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Abstract: A 26-year-old young woman, who was depressed because she had not succeeded in getting pregnant 1 year after marriage, came to our hospital and underwent an examination, and finally found the cause of her illness, which turned out to be polycystic ovary syndrome that deprived her of the right to be a mother. After 4 months of lifestyle management and medication, her condition gradually stabilized and she was able to get pregnant.
Basic information】Female, 26 years old
Type of disease】Polycystic ovary syndrome
Hospital】Hunan Provincial Maternal and Child Health Hospital
Date of consultation】January 2021
Treatment plan】Medication (Drospirenone ethinyl estradiol tablets, pioglitazone metformin tablets, progesterone soft capsules, letrozole tablets)
【Treatment period】4 months of drug treatment, review every 1 month
Treatment effect】Stable condition, successful conception, good progress
I. Initial consultation
This young female patient reported irregular menstrual cycle since menarche, menstruation: 7 days/30-60 days. After marriage, she had a normal sexual life without contraception for one year, but she has not yet conceived. On examination: facial acne (+), dense eyebrows and hair, sparse hair around the upper lip, dense hair on the lower arm and lower leg, normal vulvar development, dense pubic hair in male pattern. Pelvic ultrasound showed normal size of uterus, bilateral ovarian PCO changes, and AFC > 24. Endocrine examination: testosterone 3.08 nmol/L. Combined with the above findings, a preliminary diagnosis of polycystic ovary syndrome was made.
II. Treatment history
After communication with the patient, a treatment plan combining lifestyle management and pharmacological treatment was determined. Lifestyle management: exercise 4-5 times a week for 40-60 minutes, mainly skipping rope, running and other exercises; reasonable control of diet, recipes formulated at the nutrition clinic to limit caloric intake. At the same time, medication was administered, using drospirenone ethinyl estradiol tablets and pioglitazone metformin tablets, which can inhibit the body’s absorption of glucose and increase the utilization of glucose; progesterone soft capsules, which can regulate endocrine secretion and replenish luteal function; finally, letrozole tablets were used to promote ovulation. After taking the medication, she came to the hospital for monthly follow-up and sought medical attention promptly if she had any uncomfortable symptoms.
Treatment effect
The patient’s weight loss was 8kg and her testosterone was 1.51nmol/L, blood lipids were normal, blood glucose and insulin were normal.
He continued to take the medication. In the second month, menstruation started and weight gain was 5 kg. Drospirenone ethinyl estradiol tablets and pioglitazone metformin tablets were administered for 1 month and she was asked to see the doctor again. In the 3rd month, she lost 8kg and rechecked testosterone: 2.12nmol/L. She continued to use pioglitazone metformin tablets + nutritional recipes + aerobic exercise for 1 cycle. In the 4th month, on the second day of menstruation, testosterone was rechecked: 1.57 nmol/L. She lost 8 kg and was given letrozole tablets to promote ovulation, with dominant follicles, and was instructed to have intercourse.
IV. Precautions
I was sincerely happy that the patient was successfully conceived after her condition was stabilized. At the same time, I did not forget to advise the patient that she should also pay attention to the following points in her life.
1. it is advisable to have a light diet and avoid excessive consumption of staple foods, desserts and other foods high in sugar and fat, and also to reasonably control the weight gain during pregnancy.
2, the patient should follow the doctor’s instructions after pregnancy regular review, during the period if the weight gain is too fast, thirst, hairiness, acne and other symptoms aggravated, promptly go to the hospital for consultation.
3. Patients should follow the doctor’s instructions and use the medication correctly, avoiding increasing or decreasing the dosage, stopping the medication, or omitting to take the medication, which may aggravate the disease and affect the health of the pregnant woman and fetus.
V. Personal insight
Polycystic ovary syndrome is an endocrine metabolic disease, commonly seen in women of reproductive age. The main manifestations are abnormal menstruation, acne, hirsutism, hair loss, acanthosis nigricans, infertility, etc. In severe cases, it may also cause diabetes mellitus and endometrial cancer. Therefore, regardless of the age group of women, once the above symptoms are detected, they should be alerted and go to the hospital in time to improve the relevant examination and early treatment. As in this case, the patient was successfully conceived after treatment, and the prognosis is good, with no serious adverse consequences.