Polycystic Ovary Syndrome (PCOS) is the most common clinical condition in gynecological endocrinology and has a large patient population in China. The associated metabolic disorders including hyperandrogenemia, insulin resistance, abnormal glucose metabolism, abnormal lipid metabolism, and increased risk of cardiovascular disease are also present.
1. What are the diagnostic criteria for PCOS?
(1) Sporadic ovulation or anovulation
(2) Clinical manifestations of hyperandrogenism and/or hyperandrogenemia
(3) polycystic ovarian changes: ≥12 follicles of 2-9 mm diameter in one or both ovaries and/or ovarian volume ≥10 ml. 2 of the above 3 criteria should be met, and other hyperandrogenic etiologies and diseases causing ovulation disorders should be excluded.
2. What are the causes of PCOS?
PCOS is the most common endocrine disorder in women of childbearing age, accounting for 5-10% of women of reproductive age and 30-60% of anovulatory infertility. The etiology is complex and the exact cause is still unclear. The relevant factors are genetic, environment, lifestyle and emotion.
3.What is sporadic ovulation or anovulation?
Sporadic menstruation is defined as menstrual cycle ≥ 35 days and ≥ 3 months per year without ovulation. Regular menstruation cannot be used as evidence of ovulation. Amenorrhea is defined as menopause for more than 3 previous menstrual cycles or menstrual cycle ≥ 6 months.
4.What is the clinical manifestation of hyperandrogenism?
The clinical manifestations of hyperandrogenism are mainly acne and hirsutism.
Acne is often located on the forehead, cheeks, nose and jaw, and is recurrent.
Hirsutism is the appearance of coarse and hard hair on the upper lip, jaw, around the areola, and the midline of the lower abdomen. More dense body hair on the extremities is mainly related to genetics.
5.What are the main hazards of PCOS?
Anovulation, dilute ovulation
Menstrual disorders: mainly manifested as irregular, scanty or amenorrhea menstruation
Infertility
Hyperandrogenic signs.
Hirsutism: 60% incidence
Acne: 15-25% incidence
Obesity, hyperinsulinemia
6.What are the long term harms of PCOS
(1) Endometrial cancer: Among patients with endometrial cancer under the age of 40, about 19-25% suffer from PCOS. Girls with PCOS are four times more likely to develop endometrial cancer later than girls of the same age with normal menstruation.
(2) Diabetes: Patients with PCOS have a 2-5 times increased risk of diabetes compared to the normal population. About 40% of PCOS patients have abnormal glucose tolerance.
(3) Risk of cardiovascular disease: The results of a study with patients with PCOS aged ≥45 years showed that the incidence of subclinical atherosclerosis was significantly higher in patients with PCOS (7.2%) than in normal women of the same age (0.7%).
(4) Dyslipidemia: It is very common in patients with PCOS, with about 70% of patients having elevated blood lipids.
7, what is the treatment strategy of PCOS
The clinical treatment goals for PCOS should be based on patient needs and include the following.
(1) lifestyle modification
(2) Treatment of recent clinical symptoms
Treatment of Kaohsiung-related manifestations: e.g. acne, hirsutism
Adjustment of menstrual cycle and restoration of regular menstruation
Promoting ovulation and treating infertility
Treatment of insulin resistance – metformin
(3)Prevention of long-term complications
Type 2 diabetes
Cardiovascular system diseases
Endometrial cancer
8.How to make lifestyle adjustments
Diet control
Exercise
Lifestyle changes, smoking and alcohol cessation
Reduce weight to normal range to improve insulin resistance through behavioral modification. Reducing weight to normal range can stop the long-term development of PCOS, such as diabetes, hypertension, hyperlipidemia, and cardiovascular disease and other metabolic syndrome.
Reducing body weight by 5% or more in obese patients can change or reduce menstrual disorders, hirsutism, acne and other symptoms and facilitate the treatment of infertility.
9.What are the methods of anti-hyperandrogen treatment?
Oral contraceptives: Da-Ying-35, Mafulon, Eusebio
GnRH-a
Dexamethasone
Antiseptic
10.Why do patients with PCOS need oral contraceptives (OC)
Indications: hyperandrogenemia or hyperandrogenic clinical manifestations
Types: Various short-acting oral contraceptives, with Daimler-35 being the first choice
Advantages: correction of hyperandrogenemia and improvement of hyperandrogenic clinical manifestations; effective contraception, establishment of regular menstruation and prevention of endometrial cancer
11.How to adjust the menstruation of PCOS patients?
Use of progestin
Indications: Protection of the endometrium
-No obvious clinical and laboratory manifestations of hyperandrogenism
-Anovulatory patients without significant insulin resistance can be treated with regular progestin alone
Types
-Antrogesterone
-Micronized progesterone
-Dydrogesterone
-Oral contraceptive pills
12.Ovulation promotion treatment
Patients with fertility requirements can undergo ovulation promotion treatment under the guidance of professional doctors.