Polycystic ovary syndrome: causes. Spyka: symptoms and signs Spya decoding

Polycystic disease occurs when the ovaries overproduce male hormones (androgens), which are normally produced in very small quantities.

During each menstrual cycle, many small follicles (vesicles) form in the ovaries, from which an egg can later be released. Normally, in the middle of the menstrual cycle during ovulation (follicle rupture), one egg leaves one of the follicles (of an ovary), and the other follicles overripe and stop working. With PCOS, the egg does not mature and ovulation does not occur. The follicles do not rupture, but fill with fluid and turn into cysts. Accordingly, the ovaries can increase in size, becoming 2-5 times larger than normal.

Women with polycystic ovary syndrome often exhibit masculine characteristics, such as excess facial and body hair, acne, bald spots, and abdominal fat deposits (fat deposited around the waist).

According to doctors, it affects about 5-10% of all women who have not yet gone through it. This is one of the main causes of infertility, and many women do not know that they are sick.

Causes

There is still no consensus among doctors. However, it is known that this disease is associated with the insensitivity of body tissues to insulin (a hormone involved in regulating blood sugar levels). Recent research suggests that the ovaries of women with polycystic ovary syndrome overproduce male sex hormones because the body cannot process insulin properly. The level of insulin in the blood is so high that the ovaries react to it by overproducing male sex hormones.

Symptoms

Symptoms can appear at any age. They can develop during puberty, and then the menstrual period may be delayed or not come at all. Girls may be overweight and have male-pattern hair growth, such as on the chest and face. Also, their menstrual cycle may be disrupted, and menstruation may be quite heavy.

Symptoms may vary slightly for each woman, although it is common to experience some or all of the following symptoms:

• excess hair growth on the face, chest and abdomen;
• absent or irregular menstrual bleeding;
• bleeding from the uterus;
• high blood pressure;
• acne;
• obesity around the waist;
• thin hair and male pattern baldness;
• infertility.

As we already mentioned, polycystic ovary syndrome is accompanied by symptoms of diabetes, such as fullness or increased urination, vaginal thrush (candidiasis) or chronic skin infections.

PCOS is visible on ultrasound, although not always. In 20% of women (who have not yet gone through menopause) who do not have symptoms of polycystic disease as such, polycystic ovaries are detected during ultrasound examination.

Complications

Stein-Leventhal syndrome may increase your chance of developing certain diseases. Therefore, it is important to carry out regular medical examinations. Even if some symptoms of polycystic ovary syndrome partially disappear after menopause, various diseases may appear after a certain time.

. By the time they reach menopause, about 50% of women with sclerocystic ovary syndrome are diagnosed with type 2 diabetes. That’s why it’s so important to start leading a healthy lifestyle and eating a healthy diet early.

Increased cholesterol levels. Elevated testosterone levels can cause LDL levels (the so-called “bad” form of cholesterol) to increase in your body, which ultimately leads to an increased risk of heart disease and heart attacks.

Endometrial cancer. Because women with polycystic ovary syndrome do not ovulate frequently, they have periods during which the endometrium grows excessively. This may increase the risk of cancer of the uterine wall, although there is no exact data on this phenomenon yet.

What can you do

Your doctor may recommend a certain diet to try to normalize your insulin levels and keep your cholesterol levels normal. Losing weight and maintaining good physical fitness are also very important; these measures alone help some women with PCOS realize their desire to become pregnant.

What can a doctor do?

Your doctor will need to evaluate your symptoms based on your medical record and general examination. If you are suspected of having polycystic ovary syndrome, your doctor will order appropriate tests to confirm it and rule out other possible conditions.

Necessary examination: ultrasound examination (will show a general appearance of your ovaries), blood tests for the general level of male sex hormones, insulin, cholesterol, or luteinizing hormone.

Although PCOS cannot be cured, some symptoms can still be kept under control. Treatment will depend on your set of symptoms, how severe they are, and how you feel about getting pregnant.

Medicines

You may be prescribed a progestogen (a synthetic version of the female sex hormone) or birth control to induce regular menstrual cycles.

Some low-concentration contraceptives commonly available commercially contain estrogen and a small amount of the anti-androgen (a substance that blocks the effects of male sex hormones) cyproterone acetate. It helps to effectively control excess hair growth and acne. Cyproterone acetate is available on its own, and your doctor may recommend this or another anti-androgen that works in a similar way. Excessive hair growth can be treated simultaneously with medications and hair removal treatments. Your doctor will choose the method that is best for you.

Isotretinoin is used in cases of severe acne. This drug reduces the amount of sebaceous secretions of the skin and reduces the number of skin glands that produce them. Due to the presence of side effects, this medication can only be prescribed by a special doctor. It is contraindicated for pregnant women and those planning a pregnancy, as there is a danger of harming the baby.

You may also be prescribed medications, such as metformin, to help your body use the insulin it produces properly. These medications help reduce body weight and lower blood pressure in patients with polycystic ovary syndrome, and sometimes help restore the menstrual cycle. Additionally, it helps control excess hair growth caused by elevated testosterone levels.

When using all these drugs, you must understand that their effect does not appear immediately. Also keep in mind that if medications aimed at reducing hair growth are not effective, you will have to use other methods, such as laser hair removal, waxing or electrolysis.

Fertility treatments may include the use of medications such as clomiphene citrate, which stimulates the growth of follicles in the ovaries and the release of eggs during the middle of the menstrual cycle, or injections of synthetic hormones similar to those that your body naturally produces.

Surgical treatment

Your doctor may suggest a surgical procedure called laparoscopy as a treatment for infertility. This involves using either a hot needle or a laser beam to cauterize the ovary in several places. This procedure can stimulate ovulation and increase your chances of getting pregnant. However, surgery is usually considered a last resort because the tissue scar can later deform the ovaries, which can negatively affect your ability to become pregnant.

Weight problems, persistent anxiety or depression, chronic acne, irregular periods or even infertility - all of these problems that many women face can be symptoms of one of the most common women's diseases.

Polycystic ovary syndrome (PCOS) is a common disorder that is still unknown, and the name itself indicates a spectrum of symptoms.

The name “syndrome” is used because this disorder manifests itself in different ways: a different set of symptoms occurs from woman to woman, which can arise for various reasons.

Many girls ignore polycystic ovary syndrome for a long time due to the absence of classic symptoms, but this cannot be done, since the far-reaching consequences can be serious:

• infertility,
• type II diabetes,
• high cholesterol,
• hypertension (high blood pressure),
• endometrial cancer.

But a diagnosis of PCOS does not mean that a girl is doomed to suffer from chronic health problems for the rest of her life. Although there is no specific known cure for this disorder, there are still ways to successfully manage it.

“Polycystic ovary syndrome is highly treatable with diet, lifestyle changes and therapeutic agents,” say gynecologists. “About 20% of patients are women with polycystic ovary syndrome. A diagnosis of PCOS should not be an obstacle to having a child. If a woman is willing to change her diet and lifestyle, as well as take a number of medications, fertility will be restored and pregnancy will occur.”

The first step in the fight against PCOS is to fully understand this endocrine disorder.

POLYCYSTIC OVARY SYNDROME: WHAT IS PCOS

Polycystic ovary syndrome is most often caused by hormonal imbalance, which in turn affects various processes in the body. When just one hormone is produced in deficiency or excess, it can cause a cascade of other hormonal problems. It's not always clear what causes the initial imbalance, but genetics may play a role.

Women with PCOS typically begin to produce increased amounts of the male hormone androgens. This excess production can disrupt the normal balance of progesterone and estrogens, the female sex hormones. This syndrome can also affect the body's ability to properly use insulin, a pancreatic hormone that allows the body to process glucose from food and keep blood sugar stable.

Most women (though not all) with the syndrome also have many tiny cysts along the edges of the ovaries, hence the term polycystic.

It is estimated that 5-10% of women of childbearing age have PCOS, but only 30% of them exhibit symptoms.

POLYCYSTIC OVARIAN SYNDROME: SYMPTOMS

To make a diagnosis of polycystic ovary syndrome, it is not necessary to have all the symptoms at once. However, it is important to remember that this diagnosis cannot be made based on just one sign. A complete examination is of paramount importance: from ultrasound and blood tests for estrogens and androgens to examination of the thyroid gland, tests for cortisol, ACTH, prolactin and 17-OH progesterone.

The following symptoms are usually present in most girls.

1. Irregular periods: The cycle is extremely unstable, usually from the very onset of menstruation. Very often, a woman has fewer than 8-9 menstruation per year or no menstruation at all. The opposite situation with too short and frequent cycles is much less common.
2. Excessive production of male hormones: High androgen levels often lead to hirsutism (male-pattern hair growth on the face and body), acne (and oily skin) and hair loss.
3. "Pearl necklace": If a doctor suspects a patient has PCOS, he should order an ultrasound to detect cysts on the ovaries. Cysts in themselves do not necessarily indicate polycystic syndrome; other signs must also be present - increased androgens and menstrual irregularities. Some women with polycystic disease do not have cysts on their ovaries at all.

POLYCYSTIC OVARIAN SYNDROME: TREATMENT

Although there is no one-size-fits-all treatment for PCOS, there are various ways to influence symptoms and keep them under control. It is important to discuss all treatment options with your doctor and choose the safest and most appropriate one. Some of the most common treatments include:

1. Lifestyle change

Because many women with PCOS are overweight or obese, maintaining a healthy weight with the right foods and exercise is critical. Even minimal weight loss of 5-10% has been shown to restore menstrual cycles and fertility. A diet rich in whole grains, fruits and vegetables and containing unprocessed foods helps maintain normal blood sugar levels and improves insulin sensitivity. If you smoke, be sure to quit this habit, as smoking increases androgen levels in women.

1. Hormone therapy

If you do not want to become pregnant in the near future, your doctor will prescribe oral contraceptives, which can regulate your menstrual cycle and reduce excess androgens and acne. If you are trying to get pregnant, medications such as clomiphene (Clomid) can help stimulate ovulation.

Taking OCs is usually well tolerated by healthy women who do not have problems with reproductive function. In girls with PCOS, the hormonal levels are very unstable, and taking COCs (especially long-term) followed by them often aggravates the situation and worsens the manifestation of symptoms of polycystic disease, adding new problems. Alternatively, you can use natural extracts, fish oils and oils, vitamins and minerals, supplements and preparations such as "" with or NAC.

1. Treatment of diabetes

A common treatment for PCOS associated with insulin resistance is (Glucophage), which is usually prescribed to treat type 2 diabetes. It is often used to control insulin and blood sugar levels, which leads to decreased testosterone production in women.

Are there alternative treatments for polycystic ovary syndrome in women?

Research suggests that additional dietary changes and certain supplements may help treat PCOS. It is important that the diagnosis is made correctly and the cause of polycystic disease is established as accurately as possible. In this case, instead of

Polycystic ovary syndrome (PCOS) is an endocrine structural and functional pathology in which multiple small and large cysts form in the glandular tissue of the organ. They are modified eggs that have matured but did not leave the ovary due to lack of ovulation. As a result of such processes, the ovaries increase in size, their surface becomes lumpy.

PCOS is a manifestation of a whole complex of hormonal disorders occurring in the body. Ovarian dysfunction is usually combined with pathology of other endocrine glands - thyroid, pancreas, adrenal glands, pituitary gland, hypothalamus. Due to hormonal disorders occurring in the female body, multiple small cysts—vesicles filled with fluid—begin to form and grow on the surface of the ovaries. This is due to the overproduction of the male sex hormone - androgen. Under its influence, the eggs remain in the follicles, which gradually turn into cysts.

The disease may be asymptomatic or manifested by oligomenorrhea, hirsutism, abdominal obesity, acne on the skin. Over time, secondary male sexual characteristics include: type 2 diabetes mellitus, heart attacks and strokes. In the absence of timely treatment, the syndrome leads to spontaneous abortion and infertility.

Polycystic ovary syndrome is a multifactorial heterogeneous pathology that most often develops in teenage girls. During menopause, secondary polycystic ovary syndrome appears, caused by long-term inflammation of the female genital organs. Chronic inflammation of the ovaries leads to the formation of cysts filled with fluid and immature eggs.

Main criteria of pathology:

• Chronic lack of ovulation,
• Hyperandrogenism,
• Ovarian hypertrophy on both sides,
• Proliferation of glandular stroma with luteinization processes,
• Subcapsular arrangement of cystic formations in the form of a “necklace”,
• Compaction of the follicle capsule.

Polycystic ovary syndrome has several equivalent names: Stein-Leventhal syndrome, polycystic ovary syndrome, functional ovarian hyperandrogenism. The disease is equally common in different ethnic groups.

Forms of pathology:

1. Primary or congenital form occurs in adolescence, when the menstrual cycle begins to form. True PCOS develops in girls with normal weight and blood glucose concentration, is severe and difficult to treat.
2. Secondary form develops in mature women suffering from inflammatory diseases of the genital organs or chronic endocrinopathy. Secondary PCOS occurs predominantly in individuals with obesity and hyperglycemia.

According to ultrasound of the ovaries, diffuse and peripheral polycystic disease are distinguished:

• Diffuse polycystic disease– follicles are scattered in the stroma of the organ. This form develops in women with normal weight, mild manifestations of hirsutism and secondary amenorrhea.
• Peripheral localization of follicles characteristic of the classic form of PCOS. Cysts are located along the edge of the stroma and have the appearance of a necklace. A similar picture occurs in women with obesity and a history of spontaneous abortion.

Causes

Currently, in official medicine there is no specific data regarding the causes of the syndrome. It is believed that they remain not fully studied. PCOS is a manifestation of polyendocrine disorders occurring in the female body.

Hyperandrogenism and hypoprogesteronemia are common causes of hormonal imbalance in a woman’s body. Maintaining certain relationships between the ovaries, the anterior pituitary gland and the hypothalamus ensures adequate functioning of the reproductive system. If this interaction is disrupted, PCOS may develop.

Factors contributing to the development of the syndrome:

1. Genetic predisposition,
2. Excess weight,
3. Diabetes,
4. Hypofunction of the thyroid gland,
5. Acute infectious diseases,
6. Inflammatory diseases of the female genital organs,
7. Autoimmune processes
8. Stress,
9. Climate change
10. Abnormal fetal development.

Pathogenetic links of the syndrome:

• Insulin resistance of adipose and muscle tissue,
• Circulation of insulin in the blood
• Compensatory hyperinsulinemia,
• Ovarian stimulation,
• Hyperandrogenism,
• Ovarian dysfunction,
• Anovulation,
• Thickening of the ovarian membrane,
• Filling the follicle with fluid,
• Cyst formation,
• Menstrual dysfunction and infertility.

In this case, the ovaries are of normal size or slightly enlarged, their capsule is smooth and thickened. They contain small follicular brushes and large cysts with many atretic cells. Numerous ovarian cysts have a “pearl necklace” appearance. The ovarian capsule is compacted and pearly white. Hyperestrogenemia leads to endometrial hyperplasia, and subsequently to cancer.

PCOS is a multifactorial and genetically determined disease, the pathogenesis of which involves central and local mechanisms of endocrine regulation, as well as metabolic disorders. Together they determine the clinical picture of the pathology and morphological changes in the glandular tissue of the ovaries.

Symptoms

The symptoms of PCOS are very diverse. The appearance of the first clinical signs coincides with menarche, the onset of sexual life, and pregnancy. The syndrome is characterized by masculinization - the accumulation of male secondary sexual characteristics in women.

Since PCOS is combined with hyperglycemia and hypertension, along with the main symptoms, signs of high blood pressure and diabetes appear.

Self-discovery of specific signs of PCOS is a reason to visit a doctor who will prescribe the correct treatment. Regular use of medications significantly increases a woman’s chances of conceiving, carrying and giving birth to a healthy child. Special hormonal therapy normalizes testosterone levels, the hypersecretion of which can cause miscarriage at any time.

Experts are confident that pregnancy is possible with PCOS. To give birth to a child, sick women are recommended maintenance drug therapy throughout pregnancy.

Complications

• Persistent inability of a woman to realize her reproductive function,
• Diabetes,
• Hypertension,
• Acute cerebral and coronary insufficiency,
• Endometrial cancer
• Spontaneous abortions
• Mammary cancer,
• Obesity,
• Thrombosis, thromboembolism, thrombophlebitis,
• Dyslipidemia and vascular atherosclerosis,
• Cervical cancer,
• metabolic syndrome,
• Hepatitis,
• Fibrocystic mastopathy.

Diagnostics

Clinical recommendations for the diagnosis and treatment of polycystic ovary syndrome make it possible to find a strategy for guiding the patient to recovery and make it possible to exclude the development of severe complications. Diagnosis of PCOS involves a detailed interview and examination of the patient. The doctor collects family history, measures blood pressure, and prescribes other tests. Gynecologists evaluate the body type and the pattern of hair growth on the body, question the patient about the peculiarities of menstruation, and palpate the abdomen. Then they proceed to examine the woman on the chair, during which enlarged and thickened appendages are discovered.

Basic research methods:

If a woman has ovarian dysfunction combined with hirsutism, acne, seborrhea and is confirmed by echoscopic signs of polycystic disease, specialists have the right to make a final diagnosis.

Treatment

Treatment of polycystic ovary syndrome begins with drug therapy, and if it is ineffective, it proceeds to surgery.

Body weight correction

Women with PCOS are usually obese. To achieve the desired result from conservative treatment, you must first normalize your body weight. To do this, nutritionists recommend that patients follow the following principles of proper nutrition:

• Maintain daily caloric intake within 1800-2000 kcal,
• Eat 5-6 times a day in small portions,
• Limit consumption of spicy and salty foods,
• Drink 1.5-2 liters of liquid per day,
• A couple of times a week, arrange fasting days on apples, kefir, cottage cheese,
• The basis of the diet should be low-calorie foods - fruits and vegetables,
• Eat enough protein foods
• Limit carbohydrates – baked goods, confectionery, honey,
• Avoid smoked meats, marinades, spicy dishes, sauces,
• Completely abstain from drinking alcoholic beverages,
• Increase physical activity.

Obese patients are prescribed Sibutramine, a medicine that increases the feeling of fullness, as well as Orlistat, which interferes with the absorption of fats. Such drug correction accelerates the process of losing weight.

Conservative treatment

Drug therapy for PCOS is aimed at stimulating ovulation, restoring the cyclicity of menstruation, reducing the phenomena of hyperandrogenism, and correcting carbohydrate and lipid metabolism.

The pharmacy sells special herbal preparations for preparing decoctions and tinctures. To combat hyperandrogenism, mint, milk thistle, and nettle are used. These herbs are brewed and the infusion is drunk throughout the day. Licorice root also suppresses the action of male sex hormones. Black tea is replaced with green tea. It helps restore female hormonal levels.

Surgery

There are surgical techniques aimed at removing the part of the ovary that produces androgens, as well as restoring normal communication between the ovaries and the central structures.

• Wedge resection of the ovaries– removal of organ tissue that synthesizes androgens. Relapse of hyperandrogenism is due to the ability of glandular tissue to quickly regenerate. This treatment method is currently practically not used.

wedge resection of the ovary

These types of surgical interventions restore the menstrual cycle and allow a woman to conceive a child. If there is no expected effect from conservative and surgical treatment, the woman is sent to a human reproduction center for in vitro fertilization.

Polycystic ovary syndrome requires long-term and persistent treatment. Sick women should be observed by a gynecologist and regularly visit their doctor. Timely diagnosis and proper therapy make it possible to get rid of the pathology and restore the functions of the woman’s reproductive system at least for some time, sufficient for conception and pregnancy. If the disease is not treated, it will progress rapidly with age.

Prevention

To avoid the development of PCOS, experts recommend following the following rules:

1. Be observed by a gynecologist and visit him at least once every six months,
2. Monitor your body weight
3. If necessary, follow a diet,
4. Regularly engage in physical activity,
5. Lead a healthy lifestyle,
6. To refuse from bad habits,
7. Take hormonal contraceptives,
8. Promptly identify and treat inflammation of the appendages,
9. Monitor blood pressure, glucose and cholesterol levels in the blood,
10. Take vitamins when planning pregnancy,
11. Avoid stressful and conflict situations.

The prognosis for treatment of PCOS is relatively favorable. In most cases, timely therapy completely restores the female body. A woman can become pregnant, carry and give birth to a child.

Video: polycystic ovary syndrome

Video: polycystic ovary syndrome in the program “Live Healthy!”

Polycystic ovary syndrome (PCOS) is an endocrine (hormonal) disease characterized by pathological changes in the structure and function of the ovaries. Frequently used synonyms for PCOS are polycystic ovarian syndrome or sclerocystic ovarian syndrome.

Causes of PCOS

PCOS is a common hormonal disorder among women of reproductive age, leading to permanent infertility. Despite the relevance of the problem, the exact causes of PCOS are still unknown.

It is a known fact that almost all women with polycystic ovary syndrome have insulin resistance, that is, the body’s sensitivity to insulin, a pancreatic hormone that regulates blood sugar levels, is reduced. All this leads to insulin circulating in the blood in large quantities. According to studies, it can be assumed that increased insulin stimulates the ovaries to excessive production of male sex hormones - androgens, which disrupt the structure and function of the ovaries.

First of all, androgens have a detrimental effect on the ovulation process, without which pregnancy is impossible, preventing eggs from growing normally. The outer membrane of the ovaries thickens under the influence of male hormones and the mature follicle cannot “tear” it so that the egg can be released and take part in the fertilization process. An unruptured follicle fills with fluid and turns into a cyst. The same thing happens with other follicles - they mature and stop working, becoming cysts. Thus, the ovaries of a woman with polycystic disease are a cluster of many small cysts. Because of this, the ovaries in PCOS are larger in size than normal ones.

In addition to hormonal causes, predisposing factors leading to the development of PCOS include:

Hereditary predisposition occupies almost the main place in the causes of PCOS;
- obesity or overweight;
- diabetes.

Symptoms of PCOS

The symptoms of PCOS are varied. The first thing a woman usually notices is irregular periods. Delays in menstruation with PCOS can be months or even six months. Since disruption of the hormonal function of the ovaries begins with puberty, cycle disturbances begin with menarche and do not tend to normalize. It should be noted that the age of menarche corresponds to that in the population - 12-13 years (in contrast to adrenal hyperandrogenism in adrenogenital syndrome, when menarche is delayed). In approximately 10-15% of patients, menstrual irregularities are characterized by dysfunctional uterine bleeding against the background of endometrial hyperplastic processes. Therefore, women with PCOS are at risk of developing endometrial adenocarcinoma, fibrocystic mastopathy and breast cancer.

The mammary glands are developed correctly, every third woman has fibrocystic mastopathy, which develops against the background of chronic anovulation and hyperestrogenism.

In addition to menstrual irregularities, increased levels of male hormones cause increased hair growth throughout the body (hirsutism). The skin becomes oily, pimples and blackheads appear on the face, back, and chest. Characteristic is the appearance of dark brown spots on the skin on the inner thighs, elbows, and armpits. The hair on the head quickly becomes oily due to impaired function of the sebaceous glands. Hirsutism, of varying severity, develops gradually from the period of menarche, in contrast to adrenogenital syndrome, when hirsutism develops before menarche, from the moment of activation of the hormonal function of the adrenal glands during the period of adrenarche.

Almost all patients with PCOS have increased body weight. In this case, excess fat is deposited, as a rule, on the abdomen (“central” type of obesity). Since insulin levels are elevated in PCOS, the disease is often combined with type 2 diabetes. PCOS contributes to the early development of vascular diseases such as hypertension and atherosclerosis.

And finally, one of the main and unpleasant symptoms of PCOS is infertility due to lack of ovulation. Most often, infertility is primary (in 85% of cases), i.e. There have never been any pregnancies. Sometimes infertility is the only symptom of polycystic ovary syndrome. Infertility is primary in nature, in contrast to adrenal hyperandrogenism, in which pregnancy is possible and is characterized by miscarriage.

Since there are many symptoms of the disease, PCOS can easily be confused with any dyshormonal disorder. At a young age, oily skin, acne and pimples are mistaken for natural age-related features, while increased hairiness and excess weight problems are often perceived as genetic features. Therefore, if the menstrual cycle is not disrupted and the woman has not yet tried to become pregnant, then such patients rarely turn to a gynecologist. It is important to know that any such manifestations are not the norm and if you discover similar symptoms, you should consult a gynecologist-endocrinologist in person.

Diagnosis of PCOS

Structural changes in the ovaries in PCOS are characterized by:

• stromal hyperplasia;
• hyperplasia of theca cells with areas of luteinization;
• the presence of many cystic atretic follicles with a diameter of 5-8 mm, located under the capsule in the form of a “necklace”;
• thickening of the ovarian capsule

Diagnosis of PCOS includes:

Detailed survey and examination by a gynecologist-endocrinologist. Upon examination, the doctor notes an enlargement of both ovaries and external signs of PCOS;

- Ultrasound of the pelvic organs with a vaginal sensor. When examining the periphery of the ovaries, many unovulated follicles up to 10 mm are revealed, the volume of the ovaries is greatly increased

Clear criteria for the echoscopic picture of PCOS: ovarian volume more than 9 cm 3, hyperplastic stroma makes up 25% of the volume, more than ten atretic follicles with a diameter of up to 10 mm, located along the periphery under a thickened capsule. The volume of the ovaries is determined by the formula: V = 0.523 (L x Sx N) cm3, where V, L, S, H are the volume, length, width and thickness of the ovary, respectively; 0.523 is a constant coefficient. The increase in ovarian volume due to hyperplastic stroma and the characteristic location of the follicles help differentiate polycystic ovaries from normal (on the 5-7th day of the cycle) or multifollicular. The latter are characteristic of early puberty, hypogonadotropic amenorrhea, and long-term use of COCs. Multifollicular ovaries are characterized by ultrasound by a small number of follicles with a diameter of 4-10 mm located throughout the ovary, a normal pattern of stroma and, most importantly, a normal volume of the ovaries (4-8 cm 3);

Study of blood plasma hormones (LH, FSH, prolactin, free testosterone, DHEA-c, 17-OH progesterone). Hormones must be taken on certain days of the menstrual cycle, otherwise the study will not be informative. LH, FSH and prolactin are given on days 3-5, free testosterone and DHEA-c on days 8-10, and 17-OH progesterone on days 21-22 of the cycle. As a rule, with polycystic disease, the levels of LH are increased (an increase in the LH/FSH ratio of more than 2.5), prolactin, testosterone and DHEA-c; and FSH and 17-OH progesterone are reduced;

Biochemical blood test (with PCOS, the levels of cholesterol, triglycerides and glucose may be increased);

An oral glucose tolerance test is performed to determine insulin sensitivity;

Diagnostic laparoscopy with ovarian biopsy - a piece of ovarian tissue is taken for histological examination. Endometrial biopsy is indicated for women with acyclic bleeding due to the high incidence of endometrial hyperplastic processes.

After a test with dexamethasone, the androgen content decreases slightly, by about 25% (due to the adrenal fraction).

The ACTH test is negative, which excludes adrenal hyperandrogenism, characteristic of adrenogenital syndrome. An increase in insulin levels and a decrease in PSSG in the blood were also noted.

In clinical practice, a simple and accessible method for determining impaired glucose tolerance to insulin is the sugar curve. Blood sugar is determined first on an empty stomach, then within 2 hours after taking 75 g of glucose. If after 2 hours the blood sugar level does not return to the original values, this indicates impaired glucose tolerance, i.e. insulin resistance, which requires appropriate treatment.

Criteria for diagnosis PCOS are:

• timely age of menarche,
• disturbance of the menstrual cycle from the period of menarche in the vast majority of cases as oligomenorrhea,
• hirsutism and obesity since menarche in more than 50% of women,
• primary infertility,
• chronic anovulation,
• increase in ovarian volume due to stroma according to transvaginal echography,
• increase in T level,
• increase in LH and LH/FSH ratio > 2.5.

Treatment of PCOS

Treatment for PCOS is determined by the severity of symptoms and the woman’s desire to become pregnant. Usually they start with conservative treatment methods; if ineffective, surgical treatment is indicated.

If a woman is obese, then treatment should begin with correction of body weight. Otherwise, conservative treatment in such patients does not always give the desired result.

In the presence of obesity, the following are carried out:

• The first stage of treatment is normalization of body weight. Reducing body weight against the background of a reduction diet leads to normalization of carbohydrate and fat metabolism. The diet involves reducing the total calorie content of food to 2000 kcal per day, of which 52% comes from carbohydrates, 16% from proteins and 32% from fats, and saturated fats should make up no more than 1/3 of the total amount of fat. An important component of the diet is limiting spicy and salty foods and liquids. A very good effect is observed when using fasting days; fasting is not recommended due to protein consumption in the process of gluconeogenesis. Increasing physical activity is an important component not only for normalizing body weight, but also for increasing the sensitivity of muscle tissue to insulin. The most difficult thing is to convince the patient of the need to normalize body weight as the first stage in treatment PCOS;
• the second stage of treatment is drug treatment of hormonal disorders;
• the third stage of treatment is stimulation of ovulation after normalization of body weight and with PCOS with normal body weight. Stimulation of ovulation is carried out after excluding tubal and male factors of infertility.

Conservative treatment of PCOS

The goals of conservative treatment of PCOS are to stimulate the ovulation process (if a woman is interested in pregnancy), restore the normal menstrual cycle, reduce the external manifestations of hyperandrogenism (increased hairiness, acne, etc.), and correct disorders of carbohydrate and lipid metabolism.

In case of impaired carbohydrate metabolism, infertility treatment begins with the prescription of hypoglycemic drugs from the biguanide group (Metformin). The drugs correct blood glucose levels, the course of treatment is 3-6 months, doses are selected individually.

To stimulate ovulation, the hormonal antiestrogen drug Clomiphene Citrate is used, which stimulates the release of an egg from the ovary. The drug is used on days 5-10 of the menstrual cycle. On average, after using Clomiphene, ovulation is restored in 60% of patients, pregnancy occurs in 35%.

If Clomiphene has no effect, gonadotropic hormones such as Pergonal, Humegon are used to stimulate ovulation. Hormone stimulation should be carried out under the strict supervision of a gynecologist. The effectiveness of treatment is assessed using ultrasound and basal body temperature.

If a woman does not plan a pregnancy, for the treatment of PCOS, combined oral contraceives (COCs) with antiandrogenic properties are prescribed to restore the menstrual cycle. COCs Yarina, Diane-35, Zhanine, Jess have these properties. If the antiandrogenic effect of COCs is insufficient, it is possible to combine drugs with antiandrogens (Androcur) from the 5th to the 15th day of the cycle. Treatment is carried out with dynamic monitoring of hormone levels in the blood. The course of treatment averages from 6 months to a year.

The potassium-sparing diuretic Veroshpiron, which is also used for polycystic ovary syndrome, has a high antiandrogenic property. The drug reduces the synthesis of androgens and blocks their effect on the body. The drug is prescribed for at least 6 months.

Stimulation of ovulation in PCOS. Clomiphene

Clomiphene is a non-steroidal synthetic estrogens. Its mechanism of action is based on blockade of estradiol receptors. After discontinuation of clomiphene, the secretion of GnRH increases through a feedback mechanism, which normalizes the release of LH and FSH and, accordingly, the growth and maturation of follicles in the ovary. Thus, clomiphene does not stimulate the ovaries directly, but has an effect through the hypothalamic-pituitary system. Stimulation of ovulation with clomiphene begins from the 5th to the 9th day of the menstrual cycle, 50 mg per day. With this regimen, the increase in gonadrtropin levels induced by clomiphene occurs at a time when the selection of the dominant follicle has already been completed. Earlier use of clomiphene may stimulate the development of multiple follicles and increases the risk of multiple pregnancies. In the absence of ovulation according to ultrasound and basal temperature, the dose of clomiphene can be increased in each subsequent cycle by 50 mg, reaching 200 mg per day. However, many clinicians believe that if there is no effect when prescribing 100-150 mg of clomiphene, then further increasing the dose is inappropriate. If there is no ovulation at the maximum dose for 3 months, the patient can be considered resistant to clomiphene. The criteria for the effectiveness of ovulation stimulation are:

• restoration of regular menstrual cycles with hyperthermic basal temperature for 12-14 days;
• progesterone level in the middle of the second phase of the cycle is 5 ng/ml. and more, preovulatory LH peak;
• Ultrasound signs of ovulation on the 13-15th day of the cycle:
• the presence of a dominant follicle with a diameter of at least 18 mm;
• endometrial thickness is at least 8-10 mm.

If these indicators are present, it is recommended to administer an ovulatory dose of 7500-10000 IU of human chorionic gonadotropin - hCG (prophase, choragon, pregnyl), after which ovulation is noted after 36-48 hours. When treating with clomiphene, it should be taken into account that it has anti-estrogenic properties, reduces the amount of cervical mucus (“dry neck”), which prevents the penetration of sperm and inhibits the proliferation of the endometrium and leads to implantation failure in the event of fertilization of the egg. In order to eliminate these undesirable effects of the drug, it is recommended to take natural estrogens in a dose of 1-2 mg after stopping taking clomiphene. or their synthetic analogues (microfollin) from the 10th to the 14th day of the cycle to increase the permeability of cervical mucus and endometrial proliferation.

The frequency of ovulation induction during treatment with clomiphene is approximately 60-65%, pregnancy occurs in 32-35% of cases, the frequency of multiple pregnancies, mainly twins, is 5-6%, the risk of ectopic pregnancy and spontaneous miscarriages is not higher than in the population. In the absence of pregnancy against the background of ovulatory cycles, it is necessary to exclude peritoneal factors of infertility during laparoscopy.

In case of resistance to clomiphene, gonadotropic drugs are prescribed - direct ovulation stimulants. Human menopausal gonadotropin (hMG), prepared from the urine of postmenopausal women, is used. hMG preparations contain LH and FSH, 75 IU each (pergonal, menogon, menopur, etc.). When prescribing gonadotropins, the patient should be informed about the risk of multiple pregnancy, the possible development ovarian hyperstimulation syndrome, as well as the high cost of treatment. Treatment should be carried out only after excluding pathology of the uterus and tubes, as well as male factor infertility. During the treatment process, transvaginal ultrasound monitoring of folliculogenesis and the condition of the endometrium is mandatory. Ovulation is initiated by a single injection of hCG at a dose of 7500-10000 IU, when there is at least one follicle with a diameter of 17 mm. If more than 2 follicles with a diameter of more than 16 mm are detected. or 4 follicles with a diameter of more than 14 mm. administration of hCG is undesirable due to the risk of multiple pregnancies.

When ovulation is stimulated by gonadotropins, the pregnancy rate increases to 60%, the risk of multiple pregnancies is 10-25%, ectopic - 2.5-6%, spontaneous miscarriages in cycles ending in pregnancy reach 12-30%, ovarian hyperstimulation syndrome is observed in 5 -6% of cases.

Surgical treatment of PCOS

Surgical treatment is also used for PCOS, most often to treat infertility. The operation is performed laparoscopically, with small incisions made under general anesthesia. There are two main surgical methods for the treatment of PCOS - wedge resection of the ovaries (remove ovarian tissue that synthesizes androgens in excess) and electrocautery of the ovaries (spot destruction of androgen-producing ovarian tissue, the operation is less traumatic and less time-consuming compared to wedge resection). The advantage of laparoscopic resection is the possibility of eliminating the often concomitant peritoneal factor of infertility (adhesions, obstruction of the fallopian tubes).

As a result of surgery, ovulation is restored and within 6-12 months the woman can conceive a child. In most cases, in the postoperative period, a menstrual-like reaction is observed after 3-5 days, and ovulation is observed after 2 weeks, which is tested by basal temperature. Lack of ovulation for 2-3 cycles requires additional administration of clomiphene. As a rule, pregnancy occurs within 6-12 months, then the frequency of pregnancy decreases. If even after the operation the long-awaited pregnancy does not occur within a year, further waiting makes no sense and the woman is recommended to resort to IVF (in vitro fertilization).

Despite the fairly high effect in stimulating ovulation and pregnancy, most doctors note a relapse of the clinical symptoms of PCOS after about 5 years. Therefore, after pregnancy and childbirth, prevention of recurrence of PCOS is necessary, which is important given the risk of developing endometrial hyperplastic processes. For this purpose, it is most advisable to prescribe COCs, preferably monophasic ones (Marvelon, Femoden, Diane, Mercilon, etc.). If COCs are poorly tolerated, which happens with excess body weight, gestagens can be recommended in the second phase of the cycle: duphaston at a dose of 20 mg. from the 16th to the 25th day of the cycle.

For women who are not planning a pregnancy, after the first stage of stimulation of ovulation with clomiphene, aimed at identifying the reserve capabilities of the reproductive system, it is also recommended to prescribe COCs or gestagens to regulate the cycle, reduce hirsutism and prevent hyperplastic processes.

Physiotherapy and fitness for the treatment of PCOS

The success of PCOS treatment depends not only on the doctor and the prescribed medications, but also on the patient’s lifestyle. As already mentioned, weight management is very important for the treatment of polycystic ovary syndrome. To lose weight, it is recommended to limit the consumption of carbohydrates - sugar, chocolate, potatoes, bread, pasta, cereals. If possible, you should reduce your salt intake. In addition to diet, it is advisable to exercise at least 2-3 times a week. According to clinical trials, 2.5 hours of physical activity per week in combination with diet has the same positive effect in some patients with PCOS as the use of medications! This is explained by the fact that adipose tissue is also an additional source of androgens, and by getting rid of extra pounds, you can not only correct your figure, but also significantly reduce the amount of “extra” androgens in polycystic disease.

Physiotherapeutic procedures are also indicated for PCOS. Lidase galvanophoresis is used to activate the ovarian enzymatic system. Electrodes are installed in the suprapubic region. The course of treatment is 15 days daily.

Traditional medicine to combat PCOS, unfortunately, is ineffective, so they are usually not recommended for polycystic disease.

Treatment of polycystic ovary syndrome is long-term and requires careful monitoring by a gynecologist-endocrinologist. All women with PCOS are recommended to get pregnant and give birth as early as possible, since the symptoms of the disease, unfortunately, quite often progress with age.

Complications of PCOS:

Infertility that cannot be treated;
- diabetes mellitus and hypertension, the risk of developing heart attacks and strokes with PCOS increases several times;
- endometrial cancer can develop with polycystic disease due to long-term dysfunction of the ovaries;
- Pregnant women with PCOS are more likely than healthy pregnant women to experience early miscarriages, premature births, gestational diabetes and preeclampsia.

Prevention of polycystic ovary syndrome:

Regular visits to the gynecologist - twice a year;
- weight control, regular exercise, diet;
- taking hormonal contraceptives.

Questions and answers from an obstetrician-gynecologist on the topic of PCOS:

1. I have obesity and PCOS. They prescribed COC hormones, which made me gain even more weight. What to do?
You need to get tested for hormones and discuss them with a gynecologist-endocrinologist; in any case, try to lose weight on your own (diet, exercise).

2. Can PCOS be caused by early sexual activity?
No, he can not.

3. I have a mustache growing on my face. Does this mean I have polycystic ovary syndrome?
Not necessarily, this may be a variant of the norm. Contact a gynecologist-endocrinologist and get tested for hormones.

4. I have PCOS. I underwent treatment - no effect. Lately, hair has been growing all over my body. The gynecologist recommended ovarian resection. Will surgery help get rid of hair?
It will help, but the effect will be temporary. Complete hair removal is possible only after hormonal correction.

5. Is it necessary to take antiandrogens before and after the operation for the best effect of laparoscopy?
No, this is not necessary.

6. My period was late. The doctor diagnosed PCOS using ultrasound and prescribed hormones. But I have neither increased hair growth nor obesity. Do I need to take hormones at all?
The diagnosis of PCOS is not made solely on the basis of ultrasound, much less treatment is prescribed without checking hormone levels. I recommend contacting a gynecologist-endocrinologist again and undergoing a full examination.

7. Is it possible to go to a sauna with PCOS?
Yes, you can.

Obstetrician-gynecologist, Ph.D. Christina Frambos

is a disease that develops in women when the production of the male sex hormone is too intense. Due to such active production of androgen, the eggs remain in follicles. In turn, the follicles turn into cysts.

Modern statistics indicate that polycystic ovary syndrome most often manifests itself in girls who have entered into puberty . However, the disease can develop in women of any age. At a later age - during menstrual pause - the so-called secondary polycystic ovary syndrome , as a consequence of chronic female diseases. The disease must be properly treated, as it can threaten a woman’s health. In addition, the formation of multiple cysts on the ovaries significantly reduces a woman’s ability to conceive and bear a child. But still, after competent and timely treatment of the disease and elimination of the problem, such a patient can carry and give birth to a healthy baby.

Causes of the disease

Polycystic ovaries – a consequence of hormonal imbalance in a woman’s body. Cysts form due to too high production levels androgens and decreased production. Some experts theorize that the cause of this failure is a disrupted hormonal interaction between and ovaries . There is also evidence that the manifestation of this disease is influenced by a hereditary factor. That is, higher chances of getting sick are observed in those women who have a family history of polycystic ovary syndrome. Therefore, if this disease is present in female relatives, the woman should be regularly examined by a doctor.

Symptoms of polycystic ovary syndrome

When a woman develops polycystic ovary syndrome under the influence of endocrine imbalance not only the structure, but also the function of the ovaries is disrupted. Cysts develop in the ovarian tissue, which look like small bubbles with fluid inside. Such cysts are modified eggs , which have matured, but ovulation has not occurred. As a result, the ovaries become enlarged, and tubercles appear on their surface. In this case, the menstrual cycle fails. And in some cases, menstruation may stop completely.

In most cases, polycystic ovary syndrome begins to develop in young women. Most often, polycystic ovaries appear in parallel with first menstruation , the beginning of sexual activity , strong and sudden weight gain , . For quite a long period, a woman may not know that she is developing this disease, since there are no visible symptoms of polycystic ovary syndrome. One of the main manifestations in this case is considered irregular periods . Menstruation may occur irregularly, rarely, and eventually stop completely. In this case, the woman is diagnosed due to the absence of ovulation, during which a mature egg is released. Infertility as a consequence chronic anovulation, is diagnosed with polycystic ovaries in about a third of women. In addition, patients may experience periodic dysfunctional uterine bleeding .

There are also a number of other symptoms of the disease, but not all women experience them. In this case we are talking about heavy body hair, intense hair loss on the scalp, breast reduction, the appearance of acne And blackheads. In addition, women who suffer from polycystic ovary syndrome often experience appearance of excess weight . There are even statistics that show that approximately 30-60% of women diagnosed with polycystic ovaries suffer from. If a woman is overweight, other symptoms of the disease may become more pronounced. In addition, when examined by a gynecologist, some women with polycystic ovary syndrome experience hypertrophied clitoris .

Diagnosis of the syndrome

Unfortunately, most women suffering from polycystic ovary syndrome turn to doctors only when it becomes completely obvious. Polycystic ovary syndrome is considered one of the most common causes of infertility in women. Therefore, modern doctors insist that women who have irregular menstrual cycle or no periods at all , they must undergo examination to exclude the development of polycystic ovaries. It is especially important to exclude the disease if a woman exhibits other signs of polycystic ovary syndrome.

During the diagnostic process, it is necessary to carry out internal examination. To determine the condition of the ovaries, a woman is prescribed an internal ultrasound scan. To do this, a special sensor is inserted into the vagina. The main criterion for making a diagnosis using this method is the presence of more than 8 follicular cysts, the diameter of which is less than 10 mm. Also, in case of illness, it is determined endometrial hyperplasia . Sometimes additional research is also required, for which the patient is prescribed claporoscopy . A puncture is made in the abdominal wall, through which the optical device is inserted into the abdominal cavity. Using this device, the doctor examines the ovaries. In addition, urine and blood tests are prescribed, since the results of such tests can determine the excess or deficiency of hormones.

To confirm or refute the diagnosis, an excess of estrogen , androgen , luteinizing hormone , as well as the disadvantage . The patient also undergoes a glucose sensitivity test to determine the activity of her own insulin. In addition, with polycystic ovary syndrome there is a high level cholesterol And triglycerides . Thus, the diagnosis polycystic ovary syndrome» is established if two of the three signs are present: anovulation (female infertility) , signs of polycystic ovary syndrome identified by ultrasound, hyperandrogenism , confirmed by laboratory tests.

Treatment of the disease

Proper treatment for polycystic ovary syndrome involves more than just medical procedures and medications. It is also very important to carry out procedures aimed at the overall health of a woman. If the doctor and patient provide the correct and timely approach to therapy, then the chance of curing the disease is quite high. If the level androgens the patient's blood level decreases, her menstrual cycle is restored and some external manifestations of the disease disappear.

For the treatment of polycystic ovaries, a variety of drugs are used, the prescription of which must take into account the nature of the hormonal disorder, as well as the presence of hypertension And diabetes mellitus . But in most cases, women with polycystic ovaries are advised to take combined oral contraceptives . If there is no effect from such drugs, the doctor decides to prescribe medications that restore the woman’s ability to reproduce. Such drugs stimulate the production process follicle-stimulating hormone , which determines the start of the ovulation process.

If insulin levels are elevated, it is advisable to take medications that make the process of glucose utilization more efficient. But to this day, some experts note that the effect of such drugs on the fetus is not fully understood. Doctors say that conservative methods are effective in about 50% of cases. If the size of the ovaries greatly increases and there are a large number of cysts in them, it is possible for the patient to undergo surgical operation . To restore fertility, most often performed endoscopic surgical interventions , as they make it possible to minimize the recovery period. Often, surgery to excise cysts is performed using a laser. In addition, for polycystic ovaries it is practiced wedge resection of the ovaries , ovarian decapsulation , demedullectomy , electropuncture and other methods. During such interventions, part of the ovary that produces androgens is destroyed or removed. As a result, normal communication between the ovaries and central structures is restored. Surgical treatment for polycystic ovary syndrome is quite effective compared to drug therapy. After surgery, restoration of the monthly cycle is observed in 95% of patients, and more 80% of infertility is eliminated.

Implementation of health procedures is recommended for those women who have strong hair growth And overweight. In this case, it is very important to maintain an active lifestyle, get regular moderate physical activity, and also adhere to the diet prescribed for patients with diabetes. should be low in calories (no more 2000 kilocalories per day) If a woman suffers from severe obesity, then additional treatment methods are used to combat. Bringing body weight indicators back to normal very often makes it possible to normalize and menstrual function, get rid of excessive hair growth. But if hair growth is still a serious cosmetic defect, then the hair is removed using special creams, depilatory, wax and other methods that help eliminate unnecessary hair. All these methods allow you to get a temporary effect. With the help electrolysis You can get rid of excess hair forever. If there is no effect from the treatment methods described above, in some cases in vitro fertilization is practiced.

The doctors

Medicines

Pregnancy with illness

Women of childbearing age are often concerned about whether polycystic ovary syndrome and pregnancy are combined. In this case, it is important to take into account that the chances of conceiving a child increase sharply in a woman who has undergone adequate and complete treatment, since conception with polycystic ovary syndrome is only prevented by lack of ovulation . Therefore, in this case, it is very important to regularly take medications prescribed by the doctor.

Complications of the disease

Previously, treatment of polycystic ovary syndrome was practiced exclusively in women of reproductive age who had a desire to become pregnant. But today, treatment of the disease is considered mandatory for all women who have been diagnosed with polycystic ovary syndrome, since this disease can provoke a number of unpleasant complications. So, due to the general hormonal imbalance of the body, the content in the blood for a long period is too high. As a result, the patient's risk of developing endometrial cancer And breast cancer . In addition, due to the lack of menstruation, the endometrium thickens significantly, which also provokes the development of cancer pathology in young women.

Women with polycystic ovaries have high resistance to their own insulin . As a result, the amount of insulin produced by the pancreas increases. As a result, several types of complications are possible. In particular, the pancreas may lose its ability to produce insulin, which will lead to the development. Due to high insulin levels, androgen production may be activated. Also, due to too high insulin levels, the amount of " useful» cholesterol. The woman is growing arterial pressure and the risk of developing cardiovascular diseases in the future increases. In addition, obesity is often a complication of the disease.

Diet, nutrition for polycystic ovary syndrome

List of sources

• Manukhin, I.B. Polycystic ovary syndrome / I.B. Manukhin, M.A. Gevorkyan, N.E. Kushlinsky.- M., 2004;
• Gynecology. National Leadership, ed. IN AND. Kulakova, G.M. Savelyeva, I.B. Manukhina. 2009;
• Nazarenko T.A. Polycystic ovary syndrome: modern approaches to the diagnosis and treatment of infertility. M.: MED press-inform, 2005;
• Dedov, I.I. Polycystic ovary syndrome: A guide for doctors / I.I. Dedov, G. A. Melnichenko. - Moscow: Medical Information Agency LLC, 2007.