Polycystic ovary syndrome is an abnormal endocrine syndrome characterized by anovulation, hyperandrogenism and hyperinsulinemia and insulin resistance. It is the most common disease causing menstrual disorders and infertility in women of childbearing age.
What are the usual manifestations of polycystic ovary syndrome?
1. Irregular menstruation, sporadic ovulation or anovulation.
Irregular menstruation 2 years after menarche;
Amenorrhea (menopause for more than 3 previous menstrual cycles or ≥ 6 months);
Sporadic menstruation ≥ 35 days;
However, regular menstruation is also not evidence of ovulation.
2. Often accompanied by hyperandrogenic manifestations.
Acne: Recurrent acne, often located on the forehead, cheeks, nose and jaw;
Hirsutism: coarse, hard hair on the upper lip, jaw, around the areola, and in the lower abdomen midline.
3. Obesity: the incidence of obesity in patients with polycystic ovary syndrome is about 50%.
So what auxiliary tests do we need to do?
Hormone six (day 2-5 of menstruation)
①Total testosterone is higher than the normal laboratory reference normal value;
②Prolactin: 20%-35% of PCOS patients have mildly elevated prolactin;
③LH/FSH>2
2, insulin resistance test and insulin measurement: insulin resistance can be evaluated by detecting fasting blood sugar and oral glucose tolerance test (OGTT);
(3) Ultrasound: the volume of the ovaries is increased under vaginal ultrasound, and there are more than 12 follicles of different sizes with a diameter of 2-8 mm in each ovary.
(3) Basal body temperature measurement: Mostly manifested as monotypic temperature.
(4) Premenstrual diagnostic curettage: showing varying degrees of endometrial hyperplasia with no secretory phase changes.
(5) Laparoscopy: the ovaries are enlarged, grayish-white, with thickened envelope and smooth surface. Multiple follicles are seen under the envelope, but there are no signs of ovulation, and biopsies can be taken under the microscope to aid in the diagnosis.
Diagnostic criteria of polycystic ovary syndrome.
①sparing ovulation or anovulation;
(2) Clinical manifestations of hyperandrogenism and/or hyperandrogenemia;
(iii) polycystic ovarian changes: ≥12 follicles of 2-9 mm in diameter in one or both ovaries, and/or ovarian volume ≥10 ml;
④The diagnosis is established when two of the above 3 items are met and other hyperandrogenic etiologies are excluded.
What kind of treatment is needed for polycystic ovary syndrome?
The aim of the immediate treatment is to correct menstrual disorders, establish ovulatory menstrual cycles, improve reproductive function and achieve pregnancy; the long-term goal is to reduce and prevent long-term complications.
The treatment principle is to counteract androgens, correct metabolic disorders, promote ovulation, and reduce weight in obese people.
1.Treatment of obesity
Commonly used methods are low-calorie diet and strengthen exercise. Diet, exercise and weight reduction are the basic measures for treating insulin resistance in patients with polycystic ovary syndrome. 7%-15% weight loss can improve insulin resistance, and some of them can restore menstruation and even ovulation and conception.
2.Lowering blood androgen level
Short-acting oral contraceptives are commonly used, such as Da-Ying-35 (containing ethinyl estradiol 0.035mg and cyproterone acetate 2mg) and Ma-Fulong (containing ethinyl estradiol 0.030mg and deoxyprogesterone 0.015mg).
3.Treatment of insulin resistance
Currently, metformin and rosiglitazone are commonly used in clinical practice, which are biguanide and thiazolidinedione hypoglycemic agents respectively. The former is mainly to reduce hepatic glycogen synthesis, while the latter is mainly to improve insulin sensitivity of peripheral tissues.
4.Treatment of ovulation promotion
(1) Clomiphene (CC): It is suitable for those who are infertile due to anovulation or scanty menstruation, and the patient has fertility requirements and normal blood prolactin.
(2) Gonadotropins: for patients who have failed to respond to CC treatment. However, close monitoring of follicular development is required to prevent the occurrence of ovarian hyperstimulation syndrome (OHSS).
5.Surgical treatment
Laparoscopic surgery: suitable for those who are ineffective in ovulation promotion by drugs, who have to apply laparoscopic examination of the pelvis due to other diseases, and who cannot be monitored by gonadotropin therapy under poor follow-up conditions. Laparoscopic electrocautery or laser perforation of the ovarian surface can induce ovulation and establish a normal ovulatory cycle, with a high postoperative pregnancy rate and reduced early abortion rate.
6.Assisted reproductive technology
For patients with polycystic ovary syndrome who have ovulation but still no pregnancy after more than 6 months of standard ovulation cycle treatment, or who still have no ovulation even after ovulation treatment with multiple drugs and adjuvant therapy, assisted reproductive technology, which we usually call IVF, can be chosen.