Violations can also affect the pancreas, which manifests itself in the hypersecretion of insulin, the adrenal cortex, which results in excess production of adrenal androgens, as well as the pituitary gland and hypothalamus.

What it is?

Polycystic ovary syndrome is a polyendocrine syndrome accompanied by impaired ovarian function (absence or irregularity of ovulation, increased secretion of androgens and estrogens), pancreas (insulin hypersecretion), adrenal cortex (hypersecretion of adrenal androgens), hypothalamus and hypothalamus.

Causes of PCOS

The development of polycystic ovary is primarily based on polyendocrine disorders, manifested by dysfunction:

• ovaries (irregularity or lack of ovulation, increased secretion of estrogen);
• pituitary gland and hypothalamus (dysregulation of the adrenal glands and ovaries);
• adrenal cortex (increased secretion of androgens);
• pancreas (increased production of insulin with tissue insensitivity to it).

Violation of hormonal regulation leads to a suspension of the development and maturation of follicles, an increase in the size and compaction of the ovarian capsule, under which multiple cystic growths begin to form from immature follicles. This leads to disorders of ovulation, menstrual function and infertility. Against the background of obesity (and it occurs in women with PCOS in 40% of cases), these processes are even more pronounced.

Infectious diseases, stress and even climate change can provoke hormonal disorders.

Polycystic ovary disease and pregnancy

The diagnosis of polycystic disease is not at all a reason to abandon the idea of \u200b\u200bhaving a baby. It's just that this will have to go through a more difficult path than healthy women. In medicine, a lot of cases are known when women with a similar diagnosis successfully became pregnant, carried and gave birth to a child. During the carrying of a child, a woman is prescribed supportive therapy - Duphaston, Utrozhestan and other drugs that prevent miscarriage. Since pregnant patients have such a formidable diagnosis, they are closely monitored in the third trimester, when there is a threat of gestational diabetes, increased blood pressure, and weight gain. However, if you follow all the doctor's prescriptions, pregnancy with polycystic disease is quite possible.

As a result of the surgical intervention, more than sixty percent of women manage to achieve a positive result - they successfully become pregnant and bear children. Doctors insist that couples decide to continue the family as soon as possible after the operation, since the effect of the operation is not long - about three years. In order to support a woman during the conception of a child, she is prescribed drugs that stimulate the maturation of the egg. If you miss the time of remission, it will be more difficult to get pregnant later on.

In some cases, pregnancy itself can contribute to the cure of polycystic disease, since during conception and gestation, colossal hormonal changes occur in the female body.

Symptoms

In women, the symptoms of polycystic ovary disease are very diverse and may resemble the manifestations of other diseases. A feature is the fact that the presence of all symptoms at once is not at all necessary in one woman.

The main symptom of polycystic ovary disease, forcing you to see a doctor, is the inability to get pregnant. The most common causes and additional symptoms of polycystic ovary disease are:

1. Oligomenorrhea - irregular, rare menstruation or complete absence of menstruation; those menstruation that still occur can be pathologically meager or, conversely, excessively abundant, as well as painful;
2. Central obesity - "spider-like" or "apple-shaped" obesity of the male type, in which the bulk of adipose tissue is concentrated in the lower abdomen and in the abdominal cavity;
3. Increased blood levels of androgens (male hormones), especially free fractions of testosterone, androstenedione and dehydroepiandrosterone sulfate, which causes hirsutism and sometimes masculinization;
4. Acne, oily skin,;
5. Androgenic (significant male pattern baldness or hair loss with bald patches on the sides of the forehead, on the crown, due to hormonal imbalance);
6. Acrochordons (skin folds) - small folds and wrinkles of the skin;
7. Acanthosis (dark age spots on the skin, from light beige to dark brown or black);
8. Long periods of symptoms resembling those of premenstrual syndrome (swelling, mood swings, pain in the lower abdomen, lower back, pain or swelling of the mammary glands);
9. The appearance of stretch marks (stretch stripes) on the skin of the abdomen, thighs, buttocks, as a result of a rapid increase in body weight against the background of hormonal imbalance;
10. Depression, dysphoria (irritability, nervousness, aggressiveness), often drowsiness, lethargy, apathy, complaints of "head fog".
11. Sleep apnea - respiratory arrest during sleep, leading to frequent nighttime awakenings of the patient;
12. Multiple ovarian cysts. Sonographically, they may look like a "pearl necklace", a collection of whitish bubbles or "fruit pits" scattered throughout the ovarian tissue;
13. An increase in the size of the ovaries by 1.5-3 times due to the appearance of many small cysts;
14. Thickened, smooth, pearly white outer surface (capsule) of the ovaries;
15. Thickened, hyperplastic endometrium of the uterus is the result of prolonged excess of estrogen, not balanced by adequate progesterone effects;
16. Increased LH level or increased LH / FSH ratio: when measured on the 3rd day of the menstrual cycle, the LH / FSH ratio is greater than 1: 1;
17. Decreased levels of sex steroid binding globulin;
18. Hyperinsulinemia (elevated blood insulin levels), impaired glucose tolerance, signs of tissue insulin resistance when tested using the sugar curve method;
19. Chronic pain in the lower abdomen or in the lower back, in the pelvic region, probably due to compression of the pelvic organs by enlarged ovaries or due to hypersecretion of prostaglandins in the ovaries and endometrium; the exact cause of chronic polycystic ovarian pain is unknown.

Also, polycystic disease may be accompanied by signs of diabetes (weight gain, increased urination), chronic skin infections or thrush (vaginal candidiasis).

Complications

In addition to impaired reproductive function, polycystic ovary disease, sooner or later, can provoke the development of gestational diabetes, arterial hypertension and lead to significant weight gain.

Women with polycystic ovary syndrome are at increased risk of developing coronary heart failure, peripheral vascular disease, clogged arteries and venous thrombosis, myocardial infarction, and stroke. Those patients who are on long-term hormone therapy should be wary of the development of mastopathy, endometriosis, breast cancer and cervical cancer.

Diagnostics

PCO diagnostics includes gynecological examination, ovarian ultrasound and hormonal examination, as well as other auxiliary techniques.

1. In a blood test for hormonal status, an increased concentration of androgens, follicle-stimulating and luteinizing hormones (as well as their ratio) is noted. Also, in the course of hormonal examination, impaired glucose tolerance and increased insulin levels may be detected.
2. Ultrasound scanning. This procedure reveals multiple small cysts on the surface of the female genital glands. As a rule, the affected organs increase in size, their surface becomes bumpy, the capsule thickens. Due to the chronic excess of estrogen on the ultrasound monitor, thickening of the endometrium (the inner layer of the uterus) is clearly visible.
3. When conducting a glucose tolerance test, high blood sugar levels signal a violation of carbohydrate metabolism, that is, the development of hyperinsulinemia.
4. In order to be able to "see" the ovaries affected by polycystic disease, the patients are shown a laparoscopic examination. Today, ovarian laparoscopy is the most informative diagnostic technique. With the development of Stein-Leventhal syndrome, the capsule of the sex gland thickens and smoothes, the organ acquires a pearly-whitish color, reaches a length of 5-6 and a width of 4 cm.
5. Patients suffering from mastopathy are shown mastography or breast thermography.
6. To detect metabolic disorders, the blood lipid profile is determined. With polycystic ovary, the concentration of low-density lipoproteins increases and the concentration of high-density lipoproteins decreases.

What does polycystic ovary disease look like, a photo of symptoms:

How is polycystic ovary disease treated?

Treatment of polycystic ovary disease can take place with the involvement of several specialists at once: a gynecologist (or better a narrow specialist gynecologist-endocrinologist), an endocrinologist and a nutritionist.

It is almost impossible to completely cure polycystic disease. Gynecologists can only minimize the manifestations of the disease and thus help the woman achieve the main goal (this, as a rule, is the conception and birth of a healthy child). However, in order to get what you want, you cannot delay a visit to the doctor. The earlier the diagnosis is made, the easier it will be to normalize the hormonal background and restore the correct functioning of the reproductive system.

The conservative treatment regimen is as follows:

• Drugs that stimulate ovulation.
• Antiandrogenic agents. This is a group of drugs that reduce the amount of male hormones.
• Drugs for the treatment of diabetes mellitus. Usually, this role is played by the drug metformin, which, in addition to regulating insulin production, contributes to weight loss.
• Hormonal contraceptives. They help restore the cycle and avoid the development of endometriosis. Some drugs have an antiandrogenic effect (fighting acne and excess body hair). This method is not suitable for women who dream of getting pregnant.
• Diet. For some women, it is enough to lose weight in order for insulin levels to return to normal and ovulation occurs. Therefore, diet therapy plays an important role in the treatment of polycystic ovaries. The diet for polycystic ovary is aimed at eliminating large amounts of fats and carbohydrates. Be sure to combine diet with exercise.

Complex drug therapy is prescribed for up to 6 months. If its result is unsatisfactory (pregnancy does not occur), gynecologists resort to surgical treatment. Modern laparoscopic equipment allows such interventions to be carried out with the least traumatism for a woman - already 3-4 days after the operation, the patient is discharged home, and only a few almost invisible scars remain on her body.

Nutrition rules

The vast majority of patients with polycystic ovary disease are overweight.

Adipose tissue has the ability to store steroids, excess fat means excess steroids and dysfunction of the hypothalamus, which "directs" the menstrual cycle. Obesity leads to amenorrhea, infertility and many other serious consequences. For the successful treatment of hormonal disorders, it is necessary to eliminate the negative effect of adipose tissue on the body, therefore, polycystic ovary therapy begins with weight correction.

As a result of observations of patients, it was possible to find out which foods are most useful for women with polycystic disease:

• vegetables - lettuce, broccoli, bell peppers (red and yellow), garlic, lettuce, zucchini, eggplant, cucumbers, carrots, asparagus, celery, garlic;
• fruits - plums, oranges, grapefruit, kiwi, apples, cherries, pears;
• greens - rosemary, parsley, dill, basil;
• grains and legumes - beans, whole grain crisps, beans, durum pasta, peanuts, soybeans, pumpkin, brown rice;
• vegetable oils - sesame oil, milk thistle oil, linseed oil, olive oil, pumpkin oil;
• dried fruits - raisins, prunes, figs, dried apricots;
• dairy products - cheese, cottage cheese, yogurt and low fat milk;
• meat - chicken, quail, ostriches.

• reducing the level of calorie consumption to one thousand two hundred calories per day;
• switching to fractional frequent meals (about five to six times a day);
• the diet should contain more low-calorie foods - vegetables and fruits;
• an increase in protein consumption (primarily from fish and seafood, cottage cheese, meat);
• limiting carbohydrates (sugar, soda, baked goods);
• elimination of animal fats and transition to vegetable fats;
• exclusion of any doses of alcohol;
• eating food without spices, seasonings, spices
• refusal from smoked, pickled products.

After the body weight returns to normal, the amount and range of foods consumed can be expanded. However, if the patient returns to the previous diet, the excess weight will quickly return. To get rid of obesity forever, it is necessary to eat foods in such quantities that the body weight remains in a stable physiological state.

Physical activity (fitness, gymnastics) is a good addition to a balanced diet. For some patients, exercising for only two hours a week, together with a diet, gives a result similar to taking special pills for weight loss.

Stimulation of ovulation

After the restoration of the menstrual cycle, they proceed to the main stage of therapy - stimulation of ovulation (for those patients who want to have children). For this purpose, drugs with pronounced antiestrogenic properties are used - "Clomiphene" ("Clostilbegit").

After the abolition of these drugs, the synthesis of LH and FSH occurs, which by their action stimulate the maturation of the dominant follicle and the ovulation process. The agent is prescribed from the 5th to the 9th day of the menstrual cycle, for a period not exceeding 3 months at a dosage of 0.05 g / day. If there is no effect of therapy, the dose is increased, bringing it to 200 mg. "Clostilbegit" has one very unpleasant side effect - the risk of developing large functional cysts in the ovaries significantly increases. If therapy with this drug does not give a result within 3 months, they decide on an operation.

Surgical intervention

Surgical treatment of the disease is currently performed laparoscopically. Two surgical options are used: wedge resection of the ovaries and electrical coagulation of the brushes in the ovaries. The second method is more gentle, as it consists in applying incisions to the ovarian capsule and cauterizing multiple brushes. With wedge resection, the most altered parts of the ovaries (both the capsule and the stroma) are excised.

But it should be noted that a woman's fertility is directly proportional to the time of the operation, that is, the more time has passed after the surgical treatment, the less likely it is to become pregnant. The maximum ability to conceive falls on the first 3 months after surgery, and by the end of the year it decreases significantly. However, surgical treatment is indicated not only for patients with infertility, but also for diagnosing persistent hyperplastic endometrial processes.

IVF for polycystic ovary

The IVF program for polycystic ovary disease consists of 6 stages:

• stimulation of follicular growth;
• puncture (eggs are obtained invasively);
• fertilization and cultivation in an artificially created environment;
• embryo transfer;
• support of the luteal phase of the cycle (progesterone);
• early pregnancy diagnosis.

In case of unsatisfactory sperm quality, IVF ICSI is performed. It is necessary to dwell in more detail on the fact that in the IVF protocol for polycystic ovaries, stimulation can lead to hyperstimulation syndrome. Therefore, cryopreservation of all obtained embryos can be performed and their replanting in the next cycle.

Prevention

To date, there is no specific prevention of the disease.

Considering that the formation of polycystic ovary syndrome begins in girls in puberty, it is necessary to pay attention in a timely manner to menstrual irregularities, as well as the development of obesity and manifestations of hyperandrogenism in such a contingent of children.

Quite often, women of childbearing age develop polycystic ovary syndrome. About 15% of women suffer from this ailment. What are polycystic ovaries, let's try to figure out what the essence of the disease is.

Only an ultrasound machine can recognize the problem of polycystic disease. With this disease, small cavities (cysts) form in the ovaries. These cavities are filled with a special liquid inside. Polycystic disease develops against the background of neuro-exchange disorders.

These cysts can occur both inside the ovary itself and on its surface. Cysts can be solitary or an accumulated nest.

The female reproductive system works with the coordinated work of several components: the thyroid gland, hypothalamus, adrenal glands, pituitary gland and, of course, the ovaries. The cysts that appear lead to the fact that the dominant follicle cannot form. The woman begins to have anovulatory cycles. Therefore, the reproductive mechanism cannot do its job correctly, and this, accordingly, leads to infertility.

Distinguish:

• primary polycystic disease,
• secondary polycystic.

The first variety appears at puberty. Typically, such polycystic disease becomes the result of genetic abnormalities and is an independent disease. The second type represents an extensive complex of symptoms and is no longer an independent disease. Secondary polycystic disease begins to manifest itself after the formation of the menstrual function.

Note that "polycystic ovary syndrome" is only a secondary type.

The first signs of polycystic disease can appear during the entire reproductive age. Excess weight significantly affects their appearance. Most often, the disease blooms by the age of thirty. In 40-50 years, polycystic disease is practically not diagnosed.

Polycystic ovary disease has other synonyms:

• Stein-Leventhal syndrome.
• Polycystic ovary syndrome.
• Ovarian dysmetabolic syndrome.
• Hyperandrogenic.
• Polycystic Ovary Disease.

Causes of polycystic

Doctors do not know one hundred percent of the cause of polycystic disease. It is known only one thing, that violations of the reproductive system occur against the background of hormonal disorders. Polycystic disease is formed due to malfunctions of the pituitary gland, hypothalamus, adrenal glands, pancreas, and ovaries. This may result in:

• high secretion of androgens;
• increased production of the hormone insulin in the absence of tissue sensitivity to it;
• improper regulation of the ovaries and adrenal glands;
• lack of ovulation or its irregularity;
• high secretion of estrogen.

Associated reasons

• Excessive insulin production. Thanks to insulin, cells are able to use glucose in their work. And this gives our body the necessary energy. The hormone insulin is produced by the pancreas. In the case of insulin resistance, the body cannot fully utilize it in its work, as a result, the pancreas produces more and more insulin. Excessive excess of this hormone leads to an increase in the amount of androgens in the female ovaries. A large amount of testosterone disrupts the function, structure of the ovaries and interferes with normal ovulation.
• Excess weight. Excess fat leads to an increase in the hormone insulin. Excessive amounts of insulin can lead to polycystic disease.
• Disruption of the functioning of hormone-producing organs. Polycystic ovary disease always occurs against the background of disruption of other organs (hypothalamus, pituitary gland, adrenal glands and thyroid gland).
• Hormone imbalance. The hormone that stimulates milk production is prolactin. If an increased level is observed in the body, then this leads to a pronounced symptom of polycystic ovary. Also, the second reason may be an increase in the amount of testosterone. Polycystic disease provokes a large amount of latinizing hormone, which is the main acting hormone in ovarian stimulation. A low level of globulin also leads to the named syndrome.
• Abnormalities in the development of the fetus. Overexposure to fetal androgens disrupts gene function. As a result, gene expression occurs. The result is an increase in insulin levels and chronic inflammation that translates into polycystic ovary disease.
• Hereditary factor. Polycystic disease is a hereditary disease. If relatives have it, then the risk of its occurrence in a child is significantly high. It has also been proven that mutated genes also have a connection with polycystic disease.
• Chronic inflammation. Usually, polycystic disease is a consequence of atherosclerosis and other chronic cardiovascular diseases.

External factors of polycystic ovary

A number of other reasons precede primary polycystic disease. Usually little girls get it from mothers with infertility problems, miscarriage and some hormonal pathologies. Hormonal disorders of the mother smoothly pass to the daughter and are manifested by hormonal defects with polycystic disease. Also, the primary form can turn out against the background of infections transferred in childhood. Especially a pig.

Polycystic ovary syndrome is also observed:

• against the background of an abnormal pregnancy;
• against the background of stress;
• against the background of brain injuries;
• against the background of intoxication;
• against the background of severe endocrine pathology.

Predispositions for the further development of polycystic disease can be:

• frequent abortions;
• difficult labor;
• trauma to the genitals or the ovaries themselves;
• irregular sex life;
• unhealthy ecology;
• diabetes.

Use of plastic containers

The question of using plastic bottles has arisen for a long time. Foreign scientists have found that if you regularly drink drinks from plastic bottles, then the body will increase by more than half the substances that have a direct effect on sex hormones.

Bisphenol A is used in the production of plastic containers. Its action is similar to that of estrogen. When various drinks from plastic packaging are consumed within a week, the amount of this element in the urine will increase sharply. As a result, polycystic disease occurs, and then infertility and cancer.

If I heat the food in a plastic container, Bisphenol A gets into the food. So if you feed children with such food, then from early childhood you can get hormonal disruptions. And this, in turn, will lead:

• to excessively early puberty;
• to developmental defects;
• to growth retardation;
• to diabetes mellitus;
• to polycystic in girls;
• to heart disease.

Symptoms of polycystic

Symptoms vary from person to person. But usually with this disease you can observe:

Violation of menstruation

Most common. In this case, menstruation malfunctions mean:

• Irregularity of menstruation, that is, the onset of bleeding with a delay from a month to six months.
• Long menstrual cycle, more than 35 days.
• No bleeding for 4 months or more.
• Very long duration of bleeding. Moreover, they can be abundant or, on the contrary, scarce.
• There are more than 8 menstrual cycles per year.

High androgen levels

A large number of male sex hormones lead to the appearance of male characteristics, to virilization. Usually these are understood as:

• Change the tone of voice.
• Reduction of breast volume.
• An increase in the size of the clitoris.
• Fine hair on the scalp, which eventually leads to baldness.

The manifestation of physical symptoms due to high androgens depends on the ethnicity of the person. For example, women in the Caucasus do not have hair growth.

Deterioration of hair and skin

• Oily seborrhea. It occurs due to dysfunction of the sebaceous glands. Hair looks shiny and greasy.
• Skin pigmentation. It manifests itself as darkening of the skin and folds in the armpits, chest, neck and groin.
• Acne that mainly occurs on the back, face and neck.

Change in the state of the ovaries

With such symptoms, the following are observed:

• Pulling pains in the lower abdomen.
• Discharge with blood between menstrual bleeding.
• The ovaries are larger than normal.
• Ovarian cysts.

Other symptoms

1. The body weight can be increased by 10-15 kg, while quite sharply. Another sign is a lot of fat in the abdomen.
2. Typically, women with polycystic disease can have diabetes, high cholesterol, and high blood pressure.
3. Fibrocystic breast disease.
4. Reproductive dysfunction. As a result of such violations, a woman is not able to become pregnant, carry a baby for 9 months and fully give birth.

Because of polycystic disease, a woman begins to suffer from constant depression and anxiety. Polycystic disease leads to frequent mental disorders. Studies show that 20% of women with this ovarian disorder have the following side effects:

• severe anxiety;
• panic attacks;
• social phobias;
• low self-esteem;
• depression.

Diagnostics

When diagnosing, the doctor considers several aspects of the woman's condition. First, he takes an anamnesis and listens to the history of the illness that happened. Secondly, in parallel, the doctor asks interesting questions about menstrual bleeding, weight parameters and some other signs.

Third, he tries to make a diagnosis based on the following procedures:

1. Physical examinations.
2. Conducting a gynecological examination.
3. Blood test results.
4. Pelvic laparoscopy.
5. Mastography.
6. Diagnostics using ultrasound.

Ultrasound alone is not enough to make a correct diagnosis. Sometimes a picture of polycystic ovaries can be seen during a study in a perfectly healthy woman. Therefore, all of the listed diagnostic points are very important.

A physical examination helps to highlight a number of special points. These are height, pressure and weight. The doctor can also measure the size of the abdomen and calculate the body mass index.

A gynecological examination is carried out after a physical one. It is very important to consider the enlargement of the ovaries and the clitoris itself. The latter pathology is rarely observed. During the diagnosis, the doctor inserts his fingers into the vagina and begins to press on the stomach. Thus, he studies the uterus, the characteristics of the ovaries and other organs. The gynecologist looks at pain during palpation, assesses possible growths and other physiological disorders.

Blood test

A very important test for polycystic disease is a blood test. This material will be tested for a number of hormones that have led to possible polycystic disease. So, during blood tests, they check:

• Lipid level (this is the number of triglycerides and the level of cholesterol).
• Level.
• Level. It helps the eggs mature and synthesizes estrogens.
• Level. Under its action, ovulation takes place and the corpus luteum develops.
• The level of the androgen metabolism product of 17-ketosteroids.
• Glucose level.
• Prolactin level.

In addition, they usually do a pregnancy test and check the functioning of the thyroid gland.

During an ultrasound examination, all organs of the small pelvis are examined. The diagnostician evaluates the appearance of the ovaries and looks at the thickness of the uterine lining. In addition, the specialist conducts a transvaginal examination; for this, the sensor is placed in the internal cavity of the vagina. The sensor reads the information and transmits it to the computer screen using sound waves. In this way, the pelvic organs can be seen on the monitor.

Sometimes, under special circumstances, it is necessary to perform pelvic laparoscopy. This is a complete examination of the abdominal wall. Usually, such a diagnosis is carried out with suspicions of a tubal pregnancy, a tumor of the uterus, a tumor of the ovaries, pain in the pelvic region, a ruptured cyst, and no

Mastography is performed in case of suspicion of mastopathy.

At the time of the diagnosis of polycystic disease, some diseases that have a similar picture with polycystic disease should be excluded. Such diseases include:

• Cushing's syndrome (high in cortisol).
• (characterized by the amount of prolactin above normal).
• Androgenital syndrome (characterized by an excess of testosterone).
• Hypothyroidism (characterized by decreased thyroid function).

Diagnostic accuracy is considered high if the diagnosis is based on all types of research.

Note that polycystic ovary syndrome is a combination of symptoms: menstrual irregularities, plus infertility, plus signs of androgenic dermatology.

Polycystic ovaries and pregnancy

Usually these phenomena always go hand in hand. Women either cannot become pregnant with polycystic disease or are trying to preserve the already obtained pregnancy with this pathology.

Almost always, with polycystic disease, reproductive function suffers and a woman becomes infertile. Also, very often, polycystic disease is the only symptom of infertility. But the likelihood of pregnancy with this disease is still there. It is very small, only 5%. And then this mainly happens with damage to the adrenal glands and with the onset of hyperandrogenism. If pregnancy does occur, then there is a significant risk of termination.

If with polycystic disease the question of restoring the function of conception is solved, then it is very difficult to solve.

Treatment for polycystic ovary syndrome

The very process of treating polycystic disease is very difficult and complicated. It occurs in several stages, at which the lost physiological functions are gradually and consistently restored.

The main thing is to understand that polycystic disease is not only a gynecological problem. Treatment should be complex and based on other solutions to related problems.

In the treatment of polycystic disease, the following actions can be taken:

• Suppression of androgens, which are produced in very large quantities.
• Regulation of processes in the brain. That is, the direction of therapeutic measures to the entire hypothalamic-pituitary system.
• Normalization of body weight. That is, normalizing existing metabolic disorders.
• Carrying out the restoration of the normal course of the menstrual cycle. In addition, if infertility has arisen against the background of the disease, then by all means they try to eliminate it.

Medications

Of course, the course of treatment is not complete without medication. Usually first aid drugs are:

• glitazones (these are mainly rosiglitazone and pioglitazone);
• metformin;
• antiandrogenic drugs (these are cyproterone acetate and spironolactone);
• estrogens (alone in the form of ethinyl estradiol or in the form of birth control pills);
• progestins;
• dexamethasone in very small doses.

Note that metformin lowers insulin levels and is often recommended for type 2 diabetes. In addition, the product perfectly normalizes the ovulation process and regulates the menstrual cycle. Also, this drug helps to reduce weight a little while following the correct diet and constant physical activity.

Treatment of individual symptoms of polycostosis

Also, doctors always prescribe treatment for individual symptoms. Consider the first one: excess hair growth. In this case, drugs are recommended that reduce the production of androgens. These are usually birth control pills. Also, doctors can prescribe the drug Spironolactone, the ability of which is to suppress the action of androgens. But using this drug is dangerous. He has a side defect, which manifests itself as a congenital pathology. Therefore, if a specialist has prescribed treatment with this drug, then it is necessary to take all measures of effective contraception in order to prevent conception. It is clear that the named remedy should not be taken at the stage of pregnancy planning and during the very gestation of the fetus.

Hair growth can also be slowed down with the help of a special cream, Eflornithine. It is usually used for increased facial hair. To remove ugly and unnecessary hair, you can also resort to cosmetic procedures: electrolysis and hair removal. The best praise in these matters is laser hair removal.

If hormone treatment does not help, then ovarian resistance syndrome is said to be observed. This is when the ovaries do not perceive hormone therapy at all. This usually happens against the background of special antibodies that deliberately block hormone sensitivity. This always happens due to genetic abnormalities. In this case, it makes no sense to carry out treatment with hormones, since it will not give a result. It is possible to become pregnant with such features only with the use of donor eggs.

Excess body weight

Let's analyze the treatment of the second symptom: excess body weight. If polycystic disease is a consequence of obesity, then doctors strongly recommend strictly adhering to the following recommendations:

1. Exercise.
2. Reduce the daily calorie content to 1500-1800. In this case, eat five to six times a day.
3. Eat more low-calorie foods. These are vegetables and fruits.
4. Eat protein-rich foods. These are cottage cheese, fish, meat, seafood.
5. Eliminate animal fats completely and replace them with vegetable fats. You can eat no more than 80 grams of fat per day.
6. Completely remove spices, pickled foods, smoked foods and sauces from food.
7. Eliminate the use of alcoholic beverages.
8. Eliminate sweets.
9. Spend useful fasting days 2-3 times a week. These are special days in which it is supposed to eat one product: cottage cheese, vegetables, apples, kefir.

Next, consider the treatment of the third symptom: menstrual irregularities. In this case, the doctor prescribes oral contraceptives. The point is that they have no androgenic effect. These drugs include Marfelon. Such drugs are quite effective in normalizing the cycle. However, if androgens do affect, then you can use the Diane-35 remedy.

Operations

If the previously described therapy turns out to be ineffective, then after six months, doctors may prescribe surgical intervention. In addition, they resort to the help of a surgeon when there is a danger of endometriosis.

If, nevertheless, an operation is prescribed, then doctors can perform only two types of intervention:

• First type: wedge resection. Here, some of the ovaries are removed using surgical instruments. The method is characterized by very good efficiency. The prognosis for cure is 85%.
• Laparoscopic electrocoagulation. It consists in the fact that in several places special notches are made using a special needle electrode. This is a more gentle way than the first. Since such an operation is very unlikely to form adhesions. With this method of treatment, it is possible to eliminate adhesions and completely restore the patency of the fallopian tube.

ethnoscience

Sometimes women with polycystic disease resort to traditional medicine. I would like to say that this is useless. It is impossible to cure such a complex disease in this way. Hormonal disorders can only be overcome with medication and surgery. But such treatment can serve as additional help. With polycystic disease, they often resort to herbal preparations. One of these is in the form of an aqueous or alcoholic tincture. Phytotherapy is also recommended for prophylaxis.

Note that it is impossible to completely recover from polycystic ovary disease. With age, the disease will only progress. Therefore, if due to a disease it is impossible to become pregnant, this problem must be solved very quickly.

Possible complications

More serious problems can occur due to polycystic ovary syndrome. These include:

• sleep apnea;
• uterine bleeding;
• gestational diabetes;
• infertility;
• the level above the norm of c-reactive protein, which regulates the cardiovascular system;
• high blood pressure during pregnancy;
• metabolic syndrome;
• severe inflammation of the liver, due to the accumulation of fat in it;
• mammary cancer;
• type 2 diabetes;
• violation of lipid metabolism;
• violation of cholesterol levels;
• a small amount of lipoproteins;
• high triglyceride count;
• uterine cancer due to increased estrogen levels.

The tasks of preventing polycystic disease

First of all, you need to try to change your usual lifestyle. That is, constantly pay attention to the foods eaten, think about a healthy way and eradicate bad habits. Also, in every possible way, increase the level of your activity.

Next, you need to constantly monitor body weight. After all, obesity is the cause of polycystic disease. But if you lose weight in time, then the level of insulin and androgens will normalize. Against this background, ovulation itself will return to normal.

Do not drastically reduce weight. You just need to reduce the number of daily calories consumed. The tact of action will definitely benefit the whole body. And this, in turn, will result in the health of the ovaries themselves. In this matter, you can use the advice of doctors or make an appointment with a nutritionist.

During the diet, the following points must be observed:

• Don't eat simple carbohydrates (cookies, cakes, etc.).
• In polycystic disease, a low-carb diet is considered most effective. If the diet is based on a high carbohydrate content and a low fat content, then insulin in the blood will rise against its background.
• Do not exclude carbohydrates altogether, but use slow ones. These are foods that are high in fiber. Fiber inhibits an increase in blood sugar levels and a person does not feel so hungry.
• We must not forget about the activity of actions. Any exercise lowers blood sugar levels. That is, with polycystic disease, it is imperative to increase physical activity.

In terms of prevention, it is useful to regularly go for examinations to a gynecologist. If polycystic disease is detected at the earliest stage, then there is a real opportunity to avoid serious complications and undesirable consequences. Care must be taken to prevent inflammatory processes in the body. Be sure to have a negative attitude towards the abortion procedure.

If anyone has daughters in adolescence, then the mother needs to be interested in and take care of her women's health at all times. By all means it is impossible to prevent this disease in this transitional age.

Visit to the doctor

If a woman has several complaints and suspects she has polycystic ovary disease, then it would be good to properly prepare for an appointment with a doctor.

First you need to write down all the symptoms on a piece of paper so as not to forget about them at the reception. It is best to listen carefully to your feelings. You need to write everything down, even if it seems that the symptom is not associated with polycystic disease.

The doctor will also need information about what medications, nutritional supplements, or vitamins the woman is taking. The doctor needs to name the exact dosages that are taken orally and the frequency of administration.

It is necessary to ask about everything in terms of illness, what worries. Usually, a list of questions a woman can ask a gynecologist is as follows:

• What kind of research will she need to go through?
• Will a woman be able to get pregnant with polycystic disease (if there is such a topic)?
• How will the treatment be carried out?
• Do existing chronic diseases have an impact on polycystic disease?
• What medicines will help improve the symptoms of the disease?
• Will there be side effects from the treatment?
• Is there any correct information on polycystic disease (in books, on websites) to use it?

At the reception, you do not need to hesitate to ask the specialist again and ask other arising questions. It is necessary to fully understand what the doctor means. In turn, he can also ask a woman questions. Usually these can be:

• What date and month was your last period?
• What signs of the disease does a woman feel?
• At what age does the patient have menstrual bleeding?
• How long does a woman feel the signs of the disease?
• What body weight and how much has been gained recently?
• Did other relatives have polycystic disease?
• If the desire for pregnancy at this age?
• Are there certain things you can do to improve or worsen your symptoms?

Final points

1. Polycystic ovaries may be normal and not severe.
2. There are conditions (taking contraceptives, stress, lactation, sudden weight loss) that simply mimic the picture of polycystic disease.
3. True polycystic syndrome is extremely rare.
4. The disease develops at the stage of maturation of the girl and passes against the background of the action of male hormones.
5. Polycystic disease can be hereditary.
6. Women with polycystic disease significantly increase the risk of diabetes mellitus, heart and vascular diseases.
7. All treatment for polycystic disease is aimed at reducing the activity of male sex hormones and restoring reproductive function.
8. In order to prevent polycystic disease in oneself, it is necessary to carry out its prevention.

One of the most common diagnoses in modern gynecology is polycystic ovary disease; the causes and symptoms of the disease are associated with systemic hormonal imbalance and can develop infertility. To exclude this kind of complications, the choice of conservative therapy is made by the attending physician only after the passed diagnosis. In the worst case, women with endocrine infertility are not destined to experience the joy of motherhood, but they will have to be treated in one course.

What is polycystic ovary disease

If ovarian metabolism is disturbed, abnormal changes in the functions and structure of the ovary occur. Steroidogenesis progresses, which disrupts the specificity and duration of menstrual cycles in the female body, and reduces reproductive activity. Stein-Leventhal syndrome (another name for polycystic disease) contributes to secondary infertility, develops other chronic diseases like a woman.

Primary polycystic disease is formed at the genetic level, and progresses only in puberty. It is a serious disease, difficult to treat conservatively. Secondary polycystic disease is not an independent ailment, the complex of unpleasant symptoms in practice is called "Polycystic ovary syndrome" - PCOS in gynecology. The disease does not manifest itself immediately, and the relapse is due not only to the patient's age, but also to the influence of a number of pathogenic factors.

The reasons

Overweight women are more likely to suffer from polycystic disease than slender patients (with normal weight), so the first recommendation of a specialist is to control body weight, avoid obesity, and regulate hormonal levels. It is important to understand that the pathological process is accompanied by an excess production of androgens - male hormones as a result of a jump, excess insulin in the blood. This leads not only to a disorder of the menstrual cycle, but also to a sharp decrease in the possibilities of reproductive functions.

The following pathogenic factors can lead to an imbalance of the hormone progesterone, intensive synthesis of androgens and progressive polycystic disease:

• nervous shock;
• the presence of chronic infections;
• change of climatic conditions;
• poor heredity;
• irregular sex life;
• environmental factor;
• colds;
• a large number of abortions performed;
• pathology in the endocrine glands;
• chronic diseases inherent in the pituitary gland, hypothalamus, ovaries, thyroid gland.

Classification

Since pituitary hormones are produced in abnormal concentrations, additional hormonal medications are needed. Before starting intensive care, it is required to become familiar with the diagnosis of polycystic disease and study the classification associated with characteristic dysfunctions. So there are:

1. Ovarian form. The ovaries are ignored if forced ovulation is predominant. This is explained by the permissible indicator and the ratio of sex hormones in the blood.
2. Adrenal form. A characteristic symptom is hirsutism, a woman complains of sweating, weight gain, acne.
3. Diencephalic form. May predominate with multiple cysts, malignant ovarian tumors. Dysfunctions of the endocrine system predominate at the diencephalic level.

What is dangerous

In the absence of timely diagnosis of polycystic disease, treatment may be useless - serious health complications progress. You don't have to wait for a successful conception, the real chances of getting pregnant from immature eggs are completely excluded. The patient has not only problems with the onset of menstruation, potential complications with women's health are presented below:

• predisposition to type 2 diabetes mellitus;
• the development of cardiovascular pathologies against the background of an increase in blood cholesterol;
• endometrial cancer, malignant tumors of the walls of the uterus;
• endometrial hyperplasia;
• hyperandrogenism with a noticeable hormonal imbalance.

Symptoms

Therapy of polycystic disease begins with clarifying the symptoms and characteristics of the pathological process, which affects the ovarian capsules. In addition to the absence of the long-awaited fertilization, polycystic ovaries are manifested by such changes in general well-being:

• irregular menstrual cycle;
• soreness with planned uterine bleeding;
• signs of increased hair growth of the skin of a woman;
• dysfunction of the adrenal glands;
• acne and acne;
• ovarian problems;
• high blood pressure.

How to identify polycystic ovary

The woman draws attention to the fact that with visible health for a long time she is not able to successfully conceive a child. When follicles are formed, you can find out by ultrasound of the uterus, while eliminating the risk of the development and growth of pathogenic neoplasms. It is urgent to undergo ultrasound diagnostics in order to correctly and timely differentiate the disease. With polycystic syndrome, an integrated approach is required that includes a number of laboratory tests and therapeutic measures.

Analyzes

The specificity of the clinical picture is determined by a blood test for the detection of luteinizing, follicle-stimulating hormone (FSH), DEA-sulfate, cortisol. It is important to identify sensitivity to testosterone, thyroxine, estrogen, insulin, 17-OH-progesterone, triiodothyronine and thyrotropin. This laboratory test helps to exclude diagnoses with similar symptoms, such as:

• cushing's syndrome;
• adrenogenital syndrome;
• hyperprolactinemia;
• hypothyroidism.

Signs of PCOS on ultrasound

Ultrasound and ovarian laparoscopy are informative diagnostic methods, carried out in a hospital setting. On the screen, you can see a smooth capsule up to 5-6 cm long and 4 cm wide. Visualized as suspicious blackout. The density of the ovarian capsule can be judged by the number of follicles in its cavity. Signs of an increase in the size of the ovaries, other already tangible symptoms are not excluded.

Treatment of polycystic ovary

Since the pathology is accompanied by unstable insulin resistance, it is required to treat polycystic disease with the participation of substitution therapy. Unauthorized actions of the patient are strictly prohibited. The disease is subject to conservative and surgical treatment at the discretion of a specialist, since in the first case, a full recovery is guaranteed by 50%. So, the conservative method provides for hormonal therapy with the participation of the drug Metformin and contraceptives. The operation involves the process of removing the part of the ovary that synthesizes androgen.

Drugs

To restore the function of the pituitary and hypothalamus, it is required to take oral contraceptives with antiandrogenic properties for 2 to 3 months in the absence of planning a pregnancy. It can be tablets Janine, Jess, Regulon, Yarina. Representatives of other pharmacological groups are also needed:

1. Drugs to stimulate ovulation if you want to get pregnant: Duphaston, Clomid, Utrozhestan, Clomiphene. Hormonal pills are supposed to be taken according to a certain scheme for up to 4 months.
2. Antiandrogens for blocking male hormones in polycystic disease: Veroshpiron, Flutamide. Preparations in the form of tablets with a diuretic effect, it is supposed to take up to 3 pills per day.
3. Drugs for increasing insulin sensitivity in polycystic disease: Glucophage, Metfogamma, Bagomet.

Operation

If the positive dynamics of conservative treatment is completely absent throughout the year, the doctor resorts to surgical intervention. Previously, it was laparoscopy (ovarian resection), but in modern medicine this method is considered morally obsolete, and the gynecologist recommends wedge resection and electrocoagulation. In the first case, small cysts can be removed with a medical instrument, in the second, the surgeon acts with a needle electrode.

Diet

Radical changes are coming in the daily diet after diagnosis. For example, the calorie content of food should not exceed 1800 - 2000 Kcal, while eating is supposed to be up to 5 - 6 times. The norm of carbohydrates is 45% of the total calories, while the concentration of proteins is not standardized. The ratio of animal and vegetable fats should be 1: 3. Below are the products permitted for ovarian pathologies:

• fruits and vegetables, fresh herbs;
• low fat dairy products;
• lean meats and fish;
• mushrooms, legumes, cereals.

Prohibited foods for polycystic disease are as follows:

• fast food;
• bakery products;
• sweets;
• potatoes;
• fast food products.

Folk remedies

It is not necessary to exclude the presence in a specific clinical picture of treatment with alternative methods. However, such therapy can only be auxiliary and must be discussed with the attending physician. Here are some effective and commonly available recipes:

1. Pour 80 g of boron uterus with 500 ml of vodka, leave in a dark place for 2 weeks. Take the finished composition inside 0.5 tsp. three times a day for 2-4 weeks.
2. 100 g of green peeled walnuts are required to fall asleep 800 g of sugar, pour the same amount of vodka. The composition should be infused for 2 weeks, taken orally for 1 tsp. for 3 weeks.
3. Decoctions of nettle or milk thistle, prepared according to the recipe on the package, also provide a positive dynamics of polycystic disease. It is allowed to be treated in this way up to 2 - 4 weeks.

Pregnancy with polycystic ovary

Women with such a health problem are interested in the question of whether it is possible to become pregnant with polycystic ovary. Over the past decade, this has become a reality with the use of oral contraceptives for treatment, long-term hormone therapy and ovarian stimulation. The patient's chances of becoming a mother are 1: 1, and if the answer is negative, after the completed treatment, it is worth continuing substitution therapy. After successful conception, the woman must remain under strict medical supervision.

Video

- This is an increase in the gonads due to cystic atresia of the follicles. It is one of the signs of polycystic ovary syndrome and is often used as a synonym for this pathology. Other symptoms of the disease include menstrual and reproductive disorders, signs of virilization, and obesity. The diagnosis is based on anamnesis data, the results of a general and gynecological examination, ultrasonography, hormonal analysis. Complex treatment, includes the correction of metabolic and endocrine disorders, wedge resection or cauterization of the ovaries.

ICD-10

E28.2 Polycystic Ovary Syndrome

General information

The term "polycystic ovary disease" can be interpreted as an ultrasound sign, polycystic changes in the gonads that are observed in normal conditions or in a number of pathologies, or as a specific disease - polycystic ovary syndrome (PCOS, PCOS, scleropolycystic). Its historical name is Stein-Leventhal syndrome, after the Chicago gynecologists who most clearly described the symptoms of the classic form of the disease in 1935. Polycystic disease is detected by ultrasound at the age of 16-30, the incidence is up to 54% among women of fertile age. Scleropolycystic disease occurs in 5-20% of women.

The reasons

Common causes of asymptomatic transient polycystic ovary disease (multifollicular gonad), which is the norm, are stress, exercise, and hormonal contraceptives. The provoking factors of secondary polycystic diseases that have arisen against the background of known diseases are different and are associated with the mechanism of development of these pathologies. The etiology of PCOS is poorly understood. It is assumed that in 80% of the causes are congenital, in 20% - acquired. Possible risk factors:

• Exogenous: infectious and inflammatory diseases suffered in childhood and puberty (chronic tonsillitis, childhood infections, chronic inflammation of the internal genital organs), TBI (concussion, bruises, contusions), prolonged psycho-emotional stress (information stress, increased training load).
• Endogenous: adverse effects on the fetus (androgens, epigenetic factors, the consequences of the pathological course of pregnancy or childbirth), low birth weight, congenital genetically determined defect in the enzymatic systems of the gonads.

A special role is given to hereditary predisposition. There are known cases of familial scleropolycystic disease. There is a high probability of pathology in women whose mothers or sisters suffer from this disease. The genetic risk of having a daughter with a tendency to PCOS in a sick mother is aggravated by another reason - the fetus develops with an excess of testosterone. A risk factor for male inheritance is early baldness in male blood relatives.

Pathogenesis

Polycystic ovary disease is characterized by the accumulation of immature follicles due to anovulation. With random anovulatory cycles, such "cysts" eventually dissolve without consequences, with regular ones provoke the development of pathology. The pathogenesis of PCOS has not yet been elucidated; there are several theories on this score. The primary defect in the feedback mechanism can come from the hypothalamic-pituitary system, ovaries, adrenal glands.

Desynchronization of the functions of the endocrine glands leads to increased synthesis of androgens by gonads without their further aromatization into estradiol, lack of ovulation (as a result, to infertility), progesterone deficiency, polycystic follicular changes, thickening of the ovarian capsule. Androstenediol is aromatized by adipose tissue and adrenal glands into estrone, there is relative hyperestrogenism, leading to endometrial hyperplasia.

The level of free testosterone in the blood rises, the result of hyperandrogenism is virilization. The hyperglycemia that develops as a result of insulin resistance aggravates the imbalance, contributing to increased synthesis of ovarian androgens, impaired testosterone binding, which further increases the level of this hormone and estrone.

Classification

By origin, polycystic ovary disease is classified as primary (PCOS) and secondary (concomitant with known nosological forms). Scleropolycystic disease is divided into two forms - with obesity and with normal or reduced body weight. In addition, there are 4 phenotypes of PCOS, which are based on symptoms that are diagnostic criteria (ESHRE / ASRM, 2007):

• Phenotype A (classic). Combination of hyperandrogenism with anovulation, polycystic disease. The frequency of occurrence is 54%.
• PhenotypeB (anovulatory). With hyperandrogenism, ovulatory dysfunction, without polycystic disease. Prevalence 29%.
• PhenotypeC (ovulatory). Hyperandrogenism and polycystic disease. The frequency of occurrence is 9%.
• PhenotypeD (non-androgenic). Anovulation and polycystic. The incidence is 8%.

Symptoms of polycystic ovary disease

Transient cystic changes usually occur without external signs. With scleropolycystic, symptoms can appear with menarche, less often against the background of a steady cycle. In 85% of women, menstrual irregularities are noted: first, proyomenorrhea alternates with opsomenorrhea, acyclic bleeding, hypo- and oligomenorrhea is recorded. Then the intervals between bleeding lengthen, hypomenstrual syndrome and amenorrhea develop.

A few years after the onset of menstruation, hirsutism occurs, skin symptoms of hyperandrogenism: seborrhea, acne. Obesity develops in 30-40% of patients. Persistent anovulation leads to infertility. In 10-15% of patients, spontaneous pregnancy may occur, which most often ends in miscarriage. Symptoms such as galactorrhea, psychoemotional and vegetative-vascular disorders, similar to climacteric syndrome, can be observed.

Complications

The most formidable complication of untreated scleropolycystic disease is hormone-dependent endometrial cancer, which develops in 19-25% of patients. Other long-term consequences include various types of cerebrovascular insufficiency (the risk increases by 2.8-3.4 times), glucose tolerance, which occurs in 40% of patients after 40 years and progresses in half of them to type 2 diabetes mellitus within six years ...

For patients of reproductive age, obstetric complications are characteristic - gestational diabetes mellitus, preeclampsia, premature birth (the risk of these pathologies increases threefold, fourfold and twice, respectively). The risk of perinatal mortality increases threefold. Some methods of treating the disease often lead to complications: after the induction of ovulation, ovarian hyperstimulation syndrome develops, surgical intervention entails tubal-peritoneal infertility.

Diagnostics

Polycystic ovary disease as a morphological change is not a diagnosis, but a sign of a possible pathology. The diagnosis is established by a gynecologist with the participation of an ultrasound diagnostic doctor, an endocrinologist. The following symptoms indicate PCOS (at least two are required): laboratory or visual signs of hyperandrogenism; oligo- or anovulation; polycystic changes. Diagnostic methods include:

• Clinical examination. When talking with a patient, a general examination, scleropolycystic disease can be assumed by complaints of menstrual irregularities and infertility, the presence of PCOS in close relatives, an increased body mass index, virilization (hirsutism, hypertrichosis, oily skin prone to acne). With a gynecological examination - by enlarged ovaries.
• Ultrasonography. With transvaginal ultrasound of the ovaries, polycystic disease is characterized by an increased (over 9-10 cubic cm) volume of the gonads; located under the thickened capsule enlarged (2-10 mm) atretic follicles (more than 10) without a dominant one; hyperplastic (up to a quarter of the total volume) stroma. Folliculometry detects fewer than 6 ovulations per year.
• Laboratory research. In androgenemia, the analysis of hormones confirms an increase in the level of luteinizing hormone and its ratio to follicle-stimulating hormone (more than 2.5), an increase in the free testosterone index. Concomitant insulin resistance is indirectly evidenced by the results of a biochemical blood test - an increase in triglycerides, a decrease in HDL, hyperglycemia.

Additionally, a biochemical blood test, hysteroscopy with endometrial biopsy, ultrasound of the adrenal glands, thyroid gland, radiography or MRI of the Turkish saddle are prescribed. Some clinicians recommend differentiating polycystic ovaries by ultrasound from multifollicular ovaries, which are characterized by smaller cysts, unchanged capsule and stroma, normal gonadal volume and echogenic structure. Such changes are often a variant of the norm.

Primary polycystic ovary disease should be differentiated from secondary, the most common causes of which are congenital pathologies (adrenogenital syndrome, congenital hyperplasia of the adrenal cortex), neuroexchange-endocrine syndrome, Itsenko-Cushing's disease, as well as virilizing tumors of the ovaries and adrenal glands. To exclude a tumor process, it may be necessary to consult a gynecological oncologist, oncourologist.

Treatment of polycystic ovary

The choice of treatment tactics depends on the cause of the condition and the existing symptoms. Polycystic ovary disease, which does not manifest with any disorder, does not require treatment. With secondary polycystic disease, correction of violations caused by the underlying disease is prescribed. Therapeutic measures for PCOS are determined by the clinical picture of the pathology.

Conservative therapy

Treatment of PCOS includes several stages, aimed at normalizing metabolic disorders, restoring the ovulatory cycle and generative function, eliminating endometrial hyperplastic processes and manifestations of hyperandrogenism. First of all, the treatment of metabolic syndrome and endometrial hyperplasia (if any) is carried out, then, if the patient wants to have children, they begin to induce ovulation.

• Correction of metabolic disorders. All obese patients are recommended to modify their lifestyle - physical activity, a diet with limited spicy and salty foods, liquids - up to 1.5 liters per day. The calorie content of the daily diet is up to 2,000 kcal, 52% of calories should be carbohydrates, 16% - proteins, 32% - fats, two-thirds of the latter - unsaturated. With insulin resistance, hyperinsulinemia, insulin sensitizers are prescribed.
• Endometrial hyperplasia therapy. With obesity, recurrent hyperplastic processes, adenomyosis, it is preferable to use gestagens, with normal body weight and primary hyperplasia - estrogen-gestagens. The drugs can be administered cyclically or continuously. Adenomyosis is also treated with GnRH analogues.
• Infertility treatment. Not the most effective, but the safest method is the use of estrogen-progestin drugs (the "rebound effect" after their cancellation can lead to ovulation). With anovulatory infertility, ovulation is induced by clomiphene, letrozole, in case of their ineffectiveness - by gonadotropic agents. For the onset of pregnancy, IVF technologies can be used.
• Treatment of hirsutism and acne. To eliminate the external manifestations of hyperandrogenism, hormonal contraceptives are used (orally, in the form of patches or vaginal rings) spironolactone. The preference is given to combined hormonal drugs without androgenic action or with an antiandrogenic effect. To increase the cosmetic effect, laser and photoepilation is used.

Surgery

In most cases, only surgical treatment can restore menstrual and fertile function. Ovarian interventions are performed by laparoscopic access, which minimizes the risk of adhesions. Surgical treatment for recurrent endometrial hyperplasia is also prescribed for women who are not planning a pregnancy.

• Drilling of the ovaries. Destruction of a hyperplastic stroma with a point electrode. It is used to stimulate ovulation with a slight increase in the gonads. Includes various techniques - electro-, laser-, diathermocauterization. The disadvantage of this method is the relative short duration of the therapeutic effect.
• Wedge-shaped resection. Excision of the wedge-shaped area, including the cortical and medullary layers. It is performed to induce ovulation with pronounced enlargement of the ovaries or to prevent recurrence of endometrial hyperplasia. The disadvantage is a decrease in ovarian reserve, early or premature menopause is possible.

The success of the surgical intervention is evidenced by the restoration of ovulatory function in the first weeks after the operation. If ovulation does not occur within two to three cycles, drug stimulation is performed. Pregnancy usually occurs within 6-12 months. The likelihood of a favorable outcome decreases in direct proportion to the time since the operation.

Relapse prevention

The existing methods of treatment of polycystic ovary syndrome most often do not provide a permanent cure. The reason is the impossibility of eliminating the main pathogenetic links of the disease. Symptoms and structural ovarian changes return within five years after surgery, necessitating supportive treatment.

To regulate the menstrual cycle, prevent endometrial hyperplasia, hirsutism and hyperandrogenic dermatopathy on an ongoing basis until menopause, patients are prescribed combined hormonal contraceptives or gestagens in the second phase of the cycle. This tactic also contributes to the preservation of reproductive function in some patients.

Forecast and prevention

In polycystic ovary disease, the prognosis for life is favorable in the absence of malignant transformation of the endometrium. The prognosis of the realization of reproductive function depends on how early treatment was started, what causes the pathology is based on. Thus, infertility treatment is most effective in the absence of viril and metabolic syndrome, pronounced hypothalamic-pituitary disorders.

Primary and secondary prevention of polycystic ovary is to combat obesity, timely detection and correction of hypothalamic-pituitary, adrenal, ovarian dysfunction. Women suffering from PCOS are at high risk of developing cancer of the uterine body, therefore, they are subject to dispensary observation, including control studies (ultrasound, hysteroscopy, if necessary, therapeutic and diagnostic endometrial curettage).

About 8% of women of childbearing age suffer from polycystic ovary disease. Pathology is manifested by various disorders of the menstrual cycle, which cause infertility.

Whether polycystic ovary disease is completely cured, it is impossible to say. However, modern medical methods of correction in combination with surgical intervention can significantly reduce the manifestations of PCOS and make it possible to become pregnant.

Polycystic ovary disease is a pathological process that occurs in the gonads, which is characterized by the formation of multiple cysts. It is believed that PCOS is becoming one of the most common causes of infertility.

Women who want to get rid of pathology often do so because of the inability to get pregnant.

Features of the correct functioning of the female reproductive system consist in the cyclic production of hormones that control various processes.

In a healthy woman, an undisturbed balance of regulatory substances is determined: in the first half of the cycle, FSH is produced, which is replaced by LH, and after ovulation, progesterone comes into play. The relationship of the hormones produced is inextricable.

It is necessary for the implementation of the main task - conceiving and bearing a child. When hormone levels start dancing, secondary problems appear. The mechanism of PCOS development involves several options:

• the production of gonadotropin-releasing hormones is disrupted, LH rises and hyperandrogenism develops;
• insulin resistance provokes a violation of glucose metabolism, due to which androgens are synthesized, and LH rises;
• a decrease in estradiol provokes a decrease in the production of sex steroids that bind globulin, resulting in a high level of testosterone;
• with overweight, fat cells synthesize androgens and testosterone, which are converted into estrone.

The outcome of any mechanism for the onset of the disease is a distortion of the hormonal background, which does not allow the follicles to open in a timely manner, and a follicular cyst is formed from them.

The reasons

The true reasons for the development of pathology remain unknown to this day. The prerequisites for the formation of multiple cysts on the gonads are:

• infections and inflammation of the uterus with appendages;
• obesity and malnutrition;
• abortion and diagnostic interventions in the uterine cavity;
• diabetes;
• endocrine disorders;
• difficult childbirth;
• pelvic injury;
• indiscriminate intake of hormones;
• heredity.

Why is polycystic ovary disease dangerous?

For women, the unpleasant consequences of polycystic ovaries are expressed by a deterioration in skin condition, increased hairiness, overweight, loss of femininity and attractiveness. Apart from aesthetic troubles, PCOS causes:

• infertility;
• the formation of adhesions between the pelvic organs;
• increased blood pressure;
• strokes;
• unnatural proliferation of the endometrium (endometriosis and adenomyosis);
• endometrial and cervical cancer;
• diseases of the mammary glands.

Even if a woman miraculously managed to become pregnant, PCOS can provoke premature birth or miscarriage, gestosis, diabetes, oxygen deprivation and the birth of a child with abnormalities.

Types of polycystic

Medicine distinguishes two types of polycystic ovary disease, which differ in the mechanism and time of occurrence:

• primary - develops during puberty and is called sclerocystic disease (worse amenable to conservative treatment, characterized by infertility);
• secondary - occurs after established cyclic changes, and sometimes after the birth of children (it has infectious, inflammatory and endocrine causes of origin).

Symptoms

PCOS can run latent for a long time, without causing the patient much discomfort. For this reason, a woman seeks a doctor when the disease is already advanced. As a result of the examination, the patient is determined:

• irregular menstruation;
• chronic pain;
• oily skin;
• acne;
• increased body hair growth;
• overweight;
• lack of ovulation;
• infertility.

Pain

Pain in polycystic ovaries occurs in the late stages, when there is an extensive proliferation of the ovary and its filling with clusters of follicles.

Patients note that they have a pulling sensation in the lower abdomen, which intensifies during intercourse and menstruation. Also, the pain radiates to the lower back. It is assumed that the discomfort occurs due to enlargement of the gonads and compression of adjacent organs.

Periods

The absence of menstrual bleeding is often the reason for seeking medical attention. The delay of 2-3 months is due to the lack of proper functioning of the hormonal background. Due to the fact that the growth of the follicle does not occur, ovulation does not occur.

The second phase hormone - progesterone - is not produced, and this does not allow the endometrium to be rejected in a timely manner. The growth of the mucous layer of the uterus is also impaired.

In some cases, women complain of dark brown discharge, which may indicate inflamed appendages or internal endometriosis.

Diagnostics

It is impossible to diagnose PCOS on the basis of complaints and external signs alone. The gynecologist, suspecting a disease, prescribes a number of examinations for the patient:

• blood test;
• swab for flora and infections;
• hormone analysis;
• laparoscopy.

Diagnostics with ultrasound scanning

Ultrasound of the pelvic organs is an ultrasound study that allows you to visually assess the condition of the organs. The clinical picture of polycystic disease is characterized by an increase in glands by 2-3 times and the formation of cyst-like clusters on them, resembling grapes.

A minor sign is inconsistency with the day of the menstrual cycle and displacement of the pelvic organs, which indicates an adhesive process.

What blood tests to take and when

The study of hormonal levels plays a differential role in the diagnosis of PCOS. First of all, it is necessary to pass LH and FSH immediately after menstruation and see their ratio. With PCOS, it will reach a 3: 1 ratio.

It is also important to establish the level of testosterone and 17-OH progesterone, which should be above normal to confirm the pathology. With PCOS, there is a significant decrease in progesterone, which is investigated during the second phase of the menstrual cycle.

Important! A general blood test can be taken on any day, most importantly, on an empty stomach.

Can polycystic ovary disease be cured?

The attending physicians say that PCOS can be eliminated if a woman seeks medical help in a timely manner, rather than trying to get rid of the problem on her own.

In this case, the patient will have to take a long course of medication and may need surgery. Subsequently, it will be necessary to constantly maintain an effective state in order to eliminate the pathology forever.

Despite the assurances of experts, practice shows the opposite. It is impossible to completely cure polycystic ovaries. Medical manipulations can get rid of the disease for a certain period of time, but in the future, PCOS may again affect the sex glands.

Important! Polycystic ovary disease can be completely cured, but the effect will be temporary.

Diet to normalize weight and hormone levels

Overweight is a provocateur of polycystic ovary syndrome. It aggravates the course of PCOS, as it becomes an additional source of androgens and estrogens.

Therefore, the first thing the patient should do is to establish proper nutrition. The daily calorie requirement for a losing weight woman is 1200-1800. The diet should contain:

• protein products (lean fish and meat, steamed, dairy products with a low fat content);
• fresh vegetables and herbs in sufficient quantities;
• seasonal fruits;
• flakes and products with a high content of coarse fiber;
• legumes (peas, beans, lentils).

It is necessary to adhere to fractional nutrition and consume food at least 5 times a day in small portions. Adequate amount of water is also required. The daily fluid intake for the average girl is 1.5-2 liters.

The more weight, the more you need to drink. Proper nutrition normalizes metabolism, improves bowel function. As a result, body fat will gradually begin to decrease. Don't expect an instant effect. It takes time to correct body weight.

There are cases when the restoration of a normal body mass index led to the elimination of PCOS, since the source of hormonal imbalance was eliminated.

Drug treatment: Dufaston, Utrozhestan and other drugs

Modern pharmacology offers many drugs for the treatment of PCOS. When choosing one or several remedies, the gynecologist relies on the individual characteristics of the patient: age, desire to have children, form and type of disease.

• Gestagens - Dyufaston, Utrozhestan, Iprozhin - drugs used for polycystic ovary disease, which have positive reviews. They are prescribed for the purpose of regulating the second phase to create the illusion of a secretory transformation of the functional layer of the uterus.
• Oral contraceptives - Diana 35, Zhanin, Yarina, Belara - effective pills, with polycystic ovary, block the ovaries and prevent pregnancy.
• Glucocorticosteroids - Dexamethasone, Maxidex, Dexapos - have anti-inflammatory and hormone-regulating effects. They are used in combination with other medicines.
• Homeopathy - Remens with polycystic ovary regulates the relationship of the gonads with the pituitary gland and hypothalamus. The drug normalizes the menstrual cycle and eases the course of PCOS.
• Diuretics - Veroshpiron, Furosemide - with polycystic disease are used to relieve puffiness and remove fluid. They are prescribed in a short course, since after cancellation they can cause rebound syndrome.

Means for stimulating ovulation

After the medication course and the achievement of a noticeable improvement in the condition of the patient who wants to become pregnant, stimulation is prescribed. For this, drugs with antiestrogenic action are used, for example, Klostilbegit tablets.

The drug is used from the 5th day of the menstrual cycle and is canceled shortly before ovulation. The second phase of the cycle continues to be supported by gestagens.

Important! If, within three cycles, attempts to stimulate ovulation have not been successful, the woman is recommended to have surgical treatment.

Progestational drugs

Gestanens are drugs that participate in the hypothalamic-pituitary system and affect the ovaries. They have antiandrogenic, antiestrogenic, gestagenic effects. These tools include:

• Duphaston;
• Utrozhestan;
• Progesterone injections;
• Iprozhin;
• Progestogel.

Synthetic gestagens include: Norkolut, Orgametril, Ovestin, Postinor, Trikvilar, Janine, Yarina and others.

Contraceptive - estrogen progestogen drugs

Contraceptives in the treatment of PCOS have a double effect: they eliminate the disease and prevent unwanted pregnancies. Reviews of medications are positive, because they have a beneficial effect on the condition of the skin, body weight.

Estrogen-gestagenic drugs include:

• Diana 35;
• Marvelon;
• Rigevidon;
• Femoden;
• Silest;
• Marcelon.

All contraceptives can be divided into monophasic and multiphase.

Vitamins and Homeopathy - Folic Acid, Magne B6 and Cyclodinone

Folic acid plays an important role in the treatment of polycystic ovary disease in women planning pregnancy. It regulates the formation of new cells, normalizes blood circulation. When pregnancy occurs, folic acid is taken up to 12 weeks.

Magne b6 - participates in almost all reactions in the body. This substance is necessary for every cell, therefore, if the intake of food is insufficient, a vitamin supplement is prescribed.

During pregnancy, Magnesium normalizes the functioning of the nervous system and prevents hypertension.

Cyclodinone is a herbal remedy that regulates the level of sex hormones. As a result of the intake, the level of prolactin decreases, which may be the root cause of PCOS.

Physiotherapy methods - massage, leech therapy, exercise, hydrotherapy

Physiotherapy methods of treatment in combination with drugs show a positive result. Most commonly used:

• magnetotherapy;
• galvanophoresis;
• hydropathic and mud therapy methods (the best results are shown after visiting the sanatorium-resort organizations specializing in this profile);
• paraffin therapy;
• hirudotherapy (treatment with leeches for polycystic disease is carried out within the walls of a medical institution);
• massage (performed by a gynecologist, as a result of which blood circulation improves and cysts decrease);
• exercise (light physical activity - running, cycling, swimming).

Manipulations imply an improvement in blood flow and lymph flow, a decrease in the size of glands, normalization of metabolism, and anti-inflammatory effect.

Operation - efficiency of laparoscopy

If the attempts at treatment are not successful, surgical intervention is prescribed. Laparoscopy is performed under general anesthesia. Several incisions are made in the abdominal cavity through which miniature instruments are inserted.

During the operation, cystic formations are removed. If the clusters are small, then notches are made. Ovarian resection with polycystic disease is performed with extensive damage to the gonads.

The results of surgical treatment are mostly good. During the first year after the procedure, women have a regular cycle and it becomes possible to become pregnant. In the future, the problem may return again.

Folk remedies - boar uterus, sage, mummy, oregano, cumin

Unconventional treatments complement drug therapy well. Herbal remedies alone are not able to cure polycystic disease. In combination with prescribed drugs, you can use:

• boron uterus - take in the second half of the cycle before the onset of menstruation;
• red brush - use immediately after the end of menstruation and until the next bleeding;
• licorice root and cumin - take continuously for a month;
• oregano - take 2-3 months;
• nettle and mummy - drink from the second day of menstruation until the end of bleeding.

Pre-brew plant materials, boil or insist on a water basis. Reception of the boron uterus with polycystic ovary has good reviews. This herb is able to regulate the balance of estrogen and progesterone.

Sage should not be used with polycystic ovaries, as the herb can increase estrogen levels and stimulate additional follicular growth.

Complications

Complications of polycystic ovary disease are the development of infertility. The more the pathology is started, the more difficult it will be to cure it.

Also, the lack of therapy and the progression of the disease can lead to malignant tumors. Women diagnosed with PCOS have a greater risk of developing breast, ovarian and cervical cancers.

Treatment prognosis and consequences

The consequences of polycystic ovary disease can be avoided by contacting a gynecologist in time and starting treatment. The prognosis in the early stages is good. Secondary PCOS responds better to drug therapy and can be resolved quickly.

With a primary lesion of the gonads, getting rid of the problem will be more difficult. If drug treatment does not help, then surgical intervention will definitely give positive results.

Prevention

Today, there is no specific prophylaxis for polycystic disease. In order to avoid the development of pathology, women need to monitor nutrition and body weight, give up bad habits and lead a healthy lifestyle.

Moderate physical activity, adherence to intimate hygiene and timely treatment of inflammatory processes are the key to the normal functioning of the reproductive system.

Pregnancy

After treatment, there is a high probability of successful conception. It lasts an average of 6-12 months. After that, the chances of pregnancy in the natural cycle are reduced.

There are cases when conception occurred in women with progressive PCOS. In such a situation, it is recommended to immediately consult a doctor, since the patient requires special attention and the appointment of preserving agents.