When it comes to polycystic ovary syndrome, many people are afraid of it and have many questions in their mind. What is polycystic ovary syndrome all about? Polycystic ovary syndrome (PCOS; Stein-Leventhal Syndrome; sclerocystic ovary disease) is a syndrome characterized by ovulation, amenorrhea or scanty menstruation, infertility, obesity, hirsutism and ovarian polycystic enlargement. The main risks: infertility, endometrial hyperplasia and even cancer, metabolic disorders: hypertension, hyperlipidemia, diabetes, etc. The diagnostic criteria for PCOS have undergone several revisions and are still controversial. The diagnosis of PCOS is an exclusionary diagnosis, and in addition to meeting two of the three criteria above, special emphasis should be placed on excluding the possibility of similar problems. The diagnosis of PCOS is an exclusionary diagnosis. In addition to meeting two of the above three criteria, special emphasis should be placed on excluding diseases that may have similar manifestations, such as delayed adrenocortical hyperplasia, Cushing’s syndrome, abnormal thyroid function, hyperprolactinemia, androgen-secreting tumors, functional hypothalamic amenorrhea, pharmacological hyperandrogenism, and idiopathic hirsutism. The diagnosis of PCOS may lead to overtreatment due to the diagnosis if other diseases are not ruled out but only any 2 of the above 3 items are met. Therefore, experts from the Gynecological Endocrinology Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association developed Chinese diagnostic criteria for PCOS based on Chinese data, which were promulgated by the Ministry of Health in 2011 to guide the diagnosis and treatment of PCOS in China. Diagnostic criteria of PCOS in China: scanty menstruation or amenorrhea or irregular uterine bleeding is a mandatory condition for diagnosis, in addition, one of the following 2 items is met: (i) clinical manifestation of hyperandrogenism or hyperandrogenemia; (ii) ultrasound manifestation of ovarian polycystic changes. The diagnosis of PCOS can be considered, but it is not certain and is called a suspected diagnosis. There is a requirement that treatment can be started first; when treatment is not effective or in doubt, other diseases need to be excluded before the diagnosis is finalized. Because of the different ages and treatment needs of PCOS patients, and the high specificity of clinical manifestations, clinical management should be based on the patient’s complaints, treatment needs, metabolic changes, and individualized symptomatic treatment measures to achieve relief of clinical symptoms, meet fertility requirements, maintain health and improve quality of life. For patients of childbearing age with no fertility requirements and menstrual disorders caused by ovulation disorders, the aim is to adjust the menstrual cycle and prevent endometrial cancer, and long-term treatment is usually required. For patients with regular ovulatory menstruation and patients with ovulatory sporadic menstruation with cycles shorter than 2 months, if there is no requirement for fertility or contraception, they can be observed and followed up without medication. Commonly used methods include cyclic progestin therapy and short-acting oral contraceptives. The symptoms and effects of hyperandrogenism are one of the core aspects of PCOS and are the main manifestations that plague patients with PCOS, including facial acne, hirsutism, and obesity. Patients with moderate to severe acne or excessive sexual hair that require treatment can visit a dermatologist for topical or physical therapy. You can also come to the gynecology department. Short-acting oral contraceptives and spironolactone are commonly used in gynecology. They are usually effective for 3-6 months. For the treatment of excessive sexual hair, it takes at least 6 months for the pills to take effect, because the growth of body hair has its own cycle. Short-acting oral contraceptives can reduce the production of ovarian androgens by inhibiting the synthesis and secretion of pituitary LH. The progestins contained in some contraceptives, such as cyproterone (Daing 35) and drospirenone (Ursine), can also inhibit the synthesis of androgen enzymes in the ovaries and adrenal glands, compete with androgen receptors in target organs (sebaceous glands and hair follicles), and block the peripheral effects of androgens, thus effectively inhibiting the growth of sexual hair and sebum production. This effectively inhibits the growth of sexual hair and sebum secretion. The estrogen (ethinyl estradiol) contained in short-acting oral contraceptives can effectively promote the synthesis of SHBG in the liver, which in turn reduces the level of circulating free androgens and diminishes the effect of androgens. The use of short-acting oral contraceptives can have the effect of killing several birds with one stone by regulating menstruation, relieving Kaohsiung symptoms, and having a contraceptive effect, making them a simple and convenient option for patients who need to use them, but the disadvantage is that they may relapse after stopping. Spironolactone is a diuretic that also inhibits the 5 alpha reductase enzyme that synthesizes dihydrotestosterone and blocks the peripheral action of androgens by competing for binding to androgen receptors in the skin follicles. The disadvantages are that it may lead to hyperkalemia, irregular uterine bleeding, and teratogenic effects. Contraception should be used during the use of the drug or combined with short-acting oral contraceptives to achieve regular menstruation and to enhance the efficacy against hirsutism. Shang Lifei, Department of Obstetrics and Gynecology, Second Hospital of Chifeng City
For adolescent PCOS ,it is advocated to adjust the lifestyle, reduce stress, control weight, and progesterone withdraw blood regularly to protect the endometrium. There are also some children with obesity and hyperinsulinemia, most of whom have a family history, most of whom have some genetic background, so metformin is used to adjust her, especially those with a family history of diabetes, and it is recommended that she use some drugs for a long time, which can adjust her insulin metabolism to a certain extent and help her slow down the triggering factors of diabetes in the future.