Author: Sozinova AV, an obstetrician-gynecologist, is a continuous practice from 2001.
Polycystic ovaries - a set of symptoms, which is characterized by impaired ovarian function in the background neuroendocrine disorders (failures in the pancreas, adrenal gland, the hypothalamus and pituitary).
Ovaries disrupted folliculogenesis process, leading to anovulation and the excess of androgens (male sex hormones) leads to the development hirsutism (Increased hair growth) and obesity.
The term "polycystic" due to the presence of multiple small cysts in the ovaries, due to which the ovaries increase in size.
Common name of the state - it is the polycystic ovary syndrome, not a disease, as a symptom, a characteristic with polycystic ovaries occurs in various diseases.
Kinds
Distinguish primary syndrome of polycystic ovaries (Stein-Leventhal syndrome) and polycystic ovary syndrome secondary.
Syndrome secondary polycystic ovary develops in the adrenal hyperplasia, thyroid disease, diabetes, obesity.
Causes
The exact cause of polycystic ovary syndrome have not been established. Predisposing factors include:
- trauma, stress and childhood infections;
- genetic predisposition;
- the presence of relatives with hypertension or diabetes;
- chronic infectious disease;
- pathology of the pituitary gland, hypothalamus, thyroid;
- adrenal hyperplasia;
- obstructed labor;
- numerous abortion;
- obesity.
The symptoms of polycystic ovaries
Manifestation of polycystic ovaries are many and varied:
Menstrual disorders. Irregular menses, with long (6 months and longer) delay, or heavy periods scarce. Emmeniopathy begins with menarche (first menstrual bleeding).
Infertility. Infertility explained chronic anovulation or infrequent ovulation (during rupture of the follicle and release of the egg, it can not break through the shell too dense ovary).
Obesity. Distribution of excessive amounts of adipose tissue is male pattern (in the abdomen and in the abdomen, while the arms and legs are normal size).
Hirsutism, alopecia. Characterized by an increased hair growth on the face and on the body and scalp hair loss male pattern (receding hairline at the forehead and at the crown).
Acne, oily skin. seborrhea, Oily skin and acne on the face are a sign of androgen.
Acanthosis. The appearance of dark spots on the body (in the armpit, under the breasts), also characterized by the appearance of stretch marks - stretch as purple bands on the skin.
Coarse (male) voice.
Pain in the abdomen. Constant aching pain in the lower abdomen may be due to compression of enlarged ovaries pelvic or excessive synthesis of prostaglandins by the ovaries that cause pain.
Hyperinsulinemia. increased the content of insulin in the blood due insulinorezistenstnosti tissues.
Enlarged ovaries. Gynecological examination palpable enlarged, firm, and (probably) painful ovaries. During laparoscopy determined the ovaries with multiple cysts, covered with dense, pearly shell.
endometrial hyperplasia. The excess of estrogen and progesterone deficiency results in proliferation of the endometrium.
Diagnostics
The diagnosis of polycystic ovarian put on the basis of characteristic clinical signs and results of additional methods:
Pelvic ultrasound. An ultrasound determined enlarged ovaries with multiple small cysts. Albuginea is thickened, and the ovaries marked proliferation of connective tissue.
Hormonal studies. Is determined by the level of follicle-stimulating (FSH) And luteinizing hormone (LH). The ratio of LH to FSH to 3/1 shows polycystic ovaries. Also defined elevated level of androgens (testosterone), prolactin (Possible) and a reduced content progesterone in the second phase of the menstrual cycle. The high content of urine detected 17-KS (Androgen), and insulin can be within, above or below normal.
Blood chemistry. definition blood sugar (increased), A high content of fats (triglycerides) and cholesterol.
Scraping the uterine cavity. scraping the uterine lining after histological study suggests endometrial hyperplasia. Scraping is carried out in cases of dysfunctional uterine bleeding.
Treatment of polycystic ovary
Treatment carries a gynecologist-endocrinologist.
Treatment of polycystic ovary syndrome long, stretched on for months and even years.
The goals of treatment:
- normalization of the menstrual cycle;
- restore ovulation and later of pregnancy;
- eliminate cosmetic problems;
- weight correction.
Treatment of polycystic ovaries begins with the appointment of diet and weight normalization.
It is recommended to limit the use of fat (especially animal), liquid carbohydrates. Should abandon smoked, salty and pungent foods. Also effective exercise. Often the normalization of weight leads to a regular menstrual cycle and restore ovulation.
hormonal drugs having antiandrogen activity (Janine, Yasmin, Diane-35) are assigned to eliminate cosmetic defects and correction of the menstrual cycle. Hormonal contraceptives lasts 6-9 months.
After recovery of the menstrual cycle to commence ovarian stimulation with clomiphene (klostilbegit) from 5 to 9 day cycle. Clomifene treatment is carried out under the control of the basal temperature and ultrasound (for the determination of the dominant follicle).
In the absence of effect of conservative treatment resort to surgery. Operative intervention is performed by laparoscopy (3 puncture in the abdominal wall), while which operate ovarian wedge resection or electrocautery ovary (opening cysts electrocoagulator).
Pregnancy after surgery occurs within 6-9 months, but the more time has passed after the operation, the less chance of getting pregnant.
Complications and prognosis
Polycystic ovarian syndrome is dangerous development of the following conditions:
- diabetes;
- miscarriage (premature birth, abortions);
- shotty breast;
- hyperplasia and endometrial cancer;
- increased risk myocardial infarction, Stroke, hypertension.
The prognosis of polycystic favorable. Timely and quality treatment of polycystic ovary syndrome restores a woman's ability to conceive and, consequently, to the birth of the child, most (70-90%) of cases.
The only condition - is hormonal drugs (Utrozhestan, Duphaston) to support the pregnancy.
