- Definition of disease
- Classification and stages of development of polycystic ovary
- Complications of polycystic ovary
- Diagnostics of the polycystic ovary
- What drugs to treat
- Treatment without hormones
- Pregnancy and polycystic
- IVF for polycystic ovary
- Treatment during pregnancy
- Video about the treatment of polycystic disease
Polycystic ovary disease - endocrine pathology, which in most cases leads to infertility. The disease negatively affects not only reproductive function, but also disrupts the work of almost all body systems. It is found most often in women of childbearing age, and in each of them the pathology manifests itself in its own way. It is impossible to completely get rid of the problem, but well-chosen treatment will help eliminate the signs of a violation and prevent negative consequences.
Definition of disease
A chronic disease characterized by infrequent or complete ovulation absence is called polycystic ovary syndrome (other names are polycystic ovary syndrome, Stein-Leventhal). At the same time, numerous follicular cysts are formed in the ovaries, which leads to deformation of the organ. The exact reasons for the development of pathology have not been established.
The disease manifests itself:
- irregular periods;
- abnormal uterine bleeding;
- signs of hyperandrogenism (excess of male sex hormones);
- being overweight, eating disorders;
- psychological disorders.
Classification and stages of development of polycystic ovary
Polycystic ovary disease should be treated based on its type. The disease can be:
- classic. It is manifested by the absence of ovulation, hyperandrogenism, polycystic changes in the ovaries;
- ovulatory. Ultrasound shows signs of polycystic disease, symptoms of hyperandrogenism are noted, but ovulation persists;
- nonandrogenic. There are no manifestations of hyperandrogenism. On ultrasound, polycystic ovaries are found, there is no ovulation;
- anovulatory. Signs of excess production of male sex hormones are present, ovulation does not occur.
Depending on which complaints of the patient prevail, several types of pathology are distinguished:
- metabolic. A woman suffers from metabolic disorders (diabetes mellitus, overweight, high cholesterol);
- hyperandrogenic. It manifests itself mainly in cosmetic problems that arise due to the excessive production of male sex hormones;
- reproductive. The main complaint is the inability to conceive and bear a child.
In addition, the disease can be:
- primary. Signs of impairment appear already in adolescence. Pathology is difficult to treat;
- secondary. Middle-aged women suffer (even after childbirth or during menopause). It is accompanied by signs of metabolic disorders.
Complications of polycystic ovary
In addition to infertility, the disease can cause the development of:
- metabolic syndrome;
- type 2 diabetes mellitus;
- gestational diabetes mellitus (in pregnant women);
- fatty liver hepatosis;
- diseases of the heart and blood vessels;
- endometrial hyperplasia;
- depression, mental disorders.
The main cause of these disorders is insulin resistance, which is present in most women with polycystic disease. A decrease in the sensitivity of cells to insulin leads to the development of diabetes, hypertension, obesity, which in turn increases the likelihood of cardiovascular pathologies. In addition, insulin resistance in polycystic disease may be one of the reasons for the development of Alzheimer's disease.
Diagnostics of the polycystic ovary
Polycystic ovary disease (pathology should be treated after a thorough diagnosis) is a disease that requires a comprehensive assessment of the patient's health.
A woman should visit a gynecologist who will recommend:
- examination with anamnesis, assessment of external manifestations, palpation of the ovaries;
- ultrasound examination of the pelvic organs. The presence of the disease is evidenced by an increased volume of the ovaries (more than 10 ml at a rate of 4-7 ml). Another sign of a disorder is more than 20 follicles in the ovaries, the sizes of which vary from 2 to 9 mm;
- laboratory tests for hormones. On days 2-5 of the cycle, the level of total testosterone and SHBG (a hormone that binds sex hormones) is determined. If the indicators are normal, the amount of hormones such as androstenedione and dehydroepiandrosterone sulfate is assessed. For women taking oral contraceptives, hormonal status is assessed after 3 months. after canceling them.
In addition, you will need a pregnancy test, an assessment of glucose levels, blood cholesterol, an ultrasound of the adrenal glands. To exclude congenital pathologies, MRI of the Turkish saddle, ultrasound examination of the thyroid gland are performed.
They also conduct other studies that allow you to determine the form of pathology, the degree of its severity, to assess the patient's health as a whole:
- determination of the presence of ovulation or its absence. For this, ultrasound folliculometry is used, which is the most accurate method. If a woman has an irregular menstrual cycle, an ultrasound scan is done from day 7 of the cycle in 2-3 days to track the growth of the dominant follicle. If in two cycles out of three the release of the egg was not observed, this is a sign of a violation. If menstruation is absent, ultrasound examination is performed on any day. At home, pharmacy tests are used to determine ovulation. Egg release can also be confirmed by assessing progesterone levels. If the indicator does not exceed 3-4 ng / ml in the middle of the second phase of the cycle, then there was no ovulation;
- assessment of signs of excess production of male sex hormones. For this purpose, the degree of hairiness is determined using the Ferriman-Hallway scale. If the obtained values exceed 4-6 points, this indicates the presence of hirsutism. Also determine the degree of alopecia, which is associated with excess production of androgens. In this case, the Ludwig scale is used, according to which three degrees of violation are distinguished. In the area of the crown, at the first stage, the hair becomes noticeably thinner, at the second stage, their pronounced loss is observed, at the third stage, the crown becomes completely bald. Research is also being carried out to rule out other causes of hyperandrogenism - Cushing's disease, congenital dysfunction of the adrenal cortex, premature menopause, androgen-producing tumor, hyperprolactinemia;
- weight estimate. To do this, calculate the body mass index (from 25 to 29.9 - overweight, more than 30 - obesity), measure the waist (should not exceed 88 cm);
- diagnostics of metabolic syndrome. In addition to determining body mass index and measuring waist circumference, it is necessary to assess the level of pressure, analysis fasting blood sugar, glucose tolerance test, glycated hemoglobin. These studies are recommended to be carried out every 1-3 years, especially if a woman is at risk of developing diabetes mellitus;
- assessment of lipid profile indicators. Examine the blood for the level of cholesterol, triglycerides, lipoproteins.
Laparoscopy and biopsy are rare. They are necessary if pathological changes are pronounced and complications are present.
What drugs to treat
It is recommended to treat polycystic ovary disease based on the individual characteristics of the woman and the nature of the course of the disease. The doctor takes into account the patient's age, the desire to have children, the type and stage of the pathology.
Therapy is aimed at:
- normalization of weight and metabolic processes. To achieve this, the patient must adjust her lifestyle. If after 3 months. the situation will not change, it may be recommended to take medications that reduce appetite and prevent the absorption of fats;
- normalization of the cycle. If a woman does not plan a pregnancy, and there are no signs of hyperandrogenism, then in the second phase of the cycle, she is recommended to take progesterone drugs, which will restore the menstrual cycle. The rest of the cases require more complex and complex therapy using hormones to stimulate ovulation. At the same time, ultrasound is regularly performed to monitor the state of the endometrium and the process of follicle maturation.
If necessary, prescribe funds to correct the psychological state, eliminate the symptoms of hyperandrogenism (increased hair growth or baldness).
Drugs for the treatment of polycystic disease:
|Stimulates the maturation of follicles in the ovaries. Reception begins on the 5th day of the cycle and ends shortly before ovulation.|
|Progestogens are synthesized derivatives of progesterone, which normalizes the reproductive functions of the female body. The drugs have antiandrogenic, antiestrogenic, gestagenic properties, increase the likelihood of conception, and support gestation.|
|Antiandrogenic agents||Diane-35||Used in the complex treatment of infertility, reduce the level of male sex hormones in the blood|
|Hypoglycemic agents||Metformin; Rosiglitazone.||They reduce insulin resistance, normalize glucose levels, and prevent the development of diabetes mellitus.|
|Folic acid promotes the formation of new blood cells, activates blood circulation, evens out hormonal levels, prepares the female body for conception and gestation. Magne B6 is necessary for the normal functioning of the nervous system, prevents the development of hypertension.|
|Homeopathic remedies||Cyclodinone||A plant-based product that regulates hormonal balance, reduces prolactin levels.|
|Appetite regulators||Sibutramine||Has an effect on the central nervous system. At the same time, the feeling of fullness comes faster and lasts longer.|
|Lipase inhibitors||Orlistat||Prevents the breakdown and further absorption of fats.|
Treatment without hormones
Polycystic ovary disease can be treated without hormones, but this therapy takes longer. The patient must make some effort to restore the natural functions of the ovaries in a natural way. The choice of therapy is influenced by the individual characteristics of the patient, the presence of concomitant pathologies.
Non-hormonal treatments include:
- lifestyle correction. It is necessary to give up bad habits. Alcohol, energy drinks, smoking negatively affect the work of the heart, worsen the condition of the liver and kidneys. It is also necessary to establish a daily regimen, increase physical activity, which will speed up metabolism. You should reconsider your diet, in consultation with a nutritionist, choose a diet to normalize body mass index. The daily calorie content of the diet should not exceed 1800 kcal. Healthy low-calorie plant foods high in fiber and dietary fiber. And heavy unsaturated animal fats, which contribute to the deposition of cholesterol, should be limited. Also, you should not use pickled, smoked foods, sauces, spices. It is recommended to replenish the diet with vegetable oils that contain unsaturated fatty acids, food sources of vitamins A, E. The basis of the diet for polycystic disease is foods with a low glycemic index;
- acupuncture or massage treatments. By influencing the active points, they achieve a decrease in the level of male sex hormones, restore the hormonal background;
- hirudotherapy. The method is highly effective. The saliva of leeches contains substances that can normalize the balance of hormones, eliminate puffiness, and prevent the proliferation of connective tissue. Also, the procedure improves general and local immunity. However, it has contraindications that a specialist should warn about;
- anti-inflammatory therapy. It is necessary if the cause of the pathology is chronic inflammatory processes that may be asymptomatic. Such treatment increases local immunity, normalizes the reproductive system. Most often, homeopathic remedies are prescribed on a natural basis;
- normalization of the nervous system, since the disease can be a consequence of regular stress. For this purpose, both pharmaceutical preparations and herbs with sedative properties (chamomile, oregano, mint) are used.
As an auxiliary therapy, herbal remedies are used:
- boron uterus. It is an anti-inflammatory and antineoplastic agent. Known as a fertile plant;
- red brush. It is used for various gynecological pathologies, helps to restore the menstrual cycle, improves the condition in diseases of the adrenal glands, thyroid gland, rejuvenates the body;
- sacred vitex. The plant normalizes the balance of hormones, restores the menstrual cycle;
- basilica. It is an antioxidant, has antiseptic and anti-inflammatory properties. It has a positive effect on the body with obesity, normalizes metabolic processes;
- Mary's root. It is used for conditions associated with imbalance of hormones;
- dandelion root. In the form of a decoction or powder, it has a positive effect on the liver, promotes the elimination of toxins;
- nettle root. The plant has powerful antiandrogenic properties. To enhance the effect, you can add mint leaves to the infusion;
- sage. Gentle and effective remedy to normalize the menstrual cycle;
- licorice root. It is used as a prophylactic agent. Used as a decoction or added to food;
- flax seeds. The tool removes excess male sex hormones, normalizes hormonal levels, restores the menstrual cycle. The seeds are taken with food.
Herbal remedies are recommended to be taken within 21 days, after which it is necessary to take a break for a week, and you can resume treatment.
In advanced stages, surgical intervention is recommended. Use the method of laparoscopy, removing the ovarian cysts through a small incision. This therapy is used only for the treatment of infertility. However, the likelihood of a return of the disease remains high.
Pregnancy and polycystic
With polycystic ovary syndrome, the likelihood of pregnancy is present even without prior therapy, but bearing a child is not always successful. A woman may experience serious complications such as high blood pressure, diabetes mellitus, and preeclampsia.
The risk of premature birth increases, and a newborn baby may have health problems. In 15-20% of cases, patients with this diagnosis have miscarriages. Therefore, special control is needed not only by the gynecologist, but also by other doctors for the timely identification and elimination of complications.
If polycystic disease is not treated, then the number of cysts is constantly growing, which negatively affects the reproductive system. At the same time, the chances of conceiving a child are reduced.
After multiple unsuccessful attempts to conceive, women turn to a fertility specialist. The doctor prescribes therapy aimed at stimulating the ovaries and normalizing hormonal levels. To establish a cycle, the use of oral contraceptives is recommended, after the termination of which the likelihood of conception increases. However, such funds are not prescribed for women after 35 years. If therapy fails, IVF is recommended.
IVF for polycystic ovary
In vitro fertilization and other assistive methods do not cure the disease, but they allow a woman to become pregnant.
The procedure is recommended if:
- long-term hormonal treatment has no effect;
- cancellation of therapy leads to a rapid return of signs of pathology;
- even if ovulation is restored, conception does not occur;
- the woman's age does not allow wasting time on long-term therapy.
The procedure requires careful preparation with the elimination of endocrine system disorders, the normalization of metabolic processes. Usually the preparatory course lasts 3 months.
At the first stage, a woman is prescribed hormonal agents that promote the maturation of follicles in both ovaries. Then the follicle is punctured under ultrasound guidance in order to collect the egg. Semen collection is carried out on the same day.
In some cases, it becomes necessary to use donor material. After a few hours, fertilization of the eggs is carried out in the laboratory. The resulting embryos are transferred into the uterine cavity under ultrasound control or frozen.
A complication of IVF is ovarian hyperstimulation syndrome. The violation is manifested by bilateral enlargement of organs, increased blood clotting, malfunctioning of the kidneys and liver. Over-stimulation promotes the maturation of many follicles. At the same time, the level of estradiol increases, which provokes a violation of vascular permeability, the occurrence of edema. Therefore, the process of ovarian stimulation must be under the constant supervision of specialists.
Treatment during pregnancy
It is recommended to deal with the treatment of polycystic ovary disease even at the planning stage, since pregnancy is associated with the likelihood of developing serious disorders.
Therefore, a woman who wants to have a child must:
- undergo a comprehensive assessment of the state of the body;
- to refuse from bad habits;
- reconsider lifestyle, increase physical activity;
- switch to a healthy diet;
- take multivitamin preparations.
If conception occurred as a result of ovulation stimulation, progesterone preparations will be required in order to maintain the functions of the corpus luteum. Such funds must be taken daily until the placenta is fully formed (up to 12 weeks). Constant monitoring of specialists is important in order to timely identify and eliminate possible violations.
Polycystic ovary disease is a chronic pathology that requires constant monitoring by a gynecologist-endocrinologist. Patients should lead a correct lifestyle, monitor their weight, and assess the level of hormones every few years. Proper treatment will help restore the regularity of the cycle, compensate for the manifestations of hirsutism, and get rid of extra pounds. In about 70% of patients, fertility is restored, which increases the chance of a successful pregnancy.
Video about the treatment of polycystic disease
Polycystic ovary syndrome. How to treat: