In recent years, the number of patients with polycystic ovary syndrome is increasing, accounting for 30-40% of infertility patients, and many unmarried girls with irregular menstruation often come to us with this disease. Now we will list the knowledge about polycystic ovary syndrome and the questions of our patients, and also provide the basis for self-examination for all readers.
The picture below shows polycystic ovaries on the left and normal ovaries on the right.
1. What is polycystic ovary syndrome?
Polycystic ovary syndrome is a common disease state causing infertility in women of reproductive age, characterized by high androgens and prolonged anovulation. Patients with polycystic ovary syndrome show varying degrees of menstrual disorders (including scanty menstruation, amenorrhea, low volume, dysfunctional uterine bleeding, etc.) and infertility, hirsutism, acne and obesity.
2.What is menstrual scarcity?
Patients with polycystic often present with scanty menstruation and amenorrhea. Sporadic menstruation means that the cycle is greater than 35 days, and some people’s cycle is even as long as 3-6 months or a year, which mostly indicates long-term ovulatory failure of ovaries, but some patients can have occasional ovulation.
3.What is frequent menstruation?
Frequent menstruation refers to abnormal uterine bleeding with shortened menstrual cycle and prolonged menstrual period with dripping.
4.What is amenorrhea?
Amenorrhea can be diagnosed when menstruation stops for 6 months, or when menstruation stops for more than 3 cycles according to your own menstrual cycle.
5. Can polycystic ovary syndrome be ruled out by regular menstruation?
No, it cannot be ruled out. Menstrual disorders are the most common clinical manifestation of polycystic patients, but a few polycystic patients show regular menstrual cycles, and ovulation monitoring by ultrasound indicates that there is no ovulation in the natural cycle.
6.When is the right time for sex hormone test for polycystic patients?
Most polycystic patients do not have regular menstrual cycle and endocrine hormones do not change periodically, so they can have blood test directly without waiting for menstruation, or they can perform progesterone to withdraw blood for examination after menstruation.
7.What is polycystic ovaries?
Polycystic patients are often diagnosed with “polycystic ovarian changes” by ultrasound, which shows 12 or more follicles of 2-9 mm on one or both ovaries, and the ovaries are often enlarged.
8.What degree can be called obesity?
Obesity means the body mass index (weight/height2) exceeds 25kg/m2, more than 50% of polycystic patients are obese, fat distribution is mainly in the abdomen and viscera, obesity may be related to genetics, adrenal gland dysfunction, exercise and diet, which can affect fat metabolism and dyslipidemia. All readers can check their body mass index, divide weight by height squared, weight in kilograms and height in meters.
9.Why do polycystic patients need to perform glucose tolerance test and insulin release test?
I will check the glucose tolerance of patients diagnosed with polycystic in my clinic, and some patients may have doubts why they need to check the glucose to see the gynecological disease. Nearly 30% of polycystic patients have impaired fasting glucose or impaired glucose tolerance: impaired fasting glucose means fasting glucose ≥ 6.1 mmol/l (110 mg/dl); impaired glucose tolerance (previously known as hypoglycemia or hypoglycemia) means glucose ≥ 7.8 mmol/l (140 mg/dl) 2 hours after glucose load. Regardless of obesity approximately 50-70% of polycystic patients have insulin abnormalities. Fasting insulin levels are <20 mU/L in normal and the maximum serum insulin concentration is <150 mU/L in normal, beyond which insulin resistance is often indicated. Numerous studies have shown that insulin resistance is the central aspect of polycystic ovary syndrome.
10. Having been diagnosed with polycystic ovary syndrome, my doctor advised me to do more exercise, why is this?
Because about 50% or even more of patients with polycystic ovary syndrome have insulin resistance in their bodies, and doing more exercise can help improve the body’s sensitivity to insulin, which is an auxiliary method in the treatment of polycystic ovary syndrome.
11.What kind of polycystic patients need oral metformin treatment?
Polycystic patients with impaired fasting glucose or impaired glucose tolerance and insulin resistance as determined by glucose tolerance and insulin release test need to take oral insulin sensitizers mainly including metformin and thiazolidinediones, among which metformin is most commonly used. After treatment with metformin in polycystic patients, hyperinsulinemia or insulin resistance is effectively improved and fertility is improved. Ovulation rates in obese polycystic patients can be increased to 90% with metformin or in combination with ovulation-promoting drugs. Studies have shown that the application of metformin is safe and effective in the treatment of polycystic ovary syndrome.
12. Should I continue taking metformin after pregnancy in polycystic patients?
It is currently recommended that metformin be stopped once pregnancy is established in patients with polycystic. Studies over the years have shown that metformin does not lead to an increased rate of congenital malformations in the fetus and can reduce the incidence of spontaneous miscarriage and preterm delivery in patients with polycystic disease. There is no evidence that taking metformin when ovulation is induced or in early pregnancy will increase the risk of fetal malformations.
13.Do obese polycystic patients need to lose weight?
Obesity is a serious health hazard and can aggravate endocrine abnormalities in polycystic patients, leading to poor results of various ovulation-promoting treatments, low pregnancy rate and high miscarriage rate. Even if the pregnancy is successful, the risk of both mother and child increases during delivery, and in addition to difficult delivery, vascular embolism, such as embolic phlebitis, is likely to occur in the pelvis and lower limbs. Therefore, polycystic patients with obesity should reduce body weight, low-calorie diet and appropriate exercise to be the key.
14.How should obese polycystic patients adjust their living habits?
It is very important to adjust the living habits of polycystic patients with obesity. Mainly include: long-term adherence to moderate physical exercise, such as brisk walking for 1 hour each time not less than 2 times a week, eating fewer meals (4-6 times/d to avoid high blood sugar and not cause hunger), reducing the intake of simple sugars and fats, such as fruits and vegetables and coarse grains (tomatoes, cucumbers, green leafy vegetables, etc.), and avoiding high-sugar and high-fat food. It can control weight and obtain a series of benefits, such as reducing the risk of cardiovascular disease, improving sensitivity to insulin, restoring menstrual cycle and even ovulation and conception.
15. Do polycystic patients with high androgens have masculine manifestations?
Polycystic patients with high androgens usually show elevated testosterone levels or acne, hirsutism, rough skin, etc. Due to the high concentration of androgens, their facial, areola, lower abdomen and extremities hair growth is dense. Occasionally, mild masculine symptoms such as low voice and protruding laryngeal nodes are occasionally seen in males. However, if the symptoms of masculinity are obvious, further examination is needed to rule out other diseases causing hyperandrogenism.
16.Is the hair on my arms and legs too thick because of high androgens in my body?
Generally, the thick body hair on the arms and legs is more related to genetics than to androgen levels. The thick body hair caused by high androgen level mainly refers to the thick hair on the perineum, around the anus, the midline of the abdomen, around the areola, the front chest and the back.
17.Why are thyroid function tests often recommended for polycystic patients?
Polycystic ovary syndrome is caused by the loss of cyclic feedback regulation mechanism of hypothalamic-pituitary-ovarian axis, and some patients have abnormal thyroid function due to the dysfunction of hypothalamic-pituitary-thyroid axis. Therefore, thyroid function test is necessary for polycystic patients, and if the test is abnormal, it needs to be treated at the same time.
18. Is polycystic ovary syndrome hereditary?
The exact cause of polycystic ovary syndrome is still unclear, but it may be related to genetic susceptibility, abnormal synthesis of gonadotropic and gonadal hormones, metabolic disorders and other factors.
19.Why are polycystic patients infertile?
Infertility is one of the main symptoms of polycystic patients. Due to long-term anovulation, the level of androgens in blood is elevated, and LH concentration starts to rise in the early follicular stage. Even if pregnancy occurs, spontaneous abortion and gestational diabetes are likely to occur, leading to infertility.
20.Why do most polycystic patients need oral contraceptive treatment?
Oral short-term contraceptive pills are combined estrogen and progestin cycle therapy to prevent excessive endometrial hyperplasia and regulate the menstrual cycle, and also reduce androgen levels. Generally, 3 consecutive cycles of application can result in significant improvement of endocrine disorders in polycystic patients. The course of treatment is usually 3-6 months and can be repeatedly applied.
21.What are the commonly used ovulation-promoting drugs for polycystic patients?
Commonly used ovulatory drugs include: clomiphene, letrozole and gonadotropins. Among them, clomiphene is the first line of ovulatory drugs and is usually taken orally from the 5th day of menstrual cycle. If some patients do not respond to clomiphene or have follicular development but still cannot get pregnant, gonadotropins can be used to promote ovulation.
22. Is surgery suitable for polycystic patients?
Surgery is not recommended for polycystic patients at the moment. Surgical treatment is another treatment option for patients with polycystic infertility, which includes traditional bilateral ovarian wedge resection, laparoscopic bilateral ovarian windowing or perforation. However, because of its traumatic effect on ovarian tissues, susceptibility to premature ovarian failure and possible complications of pelvic adhesions, surgical treatment of polycystic is generally not recommended except for individual patients with very severe cases.