I. Treatment principles of PCOS
1.Adjustment of menstrual cycle: using cyclic progestin or short-acting oral contraceptives can prevent endometrial cancer at the same time.
2.Healthy lifestyle: especially for patients with metabolic abnormalities, pay attention to diet control, adhere to exercise and weight control.
3.Anti-hyperandrogen therapy: The recommended first choice of medication is short-acting oral contraceptive pills.
4.Fertility treatment: Ovulation monitoring and ovulation promotion for those who have fertility requirements, and assisted reproduction technology can be considered to assist pregnancy if necessary.
5.Management of metabolic abnormalities: Metformin is preferred for those with abnormal glucose metabolism, while emphasizing a healthy lifestyle.
6, regular review to monitor long-term complications and timely intervention: it is recommended that patients with PCOS should be screened regularly for glucose metabolism abnormalities and tumors; for those with high-risk factors (central obesity, weight gain, and diabetes and its preexisting lesions, etc.) more emphasis should be placed on long-term management.
Long-term management of PCOS
Long-term complications of PCOS are known to increase with years of disease and age. Therefore, even if patients have resolved their fertility problems, long-term management of PCOS as a chronic disease and periodic reassessment of the risk of long-term complications is necessary. In other words, there are “tactics” to deal with PCOS, but we also need to talk about “strategy”, which is to control the disease through modern medical technology, prevent and control long-term complications, and “live in peace” with PCOS in the long term. “. In the words of Chairman Mao Zedong is “on the protracted war”.
1, the long-term management of PCOS is facing challenges and problems
(1) public awareness and acceptance of PCOS as a chronic disease has yet to be popularized, and the strength and level of public health management still needs to be improved.
(2) compared with diabetes and cardiovascular disease, which are also metabolic diseases, the system of long-term management of PCOS as a chronic disease has not yet been developed.
(3) The long-term complications of PCOS involve multiple specialties (endocrinology, cardiovascular, dermatology, oncology, etc.), which requires the receiving physician to have this multidisciplinary diagnosis and treatment professional level and concept.
2. Patients and relatives have many questions about long-term treatment.
(1) Concerns about long-term use of oral contraceptives.
Concern 1: The use of oral contraceptives can cause breast cancer because they are formulated with hormones.
A great deal of research has been done at home and abroad around the relationship between the pill and the occurrence of tumors. The vast majority of studies have shown that as long as people who are not at high risk for estrogen-dependent tumors (for example, those with a family history of breast cancer and those who have had estrogen-related tumors such as breast cancer), there is no tendency for the incidence of these tumors to increase after oral contraceptive use. Long-term use of the pill steadily reduces the risk of endometrial and ovarian cancers. Therefore, it can be said that modern short-acting oral contraceptives are safe for humans.
Concern 2: The use of oral contraceptives has an effect on fertility.
Women who use short-acting oral contraceptives can plan for pregnancy after they stop using the pill and wait for their periods to come. The main contraceptive effect of the pill is to suppress ovulation, and a cycle of taking the pill can only prevent pregnancy for one month. Most women resume ovulation one month after stopping the pill; for those who have been taking the pill for a year, ovulation can be resumed within 1-2 months after stopping the pill; and for those who have been taking the pill for more than a year, 98% resume ovulation within 3 months after stopping the pill. Therefore, short-acting contraceptives do not affect fertility.
Concern 3: The use of oral contraceptives can cause obesity.
The composition of the pill is synthetic estrogen and progestin, which do not affect affect fat metabolism. A large number of clinical studies have shown that women using short-acting oral contraceptives do not experience a significant increase in body weight on average. In contrast, the weight gain that occurs in some women within a short period of time after starting oral contraceptives is due to mild water and sodium retention caused by estrogen and progestin. It may also be related to a tendency toward obesity and increased food intake in PCOS, not drug-induced fat accumulation.
Concern 4: Short-acting oral contraceptives are used for contraception, so why are they used in unmarried girls?
As mentioned above, the ingredients of short-acting oral contraceptives are synthetic estrogen and progestin, which are produced by the normal ovaries. The use of short-acting oral contraceptives in PCOS patients can kill two birds with one stone, as these ingredients can also counteract hyperandrogenism and acne. Of course, the use of these drugs must be under the guidance of a physician and as prescribed by the doctor.
(2) Side effects caused by the use of metformin are difficult to adhere to
Metformin is a drug to adjust glucose metabolism, but at the same time the early use of the drug can cause gastrointestinal reactions such as nausea, vomiting, diarrhea, etc., but also some people appear dizzy and tired reactions. These side effects are often dose-dependent, i.e. the higher the dose taken the more pronounced the side effects. It is recommended to start with a small dose, one tablet once a day, and then increase to one tablet twice a day after a period of time, gradually increasing to a therapeutic amount of one tablet three times a day. The side effects of metformin can be avoided or reduced with this stepwise dosing method, and most people have reduced or disappeared after 1 to 2 months of medication.
In conclusion, the principles of PCOS diagnosis and treatment are clear, and adherence to treatment can effectively control the disease and effectively prevent and control long-term complications. Just like the familiar cardiovascular diseases such as diabetes, hyperlipidemia and hypertension, PCOS is a chronic disease but can be controlled. PCOS patients with well-controlled disease can have a normal life and work as ordinary women. The patient and the doctor are side by side in a “trench” in this “constant battle”.