Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic abnormality common in women of reproductive age, characterized by chronic anovulation (disturbance or loss of ovulatory function) and hyperandrogenemia (excess production of male hormones in women), with the main clinical manifestations being irregular menstrual cycles, infertility, hirsutism and/or acne, and is the most common female endocrine disorder. Treatment for polycystic ovary syndrome varies according to age, clinical presentation, fertility requirements, and goals.
Western medical treatment.
Pharmacological treatment.
1, obesity and insulin resistance.
2. Pharmacological induction of ovulation.
(1) Clomiphene.
(2) Combination of clomiphene and chlortetracycline.
(3) Combination of glucocorticoid and clomiphene.
(4) Urotropic hormone.
(5) Gonadotropin-releasing hormone.
(6) FSH.
(7) Bromocriptine.
(3) Bilateral ovarian wedge resection: It is suitable for those with elevated blood testosterone and enlarged ovaries with normal DHEA and PRL (suggesting that the main cause is in the ovaries), and partial removal of ovaries to remove excessive androgens produced by the ovaries can correct the disorder of hypothalamic-pituitary-ovarian axis regulation. The pregnancy rate is 50-60%. The postoperative recurrence rate is high and is not conducive to pregnancy if complicated by pelvic adhesions. Laparoscopic ovarian cautery or resection can also receive certain results.
4, hirsutism treatment: can be regularly cut or coated with “hair loss agent”, do not pull out to prevent stimulation of excessive growth of hair follicles, can also be electrolysis treatment or application of androgen suppressant drugs.
(1) Oral contraceptives: estrogen-based estrogen and progestin complex tablets are ideal, which can inhibit LH secretion, reduce blood testosterone, androstenedione and DHEAS, and increase the concentration of sex hormone binding globulin.
(2) Progestin: It has weak anti-androgenic and mild inhibitory effect on gonadotropin secretion, and can reduce the level of testosterone and 17-ketosteroids. It is more commonly used as methylhydroxyprogesterone (Amnestic progesterone). It is usually administered orally at 6-8 mg/d. In addition, cyproterone acetate is a high-efficiency progesterone with strong anti-androgenic effects. It is often taken together with ethinylestradiol.
(3) GnRH-A: It is used from day 1-5 of the menstrual cycle and is now available in a variety of preparations such as transdermal inhalation, subcutaneous and intramuscular injection. The addition of ethinylestradiol can avoid the adverse effects caused by estrogen after the use of the drug.
(4) Dexamethasone: For hyperandrogenemia of adrenal origin, 0.25-0.5 mg/d. Administered orally every night.
(5) Spironolactone (Androstadienone): Interferes with ovarian androgen synthesis by preventing testosterone from binding to receptors in hair follicles and also by inhibiting 17α-chemistry enzyme. It can reduce hair growth and thinning of hair in patients who take 50 mg orally daily. For hyperandrogenemia with anovulatory disorders, 20mg per day can be taken orally on the 5th-21st day of menstruation, which can restore menstrual cycle and ovulation in some patients.
5.Artificial menstrual cycle: For patients without hirsutism and without fertility requirements, progestin can be given to perform artificial cycle therapy to avoid excessive hyperplasia and cancer of the endometrium.
Surgical treatment.
1.Ovarian wedge resection.
2. laparoscopic ovarian treatment.
Chinese medicine treatment for polycystic ovary syndrome.
1. Kidney Qi deficiency.
[Main symptoms] Aged 18 years or above, menstruation not yet arrived or re-closed after onset, vegetative weakness, dizziness and tinnitus, secondary sexual deficiency, lumbar and leg weakness, abdomen without distension and pain, frequent urination, light red tongue and sunken pulse.
Treatment】Nourishing the kidney, nourishing the liver and regulating menstruation.
【Remedies】Gui kidney pills with addition; Cuscuta, Eucommia, Fructus Lycii, Cornu Cervi Pantotrichum, Radix Angelicae Sinensis, Radix Rehmanniae Sinensis, Poria, Cortex Eucommiae, Shou Wu.
2.Deficiency of Qi and Blood.
[Syndrome] delayed menstrual cycle, low menstrual flow, followed by amenorrhea, dishonor, dizziness, palpitations, shortness of breath, fatigue, light tongue with thin teeth and moss on the side, thin and weak pulse.
Treatment】Supplementing Qi and nourishing Blood to regulate menstruation.
3. Yin deficiency and internal heat.
Symptoms】Menstruation is first abundant and then scanty, gradually leading to amenorrhea, irritable heat in the five hearts, red cheek and rising fire, hot flashes and night sweats, dry mouth and tongue, red tongue or cracked tongue, and fine pulse.
Treatment】Nourishing Yin, clearing heat and regulating menstruation.
4.Qi stagnation and blood stasis.
[Indications] Menstrual stagnation, chest distension, abdominal distension and pain, depression. The tongue is purple and dark, with stasis points on the side, the coating is puffy, and the pulse is sunken and astringent or sunken.
Treatment】Regulating Qi and invigorating Blood, dispelling blood stasis and clearing menstruation.
5.Phlegm-warm blockage.
Symptoms: Menstrual discontinuity, obesity, chest fullness, vomiting and phlegm, drowsiness, dizziness, or swelling of the face and feet, or excessive amount of whitish color, white and greasy coating, slippery pulse.
Treatment】Expelling phlegm and removing dampness, regulating Qi, activating Blood circulation and promoting menstruation.
[Remedy]: Cangfu Guiding Phlegm Pill with Buddha’s Hand: Fu Ling, Fa Xianxia, Chen Pi, Licorice, Atractylodes Macrocephalae, Xiang Shen, Bile South Star, Citrus Aurantium, Ginger, Shen Qu, Angelica Sinensis, Chuanxiong.
6.Cold blood stagnation.
Symptoms】Menstrual closure, cold pain in the abdomen, with heat, pain is reduced, the extremities are not warm, the stool is not solid, the fur is white, the pulse is sunken and tight.
Treatment】Warming the menstruation, dispersing cold and regulating menstruation.
[Formula] Warming the menstruation soup with reduction: Angelica sinensis, Chuanxiong, cumin, dry ginger, cinnamon powder (punching), Wu Ling Ling fat, Sheng Pu Huang, Chuan Niu Kne.