We discuss one of the most common pathologies in gynecological-endocrinology.
This is polycystic ovary disease. Provides information on the causes and provoking factors of the disease, clinical signs and complications. We discuss the basic principles of diagnosis and treatment of polycystic ovaries. We will try to answer the questions that interest the reader the most.
– What does polycystic ovary mean? What is the difference between polycystic ovary syndrome and polycystic ovary syndrome?
– “Polycystic ovaries” – this name is associated with one of the most common diseases in gynecological and reproductive practice. In fact, it is a morphological term and refers to the presence of multiple small fluid inserts in the ovaries.
In the medical literature, this disease is called polycystic ovary syndrome. It has other synonyms as well. The most common – “Stein-Leventhal syndrome”. This name is associated with the names of the physicians who first described the pathology.
Polycystic ovary syndrome is an independent disease that has specific clinical manifestations. Polycystic ovaries can be accompanied by many other endocrine disorders.
– What causes the development of polycystic ovaries?
– Polycystic ovary disease is a genetically determined multifactorial disease. This means that humans have changes in gene levels and various factors provoke the manifestation of the disease. Primarily these are malnutrition, low physical activity, emotional and physical stressors, exposure to harmful agents during pregnancy, and so on.
To clarify, a woman has a genetic predisposition to this pathology and the above environmental factors contribute to her development.
– When can the disease be detected?
– Polycystic ovary syndrome is associated with menstrual irregularities. Consequently, the disease can be detected in adolescent girls as soon as the first menstruation begins.
– When should we suspect polycystic ovary syndrome? What are the signs of the disease?
– The presence of polycystic ovary syndrome indicates an irregular menstrual cycle. At this time the woman does not menstruate every month. Misconduct can last from a few days to several months. Significant symptoms are associated with an excess of male hormones – androgens. It is overweight, acne, increased skin oiliness. Hair loss is relatively rare. More than half of patients with polycystic ovary syndrome have a problem with excess weight and obesity, which is associated with excessive secretion of insulin in the body. Characterized by e. წ. Existence of black acanthosis. At this time in some places, more often on the inner surface of the thighs, the skin is darkly colored. Women blame this on friction due to obesity, which is obviously not true.
– What is the connection between obesity and polycystic ovary syndrome?
– Polycystic ovary syndrome is often accompanied by obesity, which aggravates the disease. A vicious circle is formed – the disease causes obesity and obesity aggravates the disease. At this time patients have difficulty losing weight, so treatment is necessary.
– Does polycystic ovary syndrome cause infertility?
– The disease is directly related to the problem of infertility, because the main sign of polycystic ovary syndrome is the absence of ovulation. If a woman does not mature an egg, obviously, fertilization will not happen. The follicles regress and multiple cystic inserts appear in the ovaries.
– How possible is pregnancy during polycystic ovaries?
– In polycystic ovaries, a woman can rarely have spontaneous ovulation and pregnancy occurs without treatment. The probability of getting pregnant with the right treatment is quite high. I would definitely like to share our experience with you – when a girl is diagnosed with polycystic ovary syndrome and has been receiving treatment since adolescence, she has fewer problems with reproductive function.
– What complications can develop during pregnancy during polycystic ovaries?
– It is important to end pregnancy during polycystic ovary syndrome after pregnancy. Such patients need special supervision, as they can develop various complications – termination of pregnancy, increase in blood pressure figures, gestational (pregnancy-related) diabetes, premature birth and others.
– What about the health of children born as a result of treatment by mothers with polycystic ovaries?
– According to the many years of experience of our institute, the health of children born as a result of the treatment of mothers with polycystic ovaries is no different from that of the offspring of healthy women. However, their daughters have a relatively higher risk of developing polycystic ovaries.
In general, as far as this disease is genetically determined, familial cases are frequent. This means that several people in one family (mothers, children, sisters, aunts, uncles, grandmothers) may have polycystic ovaries.
– What complications can polycystic ovaries cause at a late age?
Polycystic ovary syndrome is a lifelong disease. Manifestations of the disease begin during puberty and continue after the cessation of menstruation. Rather, during this period, distant complications of polycystic ovaries develop – metabolic syndrome and hyperplasia (thickening) of the inner membrane of the uterus, the endometrium.
– What is metabolic syndrome and what does it have to do with polycystic ovaries?
– Metabolic syndrome is one of the complications of polycystic ovary syndrome and mainly includes type 2 diabetes, increased blood pressure, lipid metabolism disorders. It can develop at any stage of the disease. The risk of developing it is high in late reproductive age and during menopause.
– How are polycystic ovaries diagnosed?
– It is important to have clinical signs of the disease – menstrual irregularities, obesity, acne, etc. Ultrasound examination helps us a lot. During polycystic ovaries, the size of the ovaries is increased, it shows multiple fluid inclusions and thickening of the capsule. Hormonal analysis of blood is performed.
– How reliable is the ultrasound data in the diagnosis of polycystic ovaries?
– Ultrasound data are important, but they can not be relied on alone. Various factors need to be considered. For example, polycystic ovarian degeneration for adolescent girls is a physiological condition and is not considered a pathology unless it is accompanied by other symptoms.
– Which hormones should be examined to diagnose polycystic ovaries and when should a hormonal test be performed?
– During polycystic ovary syndrome, the secretion of androgens in the ovary is enhanced, so for the purpose of diagnosis, androgens, mainly testosterone, are examined. The sex hormone-binding globulin level is determined by the free androgen index. It is necessary to examine the androgens produced in the adrenal glands – dehydroepiandrosterone-sulfate and 17-hydroxyprogesterone, to diagnose various forms of polycystic ovaries. It is also informative to examine pituitary hormones – follicle-stimulating and malnutrition hormones. Anti-Müllerian hormone has been actively prescribed in recent years. Insulin secretion needs to be assessed.
Blood samples should be taken on an empty stomach, in the first half of the menstrual cycle, until the 7th day. It is especially important to follow these rules for some hormones.
Hormonal levels may be normal despite the presence of clinical signs of the disease. The reason is that all hormones have a more or less pronounced diurnal rhythm. Therefore, in the diagnosis of polycystic ovaries we can not rely only on hormonal analysis, it is necessary to reconcile all the data.
– When should we start treatment for polycystic ovaries?
– Treatment should be started as soon as the first signs of the disease appear, when the diagnosis of polycystic ovary syndrome is confirmed. We are not in a hurry with teenage girls. Menstrual irregularities, acne, the presence of multiple fluid inclusions in the ovary by ultrasound, the same multifollicular ovaries, is not considered a pathology for the first two years after the onset of menstruation.
– How is polycystic ovary treated?
– The treatment of the disease is complex, which means that we may need to use different medications. It depends on the patient’s age, clinical manifestations and severity, the patient’s desire – what is his priority – the regulation of the menstrual cycle, reduction of obesity, pregnancy or other.
Since most patients have the problem of excess weight and obesity, weight correction is necessary. The first recommendation in polycystic ovaries is to follow the principles of a healthy lifestyle.
We use anti-androgen and insulin regulating medications, ovulation stimulants, etc.
– What are the basic principles of a healthy lifestyle?
– These are the three main principles: proper nutrition (restriction of sugary products, flour products, fatty foods, up to 2 liters of water, protein foods and vegetables), physical activity (exercise, at least half an hour of brisk walking each day) and sleep regulation .
– Can polycystic ovaries be cured? How long does the treatment last?
– This is a very painful issue for patients. The disease cannot be completely cured because polycystosis of the ovaries is caused by genetic factors. The treatment is long, can last for months. Getting results is individual. We solve a specific problem, ie the goal of treatment can be to regulate the menstrual cycle, reduce obesity and acne, solve the problem of infertility, etc. Finally, it all protects a woman from complications such as metabolic syndrome, type 2 diabetes, endometrial hyperplasia and more.
Adjusting the lifestyle significantly alleviates the signs of the disease and promotes long-term remission or temporary disappearance of the symptoms of the disease.
– Is it necessary to take hormonal medications for polycystic ovaries? What side effects accompany the treatment and what complications can the hormones cause?
– In the treatment of obesity in polycystic ovary syndrome is very effective and used hormonal drugs with antiandrogenic action, mainly contraceptives. Since the hair development cycle lasts about 7 months, a long treatment is needed to get the effect. The main side effect of taking contraceptives is increased appetite and weight gain. It is important to assess the general health of the woman, the risk of developing thrombosis and breast cancer before prescribing treatment, etc.
Properly selected hormonal treatment is safe, it only brings benefits to the patient.
– When is the surgical treatment performed?
– In polycystic ovaries, surgical treatment is practically no longer performed. Proper medical treatment is enough to achieve the desired results. The main goal of surgical treatment is to restore ovulation. Surgical treatment is not recommended for adolescent girls and girls who do not plan to become pregnant yet, because after a certain period of time the disease may develop again. Surgery can be performed in case of accompanying pathologies, or very rarely, when with medical treatment we can not reach ovulation and pregnancy does not occur.
– Finally, what do you recommend to girls and women who have signs characteristic of polycystic ovaries?
– First of all, I would like to advise mothers to take girls to a gynecologist-endocrinologist in the same time, to the same reproductive specialist, because in addition to cosmetic problems (acne, obesity, obesity), which are accompanied by psychological problems (low self-esteem), ovarian dyskinesia And the cause of other complications.
Proper diagnosis and timely initiation of treatment will virtually prevent all complications.