the growth and maturation of eggs in the ovaries.
• There is a genetic predisposition. To date, there is no data that would confirm the hereditary transmission of the disease. Nevertheless, women in the family who had people with a similar ailment are at risk.
• It is worth noting that certain medications are also considered risk factors. It has also been proven that against the background of obesity, polycystic ovary syndrome occurs in a more severe form. By the way, according to statistics, about 40% of patients suffer from excess weight.
• Risk factors also include stress, a sharp change in climate, past infectious diseases (if the patient has prerequisites for the development of pathology).

Polycystic ovary syndrome: symptoms

Sometimes the pathology proceeds without the appearance of any specific signs - in some patients, the disease is diagnosed by accident. But in most cases, a number of disorders appear that indicate the presence of polycystic ovary syndrome. Symptoms in women can be different.

• Pathology primarily affects the menstrual cycle. It becomes irregular - long delays in menstruation are possible, up to their complete absence (amenorrhea). There are violations, and sometimes the disappearance of ovulation. Sometimes long delays in menstruation are replaced by full-fledged uterine bleeding.
• Since the processes of egg maturation are disturbed and ovulation is absent, women develop infertility.
• An increase in androgen levels leads to an increase in sebum production. Patients suffer from seborrhea, increased greasiness of the hair. The skin is covered with pimples and blackheads. Such disorders are permanent and practically not amenable to symptomatic treatment.
• A very characteristic feature of polycystic disease is obesity. The patient's body weight increases sharply by 10-15 kg for no apparent reason (the woman continues to eat in the usual way). Sometimes fat deposits are distributed evenly throughout the body. But due to the increase in androgen levels, male-type obesity is possible. Excess fat accumulates in the waist and abdomen.
• Obesity, impaired metabolism of carbohydrates and lipids sometimes lead to the development of type 2 diabetes mellitus.
• Increased hair growth on the body is possible: an increase in the level of male sex hormones leads to male-type hair growth - “antennae” appears above the upper lip, hair growth is observed on the chest, abdomen, and inner thighs.
• Many women complain of chronic pain in the lower abdomen. Soreness is moderately pronounced, pulling in nature. Sometimes the pain spreads to the pelvic region and lower back.

The presence of such violations cannot be ignored. If left untreated, the pathology leads to complications.

Possible Complications

How dangerous can polycystic ovary syndrome be? Reviews of experts indicate that with early diagnosis and proper treatment, the disease can be dealt with. However, in some cases, the disease leads to the development of certain complications.

Diagnostic measures

What to do if you suspect polycystic ovary syndrome? The symptoms described above are a good reason to see a doctor. Do not self-medicate or try to determine the problem yourself, as this can be dangerous.

How is polycystic ovary syndrome diagnosed? Diagnosis in this case includes a number of procedures.

Based on the results, the doctor can make a diagnosis of polycystic ovary syndrome. Treatment in this case will depend on the form and stage of development of the disease, the presence of concomitant pathologies.

Conservative treatment

Unfortunately, it is impossible to completely get rid of such a disease as polycystic ovary syndrome. Treatment in this case is aimed at restoring the normal cycle, stimulating the ovulation process (if the patient wants to get pregnant), reducing the external manifestations of the disease (skin inflammation, hairiness), normalizing carbohydrate and fat metabolism.

• If there is a violation of carbohydrate metabolism, then patients are prescribed hypoglycemic drugs, for example, Metformin. The drugs help to normalize the level of glucose in the blood.
• If the patient is trying to become pregnant, then ovulation stimulation is necessary. For this purpose, as a rule, the drug "Clomiphene" is used, which ensures the release of the egg from the ovary. As a rule, the medicine is started on the 5-10th day from the beginning of the menstrual cycle. According to statistics, such therapy in 60% of cases ends with ovulation. In about 35% of patients, it ends with fertilization.
• Combined hormonal contraceptives are used to restore a normal menstrual cycle.
• Sometimes the drug "Veroshpiron" is included in the therapy regimen. This is a potassium-sparing diuretic, which also reduces the level of androgens in a woman's body, blocks their effects. Such therapy lasts at least six months and helps to get rid of uncharacteristic hair growth, normalize the functioning of the sebaceous glands.

Proper Diet

A sharp increase in body weight is one of the symptoms of polycystic ovary syndrome. also apply to nutrition. During therapy, it is very important to normalize metabolism and maintain body weight within normal limits.

Physiotherapy

It is worth noting that taking medication is not the only thing that is required for a disease such as polycystic ovary syndrome. Doctors' recommendations also apply to the patient's lifestyle.

Of course, an important part of therapy is proper nutrition. In addition, physical activity is also recommended. We are talking about feasible activity, whether it is swimming, Pilates or long walks. The fact is that subcutaneous fat deposits are an additional source of androgens. Weight loss will not only have a positive effect on the figure and well-being, but also help to normalize hormonal levels.

Galvanophoresis with the use of lidase is effective. This procedure allows you to activate the enzymatic system of the ovaries. It also improves organ function. The course of treatment, as a rule, consists of fifteen daily procedures.

It should be understood that therapy for such a disease must necessarily be comprehensive. Do not count on a quick and complete cure.

Surgical intervention

In most cases, medical treatment, coupled with physiotherapy and proper diet, is enough to keep the endocrine system functioning normally. However, sometimes surgery is necessary. Surgery is usually used to treat infertility. Most often, laparoscopy is performed. Special equipment is inserted inside through small incisions. There are two methods for performing the operation.

• Wedge resection of the ovaries involves the removal of ovarian tissue in which androgenic hormones are synthesized.
• Electrocauterization of the ovaries consists in the point destruction of the structures of the ovaries, which are responsible for the synthesis of "male" sex hormones. This is a less traumatic procedure that allows you to save the maximum amount of healthy tissue.

It is worth noting that during laparoscopic surgery, the doctor has the opportunity to eliminate the mechanical causes of infertility, for example, cut adhesions between the walls or eliminate obstruction of the fallopian tubes. The operation is performed under general anesthesia and is considered safe.

In the future, conservative treatment is carried out. Often two weeks after the operation, the first ovulation occurs. However, it sometimes takes 6-12 months to restore a normal menstrual cycle. If within 2-3 cycles ovulation is still absent, then the patient is prescribed the same Clomiphene.

It is worth noting that even after successful fertilization and the birth of a child, the risk of relapse is high. According to statistics, often polycystic disease is activated 5 years after undergoing therapy. That is why the patient must be registered with a doctor, undergo an examination and take tests twice a year. The sooner a relapse is detected, the easier it is to stop its symptoms and prevent the development of possible complications.

Preventive measures and forecasts

It is worth noting that it is impossible to completely get rid of such a pathology. Nevertheless, therapy started in the early stages allows women to avoid such unpleasant consequences as infertility (they inevitably end with polycystic ovary syndrome). IVF, taking hormones, ovulation stimulation - all this helps a woman become a mother.

Unfortunately, there is no specific prevention. Women are advised to monitor the state of health and the regularity of the cycle, and if there are alarming symptoms, immediately consult a doctor. Remember that every six months you need to undergo a preventive gynecological examination. It is also important to follow the diet, keep fit, treat inflammatory and infectious diseases in time.

A girl during puberty must be explained what should happen to her body. Since cysts often begin to form during the formation of the menstrual cycle, girls are also recommended to undergo preventive examinations and periodically take tests.

PCOS is a hormonal disease that affects the ovaries. As a result, their structure is disturbed and the glands malfunction. In reproductive age, polycystic ovary syndrome is diagnosed most often. Despite the widespread prevalence of the disease, the causes of its occurrence are still not fully understood.

What it is?

PCOS (polycystic ovary syndrome) is a pathology characterized by the formation of multiple cystic cavities in the glands. They may be filled with clotted blood or pus. According to statistics, every fifth woman suffers from the disease.

In gynecology, PCOS is considered a serious problem. This is due to the fact that most patients who consult a doctor complain about the inability to become pregnant. This is due to the fact that enlarged ovaries are the cause of increased production of luteinizing hormone and male sexual biologically active substances. The result is an increase in estrogen levels and a decrease in progesterone levels.

The natural results of these processes are the following violations:

• there is a malfunction of the ovaries;
• their blood supply worsens;
• vital components do not enter the paired glands in sufficient quantities;
• ovulation does not appear;
• the endometrium of the uterus thickens;
• the menstrual cycle becomes irregular;
• uterine bleeding may occur periodically.

In gynecology, PCOS is classified according to several criteria.

According to the etiology, it can be:

1. Primary. Another name for the disease is Stein-Leventhal syndrome. Primary polycystic ovaries can be congenital, or it develops during the formation of the menstrual cycle.
2. Secondary. In this case, the disease is a consequence of an already existing endocrine disease.

According to the pathogenesis, the syndrome can have the following forms:

1. Typical, in which the synthesis of male sex hormones is significantly increased.
2. Central, characterized by rapid weight gain.
3. Mixed, combining the features of both forms.

In addition, there are two types. In the first case, the glands increase in size, in the second they do not.

You need to know that PCOS is a disease that needs to be treated. It significantly reduces the likelihood of pregnancy, but with timely access to a doctor, it is possible to successfully endure and give birth to a child. If you ignore the alarming symptoms, the pathology will lead not only to infertility, but also to other serious complications.

Causes

You need to know that PCOS is a disease that is the result of a hormonal imbalance. It, in turn, occurs due to the production of a large amount of testosterone, which inhibits the process of ovulation.

The reasons for this situation may be:

• hereditary predisposition;
• a state of constant psycho-emotional stress;
• depression;
• pathology of the endocrine system;
• unsatisfactory environmental conditions in the area of ​​permanent residence;
• violation of metabolic processes;
• decrease in the sensitivity of body cells to insulin;
• neurohumoral disorders;
• infectious diseases of a chronic nature;
• excess body weight;
• climate change.

Under the influence of one or more of the above factors, the process of development and formation of follicles is inhibited. At the same time, the ovarian capsules become denser and increase in size, under which numerous cystic formations begin to form.

Symptoms

Every woman needs to know that PCOS is a disease that can occur in different ways. The severity of symptoms depends only on the individual characteristics of the organism. The first signs of PCOS can appear when a pathological process has been developing in the ovaries for a long time. In this regard, most women are not even aware of the presence of PCOS and seek medical help if numerous attempts to get pregnant have been unsuccessful. In this case, the symptom of polycystic ovary syndrome is infertility.

The following symptoms may also indicate the disease:

• violation of the menstrual cycle;
• amenorrhea;
• increased hair growth on the face, neck, arms;
• acne disease;
• baldness;
• seborrheic dermatitis;
• obesity (body weight increases dramatically by 10 or more kg);
• uterine bleeding;
• increased oiliness of the skin and hair;
• pain in the lower abdomen, often radiating to the lower back or pelvic region;
• rectal body temperature is unchanged throughout the cycle (it should rise during ovulation).

Important! Most of the above symptoms of polycystic ovary syndrome may not be signs indicating the presence of pathology in women during or before menopause and in girls during adolescence. This is due to the fact that in both cases, the violation of the cycle and manifestations of excessive production of androgen can be normal physiological conditions.

After examination by a doctor, a diagnosis of PCOS can be made if the symptoms are persistent and have persisted for a long time since the first menstrual bleeding. For women who are preparing or are in menopause, the likelihood of having the syndrome is extremely high if they already noticed signs of the disease at a younger age.

Diagnostics

First of all, the doctor needs to carefully collect an anamnesis. At the initial appointment, he should receive answers to the following questions:

• what alarming symptoms disturb the patient;
• body type;
• body mass index;
• whether the condition of the skin and mucous membranes is broken;
• hair type.

Then the doctor performs a vaginal examination on the gynecological chair and performs palpation. This is necessary in order to assess the size and density of the glands.

For an accurate diagnosis, laboratory and instrumental methods for diagnosing polycystic ovary syndrome are prescribed:

1. A blood test to determine the level of the following hormones: progesterone, prolactin, testosterone, cortisol, FSH, LH, DEA-S, estradiol, androstenedione. They are produced by the adrenal glands, pituitary gland and ovaries.
2. Blood test to determine the concentration of lipids. This is necessary to detect violations of metabolic processes.
3. Blood sugar test. Most women with PCOS have diabetes or are at risk for developing it. For more accurate information, a glucose tolerance test may be ordered.
4. ultrasound. During the study, the blood flow rate, the size of the ovaries, and the density of the capsules are evaluated. Ultrasound confirms the diagnosis of PCOS if the specialist has found 25 or more formations, the diameter of which varies between 2-9 mm. In addition, with polycystic ovary volume exceeds 10 ml.
5. MRI. With its help, the doctor gets the opportunity to find out if the glands are affected by tumors.
6. Laparoscopy. With PCOS, the method allows you to visually assess the condition of the ovaries, which is impossible with a vaginal examination. In addition, the doctor can take biomaterial for further analysis.

Blood tests are ordered for all patients. Based on their results, the most appropriate instrumental diagnostic methods are selected.

Conservative treatment

According to the same medical document, the following steps should be present in the treatment of PCOS:

1. Weight loss. The fight against obesity involves adjusting the diet and increasing the intensity of physical activity. It also shows the use of hypoglycemic agents, among which doctors prefer Metformin.
2. Restoration of ovulation and normalization of the menstrual cycle. For this purpose, drugs are prescribed, the active substance of which is clomiphene citrate. The therapy is carried out for 6 cycles. If the remedy does not lead to positive results, gonadotropin preparations or GnRH agonists are additionally prescribed. If they are ineffective, the patient is shown surgery.
3. Reducing the level of androgen, getting rid of male pattern hair growth. Therapy involves taking combined oral contraceptives. To get rid of the manifestations of hirsutism (excessive hair growth), the drug Spironolactone is usually prescribed. The course of treatment is 6 months. As for COCs, a huge number of names are sold on the pharmaceutical market. The choice of contraceptive is carried out only by a doctor, taking into account the results of all studies. After cancellation, the drug should provoke the process of maturation of several follicles.

Thus, the tactics of treating PCOS is reduced to normalizing the cycle, restoring fertility, eliminating metabolic disorders or reducing their manifestations to a minimum, getting rid of cosmetic defects, and reducing body weight.

Diet

It is impossible to permanently get rid of polycystic ovary syndrome. But if it is not treated periodically, over time, health-threatening conditions will begin to develop. Of great importance in pathology is the diet of the patient. In most cases, it is the diet for PCOS that can enhance the positive effect of medications, especially if the disease is accompanied by a significant increase in body weight.

The basic principles of nutrition for polycystic:

1. The caloric content of the diet should be reduced to 2000 kcal per day. It should not be less than 1200 kcal, as this is dangerous to health. The doctor can calculate the ideal daily calorie intake for the patient using special formulas. She can do this on her own.
2. You need to eat food that contains an acceptable amount of calories. The basis of the diet should be: fruits, vegetables, lean meats, greens, fish, dairy products, seafood.
3. It is necessary to reduce the amount of carbohydrates entering the body. At the same time, you need to increase your intake of food rich in proteins.
4. It is necessary to reduce the amount of animal fats, replacing them with vegetable ones.
5. It is necessary to exclude from the diet sweet, salty, smoked, pickled, spicy dishes, as well as any alcohol-containing drinks.
6. It is important to cleanse the body 1-2 times a week to arrange fasting days.

Surgical treatment

Currently, the main method of surgical intervention is laparoscopy. This is due to the fact that the method is effective and less traumatic. Its essence is as follows: on the wall of the abdomen, the doctor makes several incisions (usually 3 or 4, the length of each does not exceed 2 cm), through which manipulators of various actions are introduced into the body. During the operation, the surgeon has the ability to change the instruments in places. The main types of manipulators used in polycystosis are: a coagulator designed to cauterize blood vessels; forceps needed to capture the gland; endoscopic scissors.

Thus, the surgeon does not carry out any manipulations with his hands inside the abdominal cavity. Thanks to the camera built into the instrument, the progress of the operation is displayed on the monitor.

The main task of laparoscopy in polycystic ovary syndrome is to restore ovulation. Due to this, the patient gets the opportunity to become pregnant naturally.

The operation can be carried out in several ways:

1. Cauterization. During surgery, the doctor grasps the ovary with forceps. Then, using a laser, he makes incisions on its capsule, the depth of which does not exceed 1 cm. The choice of a place for incisions is not accidental: the surgeon first examines the gland to detect translucent follicles. After laparoscopy, they should mature and release an egg. The operation does not imply significant blood loss, it does not exceed 10 ml.
2. Wedge resection. After grasping the ovary with forceps, the surgeon coagulates the area whose tissues will be removed. Then, with endoscopic scissors, he cuts out part of the gland and cauterizes the vessels. After that, the edges of the wound are sewn together with one seam.
3. Decortication. The essence of the method is to remove the dense area of ​​the capsule with a coagulator.

It is important to know that PCOS is a disease that will constantly recur. On average, after the operation, fertility is restored for 1 year. Further, the capsule again begins to gradually thicken. In this regard, the patient needs to conceive a child in the near future after laparoscopy.

Is it possible to get pregnant with PCOS?

It is important to understand that for successful conception, it is necessary that the process of ovulation periodically starts in the woman's body. With PCOS, pregnancy is almost impossible, since a mature egg cannot get out of the gland due to the thickening of the capsule. Gradually, the follicle fills with fluid and a cyst forms from it.

The presence of polycystic disease does not mean that a woman is infertile, but without timely treatment, all chances are reduced to almost zero. Over time, the situation is aggravated more and more, since with each cycle the number of cystic formations increases.

The greatest difficulty is the situation in which the ovarian tissue does not react in any way to the action of hormonal drugs. This condition is a consequence of a violation in the work of receptors. In this case, at the same time as PCOS, the doctor diagnoses "ovarian resistance syndrome". In the presence of this disease, the restoration of ovulation is impossible, since not a single drug or surgical intervention will allow to achieve changes in a positive direction. The only way out for women with pathology is in vitro fertilization. But it requires donor material, since with resistance syndrome it is impossible to obtain eggs suitable for IVF.

If not treated?

Polycystic is a consequence of a violation of the hormonal background, and its course is accompanied by the absence of the ovulation process. If you ignore the alarming symptoms, the disease can cause infertility. According to statistics, PCOS is one of the most common reasons women fail to conceive naturally.

In addition, the long course of polycystic ovary syndrome without regular courses of therapy significantly increases the likelihood of developing cancer of the cervix, mammary glands and other organs. The risk of a malignant process increases many times if the patient suffers from diabetes and obesity.

The following diseases can also become complications of PCOS:

• atherosclerosis;
• myocardial infarction;
• stroke.

Timely diagnosis makes it possible to detect pathology at the earliest stage of its development, due to which the likelihood of dangerous complications is minimized.

Finally

Polycystic ovary syndrome is a serious disease that not only significantly reduces the quality of life of every woman, but also prevents the desired pregnancy. The main symptoms of the disease are: failure of the menstrual cycle (up to amenorrhea), male pattern hair, acne, seborrhea, pain, increased oily hair and skin. The complexity of making a diagnosis may lie in the fact that not every patient has several characteristic symptoms at once, some may not have them at all. To diagnose the disease, both laboratory and instrumental methods are used, including: blood tests, ultrasound, MRI, laparoscopy. When the diagnosis is confirmed, the doctor prescribes medications, the action of which is aimed at restoring fertility, normalizing the menstrual cycle, and reducing the manifestations of cosmetic deficiencies. If they do not bring the desired effect, surgical intervention is indicated. The operation is performed laparoscopically. After it, the ovulation process is restored and it is important for the patient to become pregnant in the coming months. This is due to the fact that it is impossible to get rid of the disease forever, relapses will periodically occur. Without courses of treatment, it can provoke the appearance of infertility and various malignant processes.

Thank you

Polycystic ovary syndrome (PCOS) is a complex multifactorial hormonal disorder. This disease is transmitted by inheritance - genetically. It is characterized by such manifestations as: an increase in the content of male sex hormones in the blood, the absence of ovulation and a regular menstrual cycle, disorders associated with the general metabolism of the body.

Disease prevalence

PCOS is detected in 5-10% of women of reproductive age and 20-25% of cases among women with infertility. Among endocrine cases of infertility, PCOS is the main cause of disorders in 50-60% of cases.

Forms of polycystic ovary syndrome

There is no official international classification.

The form is divided into:

Central - due to violations in the regulation of the work of the female genital organs from the hypothalamic-pituitary system.
Ovarian - a violation of the hormonal status due to damage to the ovaries.
Mixed (ovarian-adrenal) - the cause of this form of the disease is a violation of the endocrine function of the ovaries and adrenal glands.

By time of occurrence:

Primary - congenital pathology.
secondary (against the background of congenital dysfunction of the adrenal cortex (VDKN), obesity and other disorders).

Causes and mechanism of development of infertility in this pathology

There is no single view on the etiology and pathogenesis of PCOS. This disease is considered as genetic, it is based on a violation of the synthesis of estrogens and testosterone in favor of the latter. Dishormonal disorders cause a violation of the maturation of the follicle, the absence of ovulation and a violation of the menstrual cycle.

Diagnosis of polycystic ovary syndrome

Clinical picture:

The main feature of PCOS is the variety of clinical manifestations, which can be conditionally represented in the form of three main groups:

Violations of the reproductive system, manifested by delays or absence of independent menstruation and ovulation, often leading to infertility and the development of spontaneous abortions.

Skin manifestations of androgenization in the form of excessive hair growth (including on the face), acne, seborrhea and blackening acanthosis (darkening of skin areas with increased friction), which is considered as a sign of insulin resistance (a phenomenon in which insulin does not have the proper effect on body cells).

Metabolic disorders, which are manifested by obesity in the abdomen, increased insulin levels, disorders of carbohydrate and lipid metabolism.

Laboratory - instrumental research

Diagnosis is based on the clinical picture of the disease and on the characteristic morphological changes in the ovaries.

The diagnosis of polycystic ovary syndrome can be made if two of the following are present:

Hyperandrogenism (increased levels of male sex hormones)
chronic anovulation (prolonged absence of ovulation)
sonographic signs (signs detected by ultrasound examination of the pelvic organs)

An increase in the level of LH and an LH/FSH index of more than 2, although not a universal sign, is considered as one of the biochemical markers of the disease.

Sonographic criteria for polycystic ovary syndrome:

an increase in ovarian volume of more than 10 cm.
at least 12 follicles located along the periphery of the ovary.
Ultrasound of the pelvic organs - to identify the above echographic signs of polycystic disease.
Ultrasound color Doppler - reveals an increase in blood flow in the tissues of the ovaries.

Clinical examination - the nature of the menstrual cycle, reproductive function and clinical signs of androgenization are assessed.

Hormonal examination (determination of serum LH, FSH, prolactin, estradiol, total and free testosterone, androstenedione, DHEA-C, 17-hydroxyprogesterone, cortisol, progesterone). Allows you to quantitatively identify dyshormonal disorders.
Test with ACTH (tetracosactide) - with suspicion of congenital dysfunction of the adrenal cortex (VDKN)
Assessment of insulin resistance - based on fasting glucose and insulin levels.
Glucose tolerance test with a quantitative assessment of the glycemic profile and insulin secretion curves (diagnosis of impaired glucose tolerance and hyperinsulinemia) - performed by an endocrinologist. It includes measurements of fasting glucose and insulin levels, then sugar syrup is taken and a series of measurements of insulin and glucose at regular intervals. The study is performed to assess the dynamics of the concentration of glucose and insulin in the blood.

Lipid Spectrum Study - the content of various forms of fats in the blood is quantified.

Magnetic resonance imaging (MRI) if you suspect a tumor of the ovaries or adrenal glands.

Do you need advice from other experts?

All patients with PCOS are shown a consultation with an endocrinologist to diagnose hormonal changes in the body, as well as clarify the severity of metabolic disorders.
Treatment of infertility in PCOS

Medical therapy

Treatment of infertility in PCOS consists of two stages. At the first stage, preparatory therapy is carried out, which is chosen depending on the form of PCOS (central, adrenal or ovarian origin). The duration of preparatory therapy is 3-6 months.

At the second stage, ovulation induction is carried out. Preparations and schemes for their administration are determined taking into account the clinical and laboratory characteristics of the patient. During ovulation induction, careful ultrasound and hormonal monitoring of the stimulated cycle is performed.

Preparatory Therapy

With PCOS and obesity, there is a decrease in insulin resistance. Therefore, it is recommended to prescribe antidiabetic drugs that increase insulin sensitivity (drugs from the group of biguanides - metformin, or drugs from the group of thiazolidinediones - pioglitazone). The therapy is carried out for 12 months.

In the presence of high levels of LH - their drug reduction to complete suppression of ovarian function.

In the adrenal form of PCOS, glucocorticoids (hormonal drugs) are prescribed to suppress the synthesis of male sex hormones.

Ovulation induction in PCOS

Hormone therapy is performed to achieve ovulation. In this case, various types of hormonal agents or agents that affect the hormonal activity of sex hormones are used.

Surgery

Indications for surgical treatment of infertility in PCOS:

Ovarian form of PCOS
inadequate response to the use of ovulation inducers
no pregnancy within 4-6 months against the background of adequate conservative treatment
combination of PCOS with tubal-peritoneal infertility factor

The optimal conditions for surgical treatment are

Polycystic ovary syndrome (PCOS) is the most common problem associated with hormonal imbalance, although the symptoms of this condition are not always the same in different women. Polycystic ovaries is not a single disease, but a set of symptoms. It is diagnosed on the basis of a number of signs, the main of which is the absence of regular ovulation.

Other common symptoms that women with PCOS experience are hair loss and hirsutism (excessive growth of body and facial hair). Also, with PCOS, women very often have problems conceiving, since ovulation occurs extremely irregularly, which can also affect the quality of the eggs. The inability to ovulate is due to insufficient amounts of estradiol and progesterone. Because of this, testosterone rises and secondary symptoms of PCOS develop, such as hair loss, acne, and infertility.

If you have been diagnosed with PCOS, determine which type of PCOS you are suffering from. Thanks to this, it is possible to radically change the way of therapy and achieve faster success in treatment.

For a correct diagnosis of PCOS, the patient must have any two of the following three features (according to established criteria, Rotterdam, 2003):

1. Oligomenorrhea, amenorrhea (menstrual dysfunction) or anovulation (lack of regular ovulation).
2. Excess androgens (“male hormones”) – measured through laboratory testing (testosterone, DHEA and androstenedione) and based on symptoms such as acne and hair loss.
3. Polycystic ovaries are visualized by ultrasound: follicles grow but do not ovulate ("pearl necklace").

The main rule: you should never make or accept from a doctor a diagnosis of "polycystic ovary syndrome" based only on ultrasound data. It is better to consult an experienced doctor who can correctly diagnose all the symptoms and identify the cause of the disorder.

Polycystic ovaries is useless to treat until the root cause of the lack of ovulation in each case is established. The causes of PCOS can vary from girl to girl. Therefore, so often natural remedies work well for one woman with PCOS and do not work well for another.

Below is a brief overview of the four types of PCOS so that you can first determine if you have it and what causes it.

TYPES OF PCOS: CAUSES OF OVARIAN POLYCYSTOSIS

1. Insulin resistant polycystic ovaries

This is the "classic" and most common option. The culprit in the development of this type of PCOS is that the body becomes less sensitive to insulin, causing the levels of sugar and this hormone in the blood to become unbalanced. High insulin and leptin prevent ovulation and stimulate the ovaries to produce testosterone.

What is the reason? Insulin resistance is caused by obesity, excessive consumption of sugar and trans fats, smoking, environmental toxins.

Diagnostics. Check fasting insulin and glucose levels. LH (luteinizing hormone) or cholesterol levels may also be elevated. Obesity may be present. Normal weight in insulin resistance can occur after dieting or eating disorders.

Treatment. The first step is to avoid high sugar intake. The best supplements for insulin resistance are magnesium, lipoic, alpha-lipoic or R-lipoic acid, and berberine. OCs are not a treatment for this type of PCOS as they only worsen insulin sensitivity. Improvement in this type of polycystic ovaries begins to appear gradually, after about six months of treatment.

1. PCOS associated with the immune system

This is the second type of polycystic ovaries that occurs due to chronic inflammation. Inflammation prevents ovulation and destroys hormone receptors, stimulating the production of adrenal androgens such as DHEA sulfate. Women who have had immune dysfunctions and autoimmune conditions in the past (including family members) are more likely to develop this type of PCOS. Inflammation, or chronic activation of the immune system, can result from stress, environmental toxins, intestinal permeability, and inflammatory foods such as gluten or A1 casein.

Cause. Immune system dysfunction causes chronic inflammation, which eventually leads to elevated androgens. Usually in such cases, someone in the family has autoimmune diseases or the woman herself has a history of skin diseases, recurrent infections or joint pain. Other symptoms may include recurring infections and headaches.

Diagnostics. Blood tests for inflammatory markers such as CRP (C-reactive protein), ESR, vitamin D deficiency, thyroid antibodies (anti-TPO), and food sensitivities/allergies should be considered first. There may be deviations in the general clinical analysis of blood. Also, a girl in this case may have elevated DEA-S04 and adrenal androgens.

Treatment. Reduce stress and exposure to environmental toxins such as pesticides and plastics. Eliminate "inflammatory" foods - wheat, dairy products and sugar from the diet. Treat leaky gut with zinc, berberine, and probiotics. Take magnesium supplements - they are anti-inflammatory and normalize adrenal hormones. Improvement occurs slowly and gradually over 6-9 months.

1. Polycystic ovaries after taking hormonal contraceptives

This type of PCOS is one of the most common and somewhat easier to treat. At the very least, it's easier to diagnose, and its cause is fairly obvious. In addition, such polycystic disease is much better and faster to treat with the help of natural remedies. It occurs after the use of oral contraceptives. Birth control pills suppress ovulation. for most women, the body returns to normal within about the first six months, but for some, this period drags on for years and requires treatment.

This is the second most common type of PCOS. And since there is a reason why it occurs, it must be reversible.

What is the reason? After a long period of taking pills and a forced “rest”, it is difficult for the body to restart its own process of producing estrogen and progesterone.

Diagnostics. It often happens that a girl had regular periods before taking COCs, and the pills were prescribed to her for contraception or to fight acne. These women may also have elevated levels of LH (luteinizing hormone) and possibly prolactin.

Treatment. If LH is elevated, it is best to use natural herbal treatments such as peony and licorice. If prolactin is high, then grass helps a lot. However, Vitex should not be taken if LH in the blood is elevated! Vitex stimulates LH, so the situation with PCOS can only get worse. Because of this, many women with PCOS feel even worse after taking Vitex. Do not take it if your luteinizing hormone is already high in your blood.

Both peony and vitex work on the pituitary-ovarian axis and are powerful herbs. They are not recommended to be used too early in the morning or late in the evening. Do not take them if you are not yet past puberty or are just stopping OCs. Wait at least 3-4 months after stopping the pills. Do not use peony or vitex for more than 10-12 consecutive weeks. They shouldn't take that long. If they suit you, they will start working fairly quickly (within 3-4 months). Further, after the abolition of their intake, menstruation should remain regular. Do not take licorice if you have high blood pressure. It is best to consult an experienced doctor before starting treatment.

1. Polycystic ovaries associated with poor ecology and external circumstances, or PCOS of unknown etiology

In this case, it is important to find the exact cause of the polycystic ovaries. You need to find out which foods, drugs or habits have affected the hormonal background and ovulation. Usually in this case there is some one reason that blocks it. Once found, PCOS usually goes away within 3-4 months. Common hidden causes of PCOS most often include:

• too much soy in the diet, because it is also an antiestrogen and can block ovulation in some women (a small amount of it does not harm);
• thyroid disease, as the ovaries need the hormone T3;
• a vegetarian diet because it causes zinc deficiency;
• iodine deficiency - iodine is needed by the ovaries;
• artificial sweeteners, as they impair insulin and leptin sensitivity
• too little starch in the diet, as the hormonal system needs a low-carbohydrate diet.

If the cause is found correctly, treatment should quickly help restore the endocrine system.

Cause. These women have hypersensitivity, so even the choice of food can affect the body's ability to ovulate. There are girls who recover ovulation after giving up all soy products or sweeteners. It is also important to rule out thyroid disease, as hypothyroidism can interfere with normal ovulation.