Polycystic ovary syndrome and western medical treatment

  Polycystic ovary syndrome (PCOS) is a syndrome of endocrine disorders characterized by persistent anovulation, hyperandrogenism or insulin resistance. The prevalence of this disease is 5-10% in women of reproductive age. The clinical manifestations of PCOS are mainly menstrual disorders, infertility, hirsutism, acne, obesity, acanthosis nigricans, and long term comorbidities such as The clinical manifestations of PCOS are mainly menstrual disorders, infertility, hirsutism, acne, obesity, acanthosis nigricans, and long-term complications such as tumors, cardiovascular disease, and diabetes. Therefore, PCOS often begins in adolescence, with typical clinical manifestations such as anovulation, infertility, obesity, and hirsutism during the reproductive years, and diabetes and cardiovascular disease in middle and old age due to long-term metabolic disorders.  The current international diagnostic criteria for PCOS were established by the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) in Rotterdam in 2003: ① sporadic ovulation or anovulation; ② clinical manifestations of hyperandrogenemia (hirsutism, acne, etc.) or laboratory evidence; ③ unilateral or bilateral ovaries containing 12 or more follicles with a diameter of 2-9 mm or follicle volume > 10 cm3. PCOS can be diagnosed when two of the above three items are present and other causes of hyperandrogenemia, such as adrenal gland disease and androgen-secreting tumors, are excluded. The current treatment in Western medicine is mainly symptomatic: 1. Lifestyle adjustment: It is reported that about 50% of women with PCOS are obese, and those with PCOS are more often infertile than those without obesity. It can lead to and aggravate insulin resistance, metabolic disorders, so control diet, moderate exercise, smoking cessation, alcohol cessation and other lifestyle changes are essential for obese patients. Weight loss can lead to a decrease in serum insulin and androgen levels and may restore ovulation and improve the response to ovarian stimulation, increasing ovulation and pregnancy rates and preventing the long-term development of PCOS. Therefore, the first step of treatment for obese infertile women with PCOS should be to recommend weight loss, which is cost-effective and without side effects.  2. Adjustment of menstrual cycle: It can protect the endometrium and reduce the occurrence of endometrial cancer. Periodic use of progestin and anti-androgen drugs.  3.Use insulin sensitizers for insulin resistant people. Such as metformin, troglitazone, side effects: gastrointestinal reactions, abnormal liver and kidney functions, etc.  4.Ovulation promotion: for patients with follicular dysplasia or anovulatory infertility. This method is likely to lead to multiple births and malformations.  5.Surgical treatment: Surgery can be considered in patients who do not have good results with medication and whose B ultrasound shows bilateral ovarian enlargement and polycystic changes, or who have complications such as hypoglycemia, intractable uterine bleeding, high LHemia and low weight, and who are not contraindicated for surgery. The biggest concern with surgical treatment is the destruction of the ovaries and the depletion of the reserve follicles, which may affect the life span of the ovaries.