Polycystic ovary syndrome (polycystic ovary syndrome (PCOS), Stein-Leventhal syndrome, scleropolycystic disease). Polycystic ovary syndrome, what is it? Symptoms and treatment Is polycystic disease curable?

– this is an enlargement of 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 dysfunction, signs of virilization, and obesity. The diagnosis is based on medical history, results of a general and gynecological examination, ultrasonography, and hormonal analysis. Treatment is complex and includes 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 syndrome” can be interpreted as an ultrasound sign, polycystic changes in the gonads, observed normally or in a number of pathologies, or as a specific disease - polycystic ovary syndrome (PCOS, PCOS, scleropolycystic syndrome). Its historical name is Stein-Leventhal syndrome, named 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 years, the incidence rate is up to 54% among women of fertile age. Scleropolycystic disease is registered in 5-20% of women.

Causes

Common causes of asymptomatic transient polycystic ovary syndrome (multifollicular gonads), which is the norm, are stress, physical activity, and taking hormonal contraceptives. The provoking factors of secondary polycystic diseases that arise 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% the causes are congenital, in 20% they are 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 (concussions, bruises, contusions), prolonged psycho-emotional stress (information stress, increased study load).
Endogenous: adverse effects on the fetus (androgens, epigenetic factors, consequences of the pathological course of pregnancy or childbirth), low birth weight, congenital genetically determined defect of the enzymatic systems of the gonads.

A special role is played by 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 due to another reason - the fetus develops with an excess of testosterone. A risk factor for inheritance through the male line is early baldness in male blood relatives.

Pathogenesis

Polycystic ovary syndrome is characterized by the accumulation of immature follicles due to anovulation. With occasional anovulatory cycles, such “cysts” dissolve over time without consequences, but with regular ones they provoke the development of pathology. The pathogenesis of PCOS has not yet been clarified; there are several theories on this matter. The primary defect in the feedback mechanism can come from the hypothalamic-pituitary system, ovaries, and adrenal glands.

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

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

Classification

Based on its origin, polycystic ovary syndrome is classified as primary (PCOS) and secondary (accompanying 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 (classical). Combination of hyperandrogenism with anovulation, polycystic disease. Frequency of occurrence: 54%.
PhenotypeB(anovulatory). With hyperandrogenism, ovulatory dysfunction, without polycystic disease. Prevalence 29%.
PhenotypeC(ovulatory). Hyperandrogenism and polycystic disease. Frequency of occurrence: 9%.
PhenotypeD(non-androgenic). Anovulation and polycystic disease. Occurrence 8%.

Symptoms of polycystic ovary syndrome

Transient cystic changes usually occur without external signs. With scleropolycystic disease, symptoms may appear at menarche, or less often against the background of an established cycle. 85% of women experience menstrual irregularities: first, proyomenorrhea alternates with opsomenorrhea, acyclic bleeding, hypo- and oligomenorrhea are recorded. Then the intervals between bleeding lengthen, hypomenstrual syndrome and amenorrhea develop.

A few years after the onset of menstruation, hirsutism and skin symptoms of hyperandrogenism occur: 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 menopausal syndrome may be observed.

Complications

The most serious 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 of age and progresses in half of them to type 2 diabetes mellitus over six years .

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

Diagnostics

Polycystic ovary syndrome 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 doctor and 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. During a conversation with the patient and a general examination, scleropolycystic disease can be assumed based on complaints of menstrual irregularities and infertility, the presence of PCOS in close relatives, increased body mass index, virilization (hirsutism, hypertrichosis, oily, acne-prone skin). During gynecological examination - 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 a 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 reveals less than 6 ovulations per year.
Laboratory research. With androgenemia, hormone analysis 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 indicated by the results of a biochemical blood test - increased triglycerides, decreased HDL, hyperglycemia.

Additionally, a biochemical blood test, hysteroscopy with endometrial biopsy, ultrasound of the adrenal glands, thyroid gland, radiography or MRI of the sella turcica are prescribed. Some clinicians recommend distinguishing polycystic disease according to ultrasound data from multifollicular ovaries, characterized by a smaller “cyst” size, an unchanged capsule and stroma, normal volume and echogenic structure of the gonads. Such changes are often a variant of the norm.

Primary polycystic ovary syndrome should be differentiated from secondary polycystic disease, the most common causes of which are congenital pathologies (adrenogenital syndrome, congenital adrenal hyperplasia), neurometabolic-endocrine syndrome, Itsenko-Cushing 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 or urologist.

Treatment of polycystic ovary syndrome

The choice of treatment tactics depends on the cause of this condition and the existing symptoms. Polycystic ovary syndrome, which does not manifest itself with any disorders, does not require treatment. In case of secondary polycystic disease, correction of disorders 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, metabolic syndrome and endometrial hyperplasia (if present) are treated, then, if the patient wishes to have children, ovulation induction is started.

Correction of metabolic disorders. All obese patients are recommended to modify their lifestyle - exercise, diet with limited spicy and salty foods, fluids - up to 1.5 liters per day. The calorie content of the daily diet is up to 2,000 kcal, 52% of calories should come from carbohydrates, 16% from proteins, 32% from fats, two thirds of the latter being unsaturated. For insulin resistance and hyperinsulinemia, insulin sensitizers are prescribed.
Therapy for endometrial hyperplasia. In case of obesity, recurrent hyperplastic processes, adenomyosis, it is preferable to use gestagens; in case of normal body weight and initially detected hyperplasia, estrogen-gestagens are preferable. Drugs can be prescribed 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 withdrawal can lead to ovulation). In case of anovulatory infertility, ovulation induction is carried out with clomiphene, letrozole, and in case of their ineffectiveness - with gonadotropic agents. IVF technologies can be used to achieve pregnancy.
Treatment of hirsutism and acne. To eliminate the external manifestations of hyperandrogenism, hormonal contraceptives (orally, in the form of patches or vaginal rings) spironolactone are used. Preference is given to combined hormonal drugs without androgenic effects or with antiandrogenic effects. To enhance the cosmetic effect, laser and photoepilation are used.

Surgery

In most cases, only surgical treatment can restore menstrual and reproductive function. Interventions on the ovaries are performed laparoscopically, which minimizes the risk of adhesions. Surgical treatment for recurrent endometrial hyperplasia is also prescribed for women who are not planning a pregnancy.

Ovarian drilling. Destruction of hyperplastic stroma with a point electrode. Used to stimulate ovulation with a slight increase in gonads. Includes various techniques - electro-, laser-, diathermocautery. The disadvantage of the method is the relative short duration of the therapeutic effect.
Wedge resection. Excision of a wedge-shaped area, including the cortical and medulla layers. It is performed to induce ovulation in cases of pronounced enlargement of the ovaries or to prevent relapses of endometrial hyperplasia. Disadvantage: decreased ovarian reserve, possible early or premature menopause.

The success of surgical intervention is indicated by the restoration of ovulatory function in the first weeks after surgery. If ovulation does not occur within two or three cycles, drug stimulation is carried out. 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

Existing methods of treating polycystic ovary syndrome most often do not achieve a permanent cure. The reason is the impossibility of eliminating the main pathogenetic links of the disease. Symptoms and structural ovarian changes recur within five years after surgery, necessitating maintenance 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 helps preserve reproductive function in some patients.

Prognosis and prevention

With polycystic ovary syndrome, the prognosis for life is favorable in the absence of malignant transformation of the endometrium. The prognosis for reproductive function depends on how early treatment was started and what reasons underlie the pathology. Thus, infertility treatment is most effective in the absence of virile and metabolic syndrome and severe hypothalamic-pituitary disorders.

Primary and secondary prevention of polycystic ovary syndrome consists of combating obesity, timely detection and correction of hypothalamic-pituitary, adrenal, and ovarian dysfunction. Women suffering from PCOS are at high risk of developing uterine cancer, and therefore are subject to clinical observation, including control studies (ultrasound, hysteroscopy, and, if necessary, diagnostic and treatment endometrial curettage).

About 8% of women of childbearing age suffer from polycystic ovary syndrome. The pathology is manifested by various menstrual cycle disorders that cause infertility.

It is impossible to say whether polycystic ovary syndrome can be completely cured. However, modern medicinal methods of correction in combination with surgical intervention can significantly reduce the manifestations of PCOS and make it possible to get pregnant.

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

Women who want to get rid of pathology often do this due to the inability to get pregnant.

Features of the proper functioning of the female reproductive system lie 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 between the hormones produced is inextricable.

It is necessary to carry out the main task - conceiving and bearing a child. When hormone levels begin to “dance,” secondary problems appear. The mechanism of development of PCOS suggests several options:

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

The outcome of any mechanism of the disease is a distortion of the hormonal background, which prevents the follicles from opening in a timely manner, and a follicular cyst is formed from them.

Causes

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

infections and inflammations of the uterus and appendages;
obesity and poor nutrition;
abortions and diagnostic interventions in the uterine cavity;
diabetes;
endocrine disorders;
difficult childbirth;
pelvic injuries;
indiscriminate use of hormones;
heredity.

Why is polycystic ovary syndrome dangerous?

For women, the unpleasant consequences of polycystic ovaries are expressed by deterioration of the skin, increased hairiness, excess body weight, loss of femininity and attractiveness. In addition to aesthetic troubles, PCOS causes:

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

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

Types of polycystic disease

Medicine distinguishes two types of polycystic ovary syndrome, differing in the mechanism and time of occurrence:

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

Symptoms

PCOS can occur latently for a long time, without causing much discomfort to the patient. For this reason, a woman consults a doctor already with an advanced disease. As a result of the examination, the patient is diagnosed with:

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

Pain

Pain with polycystic ovary syndrome occurs in the later stages, when extensive growth of the ovary occurs and it is filled with clusters of follicles.

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

Period

Lack of menstrual bleeding often becomes a reason to consult a doctor. A delay of 2-3 months is explained by the lack of proper functioning of hormonal levels. Due to the fact that the follicle does not grow, 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 uterine mucous layer 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 based on complaints and external signs alone. The gynecologist, suspecting a disease, prescribes a number of examinations to the patient:

blood analysis;
smear for flora and infections;
hormone analysis;
laparoscopy.

Diagnostics by ultrasound scanning

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

A secondary sign is a discrepancy 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, you need to test LH and FSH immediately after menstruation and look at their ratio. With PCOS it will reach a ratio of 3:1.

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

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

Is it possible to cure polycystic ovary syndrome?

Doctors 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 cure polycystic ovaries completely. Medical manipulations can relieve the disease for a certain period of time, but in the future, PCOS may again affect the gonads.

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

Diet to normalize weight and hormone levels

Excess (extra) weight 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 establish proper nutrition. The daily calorie requirement for a woman losing weight is 1200-1800. The diet should contain:

protein products (low-fat steamed fish and meat, low-fat fermented milk products);
fresh vegetables and herbs in sufficient quantity;
seasonal fruits;
cuts and products with a high content of coarse fiber;
legumes (peas, beans, lentils).

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

The more you weigh, the more you need to drink. Proper nutrition normalizes metabolism and improves intestinal function. As a result, body fat will gradually begin to decrease. Don't expect an immediate effect. Correcting body weight takes time.

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

Drug treatment: Duphaston, Utrozhestan and other drugs

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

Gestagens - Duphaston, Utrozhestan, Iprozhin - drugs used for polycystic ovary syndrome, which have positive reviews. Prescribed to regulate the second phase to create the illusion of secretory transformation of the functional layer of the uterus.
Oral contraceptives - Diane 35, Zhanin, Yarina, Belara - effective pills, for polycystic ovary syndrome they block the functioning of the ovaries and protect against pregnancy.
Glucocorticosteroids - Dexamethasone, Maxidex, Dexapos - have anti-inflammatory and hormone-regulating effects. Used in combination with other medications.
Homeopathy – Remens for polycystic ovary syndrome regulates the relationship of the gonads with the pituitary gland and hypothalamus. The drug normalizes the menstrual cycle and alleviates PCOS.
Diuretics - Veroshpiron, Furosemide - for polycystic disease are used to relieve swelling and remove fluid. They are prescribed for a short course, as after withdrawal they can cause rebound syndrome.

Means for stimulating ovulation

After completing a course of medication and achieving a noticeable improvement in the patient’s condition, the patient who wants to become pregnant is prescribed stimulation. For this purpose, medications with an antiestrogenic effect are used, for example, Clostilbegit tablets.

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

Important! If attempts to stimulate ovulation are unsuccessful within three cycles, the woman is recommended to undergo surgical treatment.

Progestin drugs

Gestanenes are drugs that participate in the chain relationship between the hypothalamic-pituitary system and affect the ovaries. They have antiandrogenic, antiestrogenic, gestagenic effects. Such means include:

Duphaston;
Utrozhestan;
Progesterone injections;
Iprozhin;
Progestogel.

Synthetic gestagens include: Norkolut, Orgametril, Ovestin, Postinor, Triquilar, Zhanin, Yarina and others.

Contraceptives - estrogen progestin drugs

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

Estrogen progestogen drugs include:

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

All contraceptives can be divided into monophasic and multiphasic.

Vitamins and homeopathy – Folic acid, Magne b6 and Cyclodinone

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

Magne b6 - participates in almost all reactions occurring in the body. This substance is necessary for every cell, so if there is insufficient intake from food, 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 taking it, the level of prolactin decreases, which may be the root cause of PCOS.

Physiotherapeutic methods - massage, leech treatment, exercises, hydrotherapy

Physiotherapeutic methods of treatment in combination with medications show positive results. The most commonly used:

magnetic therapy;
galvanophoresis;
hydrotherapy and mud therapy methods (the best results are shown after visiting 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, which improves blood circulation and reduces cysts);
exercise (light physical activity - running, cycling, swimming).

Manipulations involve improving blood and lymph flow, reducing the size of glands, normalizing metabolism, and having an anti-inflammatory effect.

Operation - effectiveness of laparoscopy

If treatment attempts are unsuccessful, surgery 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 bunches are small, then cuts are made. Ovarian resection for polycystic disease is performed when there is extensive damage to the gonad.

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

Folk remedies – boron uterus, sage, mumiyo, oregano, cumin

Non-traditional treatment methods complement drug therapy well. Herbal medicines alone cannot cure polycystic disease. In combination with prescribed medications, you can use:

Borovaya 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 caraway seeds – take continuously for a month;
oregano – take 2-3 months;
nettle and mumiyo - drink from the second day of menstruation until the end of bleeding.

Pre-brew, boil or infuse plant materials in a water base. Taking boron uterus for polycystic ovary syndrome has good reviews. This plant is able to regulate the balance of estrogen and progesterone.

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

Complications

Complications of polycystic ovary syndrome include the development of infertility. The more advanced the pathology, the more difficult it will be to cure it.

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

Treatment prognosis and consequences

The consequences of polycystic ovary syndrome can be avoided if you consult a gynecologist in time and start treatment. The prognosis in the early stages is favorable. Secondary PCOS responds better to drug therapy and can be eliminated in a short time.

With primary damage to the gonads, it will be more difficult to get rid of the problem. If drug treatment does not help, then surgical intervention will definitely give positive results.

Prevention

There is currently no specific prevention of polycystic disease. To avoid the development of pathology, women need to monitor their diet and body weight, give up bad habits and lead a healthy lifestyle.

Moderate physical activity, maintaining 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 on average 6-12 months. After this, the chances of pregnancy in a natural cycle decrease.

There are cases where 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 prescription of preservatives.

Content

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

What is polycystic ovary syndrome

If ovarian metabolism is disrupted, abnormal changes in the function 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 and develops other chronic diseases in women.

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

Causes

Overweight women are more likely to suffer from polycystic disease than slim 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 excessive production of androgens - male hormones as a result of a surge in excess insulin in the blood. This leads not only to menstrual cycle disorders, but also to a sharp decrease in reproductive functions.

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

nervous shocks;
presence of chronic infections;
change in climatic conditions;
bad heredity;
irregular sex life;
environmental factor;
colds;
a large number of abortions;
pathologies in the endocrine glands;
chronic diseases inherent in the pituitary gland, hypothalamus, ovaries, and thyroid gland.

Classification

Since pituitary hormones are produced in abnormal concentrations, additional hormonal medications are necessary. Before starting intensive therapy, it is necessary to familiarize yourself in detail with the diagnosis of polycystic disease and study the classification associated with characteristic dysfunctions. So, there are:

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

How dangerous

In the absence of timely diagnosis of polycystic disease, treatment may be useless - serious health complications progress. You can’t expect a successful conception; the real chances of getting pregnant from immature eggs are completely excluded. The patient not only has problems with the arrival of her period, but potential complications with women's health are presented below:

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

Symptoms

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

irregular menstrual cycle;
pain during planned uterine bleeding;
signs of increased hair growth on a woman’s skin;
dysfunction of the adrenal glands;
pimples and acne;
problems with the functioning of the ovaries;
high blood pressure.

How to determine polycystic ovary syndrome

The woman draws attention to the fact that, despite her apparent health, she is unable to successfully conceive a child for a long time. When follicles form, you can find out by ultrasound of the uterus, while eliminating the risk of development and growth of pathogenic tumors. It is urgently necessary to undergo ultrasound diagnostics in order to correctly and timely differentiate the disease. Polycystic syndrome requires a comprehensive approach, which includes a number of laboratory tests and therapeutic measures.

Analyzes

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

Cushing's syndrome;
adrenogenital syndrome;
hyperprolactinemia;
hypothyroidism

Signs of PCOS on ultrasound

Ultrasound and laparoscopy of the ovaries are informative diagnostic methods and are 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 darkening. 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 and other already noticeable symptoms cannot be ruled out.

Treatment of polycystic ovary syndrome

Since the pathology is accompanied by unstable insulin resistance, treatment of polycystic disease requires replacement therapy. Unauthorized actions by the patient are strictly prohibited. The disease is subject to conservative and surgical treatment according to the decision of a specialist, since in the first case, complete recovery is 50% guaranteed. So, the conservative method involves 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 gland and hypothalamus, it is necessary to take oral contraceptives with antiandrogenic properties for 2 to 3 months in the absence of planning pregnancy. These can be tablets Janine, Jess, Regulon, Yarina. Representatives of other pharmacological groups are also necessary:

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 schedule for a course of up to 4 months.
Antiandrogens for blocking male hormones in polycystic disease: Veroshpiron, Flutamide. Drugs in the form of tablets with a diuretic effect, you should take up to 3 pills per day.
Drugs to increase insulin sensitivity in polycystic disease: Glucophage, Metfogamma, Bagomet.

Operation

If the positive dynamics of conservative treatment are completely absent throughout the year, the doctor resorts to surgical intervention. Previously, it was laparoscopy (resection of the ovaries), but in modern medicine this method is considered 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 uses a needle electrode.

Diet

Radical changes are coming in your daily diet after diagnosis. For example, the calorie content of food should not exceed 1800 - 2000 Kcal, and you should eat up to 5 - 6 times. The norm of carbohydrates is 45% of 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 allowed for ovarian pathologies:

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

Products prohibited for polycystic disease are:

fast food;
bakery products;
sweets;
potato;
instant food products.

Folk remedies

The presence of traditional methods of treatment in a specific clinical picture should not be excluded. However, such therapy can only be auxiliary and must be previously discussed with the attending physician. Here are effective and publicly available recipes:

Pour 80 g of boron uterus with 500 ml of vodka, leave in a dark place for 2 weeks. Take the prepared composition orally, 0.5 tsp. three times a day for 2-4 weeks.
100 g of green peeled walnuts need to be filled with 800 g of sugar and poured with the same amount of vodka. Infuse the composition for 2 weeks, take 1 tsp orally. for 3 weeks.
Decoctions of nettle or milk thistle, prepared according to the recipe on the package, also provide positive dynamics for polycystic disease. Treatment in this way is allowed for up to 2 – 4 weeks.

Pregnancy with polycystic ovary syndrome

Women with such a health problem are interested in the question of whether it is possible to get pregnant with polycystic ovary syndrome. 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 treatment, replacement therapy should be continued. After successful conception, a woman should remain under strict medical supervision.

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Instructions

In healthy women of childbearing age, follicles form in the ovaries during the menstrual cycle. During ovulation, an egg is released from one of them, and the remaining follicles become overripe and stop functioning. With polycystic ovary syndrome, the egg does not mature, the follicles do not rupture (ovulation), and they fill with fluid, forming cysts. The ovaries can increase in size up to 5 times.

The reasons for the development of polycystic disease are not fully understood, but it is known that the occurrence of the disease is associated with excessive production of insulin by the pancreas. In turn, this causes excess production of androgens - male sex hormones, which leads to hormonal imbalance. Hereditary predisposition also plays a big role.

Manifestations of polycystic ovary syndrome can appear at any age. If the disease begins during the period of formation of menstrual function, there is a prolonged absence of the first menstruation, an irregular monthly cycle, and heavy bleeding. Also worrying about oily skin and hair, the presence of acne, without visible acne, the weight can increase by 12-15 kg.

If the disease develops in adulthood, the main clinical sign is menstrual irregularity, when the break between two menstruation can be more than 35 days, the woman cannot become pregnant and bear a child. Since the level of androgens is increased, male-type hair appears - on the chest, back, face, limbs, but this symptom may not be present in all patients. Also characteristic is weight gain, localization of fat deposits in the waist area, and male pattern baldness.

Some women are bothered by aching pain in the pelvic area, darkening of the skin on the inner thighs, under the mammary glands, and in the groin area. Half of the women who have polycystic ovary syndrome develop type 2 diabetes by the age of 45-50, have elevated cholesterol levels, and all patients have an increased risk of developing endometrial cancer (the inner lining of the uterus).

To confirm the diagnosis of polycystic ovary syndrome, the doctor prescribes an ultrasound of the ovaries, a general blood test, and a blood test for androgen, sugar and cholesterol levels. Treatment directly depends on the severity of symptoms and the level of male sex hormones; the goal of treatment is to achieve the maturation and release of eggs. For this purpose, hormonal drugs are used that stimulate ovulation and make it possible to achieve its regularity in 70% of women, and the ability to become pregnant in 40%.

Drugs that regulate the functioning of the pituitary gland are also used; under their action, the size of the ovary decreases. Subsequently, hormonal drugs are prescribed to stimulate ovulation. This treatment regimen restores ovulation by 95% and the ability to become pregnant by up to 65%.

In some cases, birth control is used to induce regular menstruation. There are contraceptives containing a small amount of antiandrogen - a substance that blocks the action of male sex hormones. They allow you to get rid of excess hair growth, oily skin and acne. Sometimes surgical treatment is performed using the laparoscopic method - from ovarian resection to tissue burning with electric current.

Women often encounter. A decrease in the volume of discharge, duration, and regularity indicate a malfunction of the reproductive system. Let's take a closer look at such a disease as polycystic ovary syndrome, highlight its causes, signs, and control measures.

Polycystic ovary syndrome - causes

To begin with, it should be noted that polycystic ovary syndrome is a disease of an endocrine nature. It is associated with a violation of the secretory and reproductive functions of the gonads. According to statistics, it occurs in approximately 15% of women of reproductive age. To understand the cause of the disease, let us consider the mechanism of its development, briefly highlighting the physiological characteristics of the female gonads.

Thus, in the ovary of a healthy woman, 5-6 follicles simultaneously mature each month, in which germ cells are located. But at the same time, only one fully matures and ovulates (bursts). It directly contains the most viable egg. The rest undergo reverse development under the influence of hormones. In the case when the hormonal background is unstable, there is an excess of estrogens and androgens, and little progesterone, immature follicles do not resolve, but form cysts - cavities that are filled with liquid contents.

The situation repeats itself every month. As a result, the ovaries are completely covered with cysts. Doctors have been studying the nature of a disease such as polycystic ovary syndrome for a long time, the causes of which cannot always be determined. Among the probable theories of the development of the disease, it is worth highlighting:

A decrease in tissue susceptibility to the hormone insulin, which causes compensatory synthesis by the pancreas. As a result, female gonads intensively produce, which leads to suppression of the ovulatory process.
Failure of the hypothalamic-pituitary system, leading to disruption of the functioning of the reproductive system.
Inflammatory process in the ovaries.
Dysfunction of the adrenal glands, which produce androgens.

In addition, the trigger for the development of pathology can be:

severe stress;
autoimmune processes;
infectious diseases.

Polycystic ovary syndrome - symptoms

Often, the signs of polycystic ovary syndrome are hidden. Because of this, women go to the doctor with severe manifestations of the disorder, including:

Irregular menstrual cycle. With polycystic ovary syndrome, frequent delays in menstruation are recorded. In this case, the duration of absence of menstrual flow may vary and depends on the severity of the disease and the degree of damage to the gonads. On average, the delay ranges from 2 weeks to several months.
Chronic, painful sensations in the lower third of the abdomen, lumbar region and pelvis. The pain is not very pronounced and is intermittent.
Increased production of sebaceous gland secretions. Women note that the skin and hair on the head become oily faster.
Excessive hair growth on the hands, the appearance of hair on the chin and chest. This is due to an increase in the concentration of male sex hormones in the blood.
Rapid and significant increase in body weight. Deposits of adipose tissue occur in the waist area due to impaired sensitivity of the body to glucose and increased levels in the blood.
No change in basal temperature values. The parameter remains unchanged throughout the entire cycle, which confirms the absence of ovulation.
Problems with conception.

Pain with polycystic ovary syndrome

Suspecting that they have this disease, women often ask the gynecologist a question about whether the ovaries hurt with polycystic disease. The doctor answers in the affirmative, but warns that with small tumors there may be no pain. Most patients with this disease report aching pain in the lower abdomen and lower back. However, the nature of the development of pain syndrome has not been fully studied. Doctors believe that pain is caused by excessive growth of the ovaries, which begin to put pressure on the pelvic organs.

Menstruation with polycystic ovary syndrome

When talking about the symptoms of polycystic ovary syndrome in women, doctors put menstruation disorders first. The main reason for their delay during illness is a decrease in the concentration of sex hormones. Follicle-stimulating and luteinizing hormones, which are so necessary to begin with, have low concentrations. The follicle does not mature completely, does not develop - it does not occur, and menstruation is also absent.

The substances necessary for the second phase of the cycle are synthesized in insufficient quantities. Because of this, menstruation is delayed. It lasts from 14 days. With severe disorders, changes in the gonads, menstruation may be absent for 2-3 months or more. Often the delay itself becomes the reason for contacting a gynecologist and diagnosing the disease.

Diagnosis of polycystic ovary syndrome

The diagnosis of polycystic ovary syndrome is made based on the results of a comprehensive examination. It includes:

general examination of the patient - the doctor determines the body type, excludes the presence of excess weight, evaluates the skin and hair;
examination in a gynecological chair;
– forms the basis of diagnostic measures; on the screen, the doctor records endometrial thickening, cysts, and an increase in the size of the gland by 2-3 times;
laboratory tests - the concentration of pituitary and ovarian hormones in the blood is assessed, glucose levels and lipid profiles are determined.

How to treat polycystic ovary syndrome?

When a diagnosis of polycystic ovary syndrome is made, treatment begins with eliminating the cause of its occurrence. This is determined using diagnostics. Based on its results, an individual plan of therapeutic measures is developed, which includes:

hormone therapy;
lifestyle changes;
dieting.

Can PCOS be cured?

Doctors say that polycystic ovary syndrome can be cured if a woman seeks help in a timely manner. Moreover, the treatment process for such a disease is always long. Taking hormonal medications for at least six months. Courses have to be repeated periodically to maintain hormone levels at the required concentration. But, as practice shows, it is not possible to completely get rid of the disease. The therapy helps to minimize the manifestations of polycystic ovary syndrome and achieve the desired goal - to conceive a baby.

Polycystic ovary syndrome - treatment, drugs

As noted above, the basis of therapy is hormonal agents. Their selection is carried out individually, with preliminary analysis. Among the common remedies, it is worth noting that it is often prescribed for polycystic ovary syndrome. In addition to this, they are used:

Jess;
Janine;
Yarina.

When there is a decrease in glucose tolerance, doctors prescribe glucose-lowering drugs. Metformin for polycystic ovary syndrome is used directly for this purpose. The dosage and frequency of administration are determined individually. It reduces the concentration of insulin in the blood. As a result, the stimulating effect of this hormone on the sex glands is reduced.

Vitamin therapy is also often included in the complex treatment of a disease such as polycystic ovary syndrome. It has been established that vitamins such as:

Polycystic ovary syndrome - treatment with folk remedies

The use of traditional medicine is an excellent complement to basic drug treatment. Before using them, you should consult your doctor. Among those effective for polycystic disease, it is worth mentioning the following:

Red brush. The medicinal plant restores hormonal levels. Reduces the concentration of male sex hormones. The red brush for polycystic ovary syndrome is used in the form of:

tinctures: 80 g of roots are poured into 0.5 liters of vodka, allowed to brew for a week in a dark, cool place, take half a teaspoon, 3 times a day, course – 2 weeks;
decoction: 1 tablespoon of roots is poured into 200 ml of boiling water, left for an hour, taken half an hour before meals, 50-70 ml, 3 times a day, drunk for at least 1 month.

Borovaya uterus. A medicinal plant used to treat gynecological diseases. Polycystic ovary syndrome is treated with this plant as follows: add 500 ml of vodka to 80 g of herb, infuse for 7 days, take half a teaspoon, before meals 3 times a day, drink for 2 weeks.
Liquorice root. Used as an infusion: 1 tablespoon of roots is poured into 200 ml of boiling water, left for an hour, taken throughout the day in small portions. The course of treatment is a month.

Diet for polycystic ovary syndrome

When answering questions from patients regarding how to cure polycystic ovary syndrome, doctors point out the need to follow prescriptions and instructions. Diet plays an important role in the disease. At the same time, doctors recommend eating foods with a low glycemic index:

lean meat;
fish;
chicken eggs;
Rye bread;
lentils;
legumes (peas, beans);
cottage cheese;
dairy products;

Fruits should be present in the diet. Preference should be given to:

apples;
oranges;
grapefruits;
kiwi;
cherry;
plum

When preparing a diet, adhere to the following rules:

equilibrium ratio of proteins and carbohydrates;
fractional meals - 5-6 meals;
maximum organic products.

Laparoscopy for polycystic ovary syndrome

Surgery for polycystic ovary syndrome is indicated when drug treatment is ineffective. Doctors insist on carrying it out after completing a six-month course of hormone therapy, which has not brought results (the number of cysts has increased, they have become larger in size). Surgical intervention is performed laparoscopically. The advantages of this method are:

reduction of injuries;
reducing the risk of complications (adhesions, internal bleeding, inflammation - are recorded less frequently);
fast recovery;
good aesthetic effect.

Polycystic ovary syndrome and pregnancy

With this disease, conception becomes a problem due to the lack of the ovulatory process. To normalize the cycle, a woman has to undergo a course of hormone therapy, which lasts up to 6 months. If there is no effect, surgery is prescribed. Pregnancy after ovarian laparoscopy for polycystic disease occurs within 2-3 menstrual cycles (if there are no concomitant diseases).

Is it possible to get pregnant with polycystic ovary syndrome?

With polycystic ovary syndrome, you can get pregnant only if you strictly follow the prescribed therapy. It includes:

taking hormonal medications;
weight correction;
exclusion of diseases of the reproductive system.

It is worth considering that polycystic ovaries during pregnancy that has already begun can lead to complications:

bleeding;
spontaneous abortion;
pregnancy fading;
premature birth.

How to get pregnant with polycystic ovary syndrome?

Ovulation with polycystic ovary syndrome becomes irregular. Because of this, all the doctors’ actions are aimed at stabilizing her. The woman remains to fully comply with medical prescriptions and take prescribed medications. In order to increase the chances of conception, it is necessary to determine the date of ovulation using special tests. Sex during this period will bring long-awaited results.

IVF for polycystic ovary syndrome

Tired of fighting the disease, women ask doctors whether it is possible to do IVF for polycystic ovary syndrome. Doctors answer in the affirmative. With in vitro fertilization, ovulation is stimulated; with polycystic ovary syndrome, it is absent. After this, the mature egg is artificially inseminated in the laboratory. An already fertilized germ cell is implanted into the woman’s body. Implantation occurs and pregnancy begins. The pregnant woman is monitored.