1.What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (PCO) is one of the most common gynecologic endocrine disorders. It is characterized by hyperandrogenism, chronic anovulation and polycystic ovarian changes, often accompanied by insulin resistance and obesity.
2.What is insulin resistance?
The sensitivity of peripheral tissues to insulin is reduced, and the function of insulin is lower than normal, which is called insulin resistance. At this time, the body will think that insulin secretion is insufficient, and excess insulin is produced, which not only affects the body’s glucose metabolism and leads to abnormal blood sugar, but also acts on the pituitary gland and promotes androgen secretion.
3. Is the incidence of polycystic ovary syndrome high?
The incidence of polycystic ovary syndrome is about 5-10% in women of reproductive age, and it accounts for 40-60% of gynecological endocrine diseases and more than 50% of women who need assisted reproduction.
4. What is the difference between polycystic ovaries and normal ovaries?
Normal mature ovaries are flat and oval in shape, about 4 cm x 3 cm x 1 cm in size, weighing about 5-6 grams, with a grayish white surface covered by a white membrane and containing follicles of varying sizes at all levels of development.
Polycystic ovaries are bilaterally enlarged, two to five times the normal size, with a thickened, tough surface envelope and a white membrane two to four times thicker than normal, with more than 12 cystic follicles of various sizes visible underneath.
5. Why does polycystic ovary syndrome occur?
The cause of polycystic ovary syndrome is not fully understood scientifically, but it is thought to be due to a variety of causes, which may be the result of the interaction of certain genetic and environmental factors.
6.What are the risks of polycystic ovary syndrome?
Due to the pathological endocrine changes of polycystic ovary syndrome, it may cause infertility, type II diabetes, cardiovascular disease, endometrial hyperplasia and even endometrial cancer.
7. Why does polycystic ovary syndrome lead to diabetes mellitus?
Overweight, high androgen and insulin, and anovulation are all high risk factors for diabetes, and the incidence is 7 times higher than that of normal women of comparable age.
8. What are the cardiovascular effects of polycystic ovary syndrome?
Hyperinsulinemia can act directly on arterial vessels, causing sclerosis, and can also indirectly affect lipoprotein status, thus increasing the occurrence of cardiovascular disease.
9.Does polycystic ovary syndrome affect pregnancy?
Excessive androgens in the body not only inhibit the maturation of follicles, but also affect the ovulation process and persistent anovulation, which eventually leads to infertility. However, there are some women who ovulate sporadically and conceive naturally, but in general, the chance of natural pregnancy is lower than that of normal women.
10.When does polycystic ovary syndrome usually develop?
Most polycystic ovary syndrome starts in adolescence, with obesity, irregular menstruation and hairiness before or after the first menstruation.
11. Why do some patients with polycystic ovary syndrome look like men?
The excessive androgens in the body stimulate the accelerated growth of hair, and androgens also promote the development of sebaceous glands to produce large amounts of sebum leading to acne. Therefore, some women with polycystic ovary syndrome will have facial acne and hairy torso. Thick, hard, long and dark hair will grow above the lips, on the lower jaw, around the areola and in the midline of the lower abdomen, which seriously affects women’s appearance and psychology.
12.What other symptoms do patients with polycystic ovary syndrome have?
Menstrual disorders are the most common symptoms, mostly prolonged menstrual cycles (35 days to 6 months) or even amenorrhea, which can also be manifested as irregular bleeding. More than 50% of patients are obese, with a body mass index (weight/height 2) ≥ 25 kg/m2, with abdominal obesity predominating. Some patients develop gray-brown pigmentation in the skin folds of the labia, back of the neck, axillae and groin, with thickened, symmetrical skin, called acanthosis nigricans. There are also patients with atypical clinical manifestations.
13.What tests are needed for polycystic ovary syndrome?
(1) Measurement of basal body temperature.
(2) B-ultrasound examination.
(3) Diagnostic curettage.
(4) laparoscopic monitoring of the ovaries and biopsy of ovarian tissue can be done to confirm the diagnosis.
(5) Endocrine examination of androgens, progesterone and other hormone levels.
(6) Patients with abdominal obesity should also be tested for blood glucose and lipids.
14.What are the diagnostic criteria for polycystic ovary syndrome?
(1) Significant reduction in ovulation or even absence of ovulation.
(2) Clinical manifestations of hyperandrogenism.
(3) Ultrasound suggestive of polycystic ovarian changes.
(4) The diagnosis can be confirmed if 2 of the above 3 items are met and other causes of hyperandrogenism are excluded.
15.How is polycystic ovary syndrome treated?
Treatment includes: reducing androgen levels, adjusting menstrual cycle, improving insulin resistance and promoting ovulation, and restoring fertility.
16.How to treat insulin resistance that accompanies polycystic ovary syndrome?
Metformin is used for obese patients or patients with insulin resistance. This drug can increase the sensitivity of peripheral tissues to insulin, reduce blood insulin levels, correct hyperandrogenism and improve the effect of ovulation promotion treatment.
17. Can complications of polycystic ovary syndrome be prevented?
Adherence to oral contraceptive pills in patients with long-term anovulation can prevent endometrial hyperplasia that progresses to cancer. Avoid long-term overuse of ovulation promotion methods, which have the potential to cause ovarian cancer. Optimize diet, prevent calorie excess, adhere to exercise, control weight, blood sugar and blood lipids, and prevent cardiovascular diseases.
18.What do patients with polycystic ovary syndrome need to pay attention to in their life?
For obese type patients, it is necessary to improve from daily life, regulate diet, pay attention to calorie and fat control, meat and vegetable mix and diversification to avoid excess or insufficient nutrition. Adhere to physical exercise to control weight and reduce waist circumference.
19.Is it necessary for patients with polycystic ovary syndrome to lose weight?
Weight loss is an effective therapy for obese patients, which can not only reduce hyperinsulinemia and hyperandrogenemia, improve menstruation, restore ovulation, and even be able to get pregnant.
20. How can patients with polycystic ovary syndrome restore their normal menstrual cycle?
The use of short-acting oral contraceptives, which contain estrogen and progestin, under the guidance of a doctor can not only restore menstruation, but also effectively inhibit hair growth and acne. However, the cycle often returns to irregular after stopping the pill, so it is recommended to take the pill for a long time until menopause.
21.How to lower androgens?
Dexamethasone, progesterone and other drugs taken orally can fight against androgens. In addition, spironolactone can not only fight against androgens, but also treat hirsutism after 6 to 9 months of use.
22. How to promote ovulation in patients with polycystic ovary syndrome?
Clomiphene is the first-line ovulation treatment for patients with fertility requirements. Patients who are resistant to clomiphene can use second-line drugs, such as gonadotropins.
23.Does ovulation treatment have any side effects?
Ovulation promotion therapy is prone to ovarian hyperstimulation syndrome, which can lead to symptoms such as abdominal distension, ascites, nausea and vomiting, weight gain, and even shock in severe cases, so close monitoring and prevention are needed.
24.Can I take birth control pills by myself to regulate my menstruation in polycystic ovary syndrome?
The specific medication plan, dosage and course of treatment should be determined by a professional physician, especially hormonal drugs, which have many contraindications and side effects, so do not use them blindly.
25.Can polycystic ovary syndrome be treated surgically?
For patients with high luteinizing hormone and testosterone levels, laparoscopic ovarian perforation can be performed, which has the advantages of precise efficacy, minimal damage and moderate price. In the past, wedge resection of ovaries was commonly used to reduce androgen levels, alleviate symptoms of hirsutism, and improve pregnancy rate, but due to the high incidence of perivitelline adhesions after surgery, this method is no longer commonly used in clinical practice.
26. Can patients with polycystic ovary syndrome receive assisted reproductive technology?
In vitro fertilization-embryo transfer (IVF-ET), commonly known as IVF, involves taking eggs and sperm outside the body and completing the fertilization process in an artificially controlled environment, followed by transferring early embryos into the woman’s uterus for gestation until full-term delivery. This technique can be applied to women with anovulatory infertility with polycystic ovary syndrome for whom conventional ovulation promotion is ineffective, with significant results in helping pregnancy.
27. What should I pay attention to after pregnancy in patients with polycystic ovary syndrome?
Patients with IVF need to use progesterone for luteal support. Serum human chorionic gonadotropin (hCG) levels are measured 2 weeks after embryo transfer to determine whether pregnancy is present or not, and vaginal ultrasound is performed 4-5 weeks after transfer to determine whether intrauterine pregnancy is present. Avoid multiple pregnancies, eliminate three or more pregnancies, and have regular checkups during pregnancy to prevent complications and spontaneous abortions.