Polycystic ovary syndrome, or PCOS for short, is a common endocrine syndrome in women of childbearing age, with the incidence increasing yearly to 5-10%.
Why do you have this disease?
The cause of PCOS is not known. It is generally believed to be related to hypothalamic-pituitary-ovarian axis malfunction, adrenal gland dysfunction, insulin resistance, genetics, metabolism and other factors.
What are its symptoms?
1. Menstrual abnormalities: scanty menstruation, amenorrhea (stopping menstruation for more than six months), a few of them can be manifested as menstrual cycle disorder, irregular period length, bleeding volume sometimes more and sometimes less, or even heavy bleeding. It mostly occurs in adolescence and is a continuation of irregular menstruation after menarche, sometimes accompanied by dysmenorrhea.
2, masculine performance: due to androgen elevation, PCOS women show different degrees of hairy, the incidence of nearly 20%. Hairy pubic hair, axillary hair is mainly thick, especially pubic hair, even down to the perianal area, hair can also be distributed in the upper lip, jaw, chest, back, the middle of the abdomen, upper thighs on both sides, but the degree of hairiness and androgen levels are not proportional. At the same time, it can be accompanied by acne, rough skin, enlarged pores, excessive secretion of facial sebum, low coarse voice, enlarged clitoris, throat knots and other signs of masculinity.
3, infertility: due to long-term non-ovulation, patients are often combined with infertility, even if the pregnancy is also prone to miscarriage.
4, obesity: many girls feel that they are very fat, in fact, in the medical obesity or a certain standard, here to teach you a relatively simple but very commonly used to assess the weight standard parameters – body mass index (BMI), the calculation method is also very simple: weight (kg) / height (cm) 2, the normal range of 18.5 – 25, generally recognized BMI ≥ 25. Obesity is mostly concentrated in the upper body, with a waist/hip ratio of >0.85, mostly starting from adolescence and gradually increasing with age. Obesity and the development of PCOS have a mutually reinforcing effect.
5, ovarian enlargement: a few patients can be palpated by general gynecologic examination of enlarged, tough ovaries, most require ancillary examinations such as gynecologic ultrasound to determine the typical PCOS patient’s ovarian ultrasound presentation of ≥ 12 follicles of 2-9 mm in diameter on one or both ovaries, and/or ovarian volume ≥ 10 cm3.
6, acanthosis nigricans: PCOS patients may develop localized velvety, flaky, gray-brown lesions on the skin, either large or small, often distributed in the skin folds of the posterior neck, axilla, vulva, and groin, associated with hyperandrogenism and insulin resistance and hyperinsulinemia.
7. Endocrine changes: including androgen hypertrophy, estrogen hypertrophy, gonadotropin LH/FSH ratio hypertrophy, insulin resistance and hyperinsulinemia, mildly elevated prolactin, etc. Among them, androgen elevation is the most important endocrine change in PCOS patients and is one of the necessary conditions for the diagnosis of PCOS. In addition, if you want to know more about PCOS, you must be familiar with the term “insulin resistance (IR)”, which refers to a condition in which the normal amount of insulin is not enough to produce a normal insulin response to fat cells, muscle cells and liver cells. Presenting IR, there is a risk of developing impaired glucose tolerance or even type 2 diabetes.
8, distant complications: some people must ask, then this disease in the end dangerous? If it’s just irregular periods, inability to get pregnant or poor skin texture doesn’t feel very serious. Then I have to tell you: the impact is certainly not so simple! The more serious complications are the following.
a. Tumors: Continuous, non-cyclical, relatively high estrogen levels stimulate the endometrium without progesterone resistance, which increases the incidence of endometrial and breast cancer.
b. Cardiovascular diseases: disorders of lipid metabolism, which easily cause atherosclerosis, leading to coronary heart disease and hypertension.
c. Diabetes: insulin resistance state and hyperinsulinemia, obesity, and easy to develop into occult diabetes or diabetes mellitus.
How to diagnose it?
Since PCOS is so serious, how exactly do we diagnose it? In fact, the diagnostic criteria for this disease has not been unified, and even many countries have their own set of PCOS diagnostic criteria, at present, the more recommended diagnostic criteria in our industry are as follows.
1, sporadic ovulation or anovulation: clinical manifestations of amenorrhea, sporadic menstruation, 2-3 years after menarche can not establish regular menstruation as well as basal body temperature showing monophasic. Some people may ask, “Is regular menstruation always ovulatory? The answer is no. Sometimes, regular menstruation is not ovulatory.
2. Clinical manifestations of hyperandrogenism and/or hyperandrogenemia: The clinical manifestations have already been described, including acne and hirsutism. Hyperandrogenemia, on the other hand, needs to be determined by blood tests.
3. Ovarian polycystic changes: ≥12 follicles of 2-9 mm in diameter on one or both ovaries and/or ovarian volume ≥10 cm3 are visible on ultrasound examination.
The diagnosis of PCOS can be made if any 2 of the above 3 items are met. Do you think it’s easy to diagnose PCOS? Remember, it is not easy to diagnose and treat a disease, not only to see if you meet the diagnostic criteria, but also to make a series of relevant differential diagnoses, that is, to exclude other diseases that can be easily confused with it to avoid misdiagnosis. For example, diseases that need to be differentiated from PCOS include congenital adrenocortical hyperplasia, vesicular cell proliferation disorder, hyperprolactinemia, Cushing’s syndrome, and so on. Therefore, if you have doubts, you must go to a regular hospital as soon as possible and consult with your doctor. You must not blindly diagnose or even treat yourself, so as not to delay the best time for treatment and even cause harm to your body.
How do we treat it?
Since PCOS has so many effects, let’s introduce the treatment of PCOS next. In fact, there are a variety of treatment methods, simply put, is based on the patient’s prominent clinical symptoms and signs, age and whether there are fertility requirements and give drugs, surgery or other treatment respectively.
1, strengthen the exercise, reduce weight: this is really a very economical and effective way of treatment. It can also correct the endocrine metabolic disorders aggravated by obesity, reduce insulin resistance and hyperinsulinemia, and at the same time make the free androgen level decrease. Weight loss can make some obese PCOS patients resume ovulation, and can prevent the occurrence of type 2 diabetes and cardiovascular disease.
2, drug treatment insulin resistance: because obesity and insulin resistance is the main cause of PCOS, so any drugs that can reduce weight and increase insulin sensitivity can treat the syndrome. Frequently available drugs are metformin (i.e., Geva), which can be used with or without diabetes to effectively reduce body weight, improve insulin sensitivity, lower insulin levels, reduce hair and even restore menstruation and ovulation. Thiazolidinediones are a class of oral insulin sensitizers mainly used for the treatment of diabetes mellitus. For example, troglitazone can significantly reduce hyperinsulinemia and hyperandrogenemia in PCOS patients and help induce ovulation. Insulin sensitizers can also significantly reduce blood LH and androgen levels, inhibit insulin secretion and increase SHBG concentration, and can be used for long-term treatment. Insulin sensitizers may be more suitable for PCOS patients with hyperinsulinemia.
3.Drug to induce ovulation
(1) Clomiphene: It is the drug of choice for ovulation in PCOS, with an ovulation rate of 60% to 80% and a pregnancy rate of 30% to 50%. It is given orally at 50mg per day for 5 times as a course of treatment starting on the 5th day of natural menstrual cycle or withdrawal of uterine bleeding, and ovulation usually occurs in 3-10 days (average 7 days) after taking the drug, and most pregnancies occur within 3-4 courses. If ovulation does not occur after 3 treatment cycles, the dose can be increased to 100-150 mg per day. after taking this drug, the ovaries will be enlarged due to overstimulation, and there will be side effects such as bouts of heat due to vasodilation, abdominal discomfort, blurred vision or rash and mild hair loss.
During treatment, basal body temperature of menstrual cycle should be recorded to monitor ovulation, or serum progesterone and estradiol should be measured to confirm the presence or absence of ovulation and to guide the dose adjustment of the next course of treatment.
(2) Urotropin (HMG): Contains FSH and LH in a 1:1 ratio and is mainly used in patients with reduced secretion of endogenous pituitary gonadotropins and estrogen. Urotrophin is considered as an alternative ovulation-inducing drug for the treatment of anovulatory infertility, as it has more side effects and a higher risk of inducing ovarian hyperstimulation syndrome (OHSS). The therapeutic dose of chlortetracycline should be varied according to the person and the treatment cycle, and close monitoring of follicular maturation should be provided to prevent ovarian hyperstimulation syndrome.
(3) Gonadotropin-releasing hormone (GnRH): GnRH can promote the release of FSH and LH from the pituitary gland, but long-term application makes the GnRH receptors in pituitary cells insensitive, leading to a decrease in gonadotropins and thus a decrease in ovarian sex hormone synthesis. Its effects are reversible, starting with excitatory effects on pituitary FSH, LH and ovarian sex hormones, decreasing to normal levels after 14 days and reaching depot levels in 28 days. However, the clinical application of GnRH is limited due to its expensive value and large dosage.
(4) FSH: FSH has 2 kinds of purified and recombinant human FSH (rhFSH). fsh is a more ideal therapeutic agent for polycystic ovaries, but it is expensive and may cause OHSS. during application, ovarian changes must be closely monitored.
(5) Bromocriptine: It is indicated for patients with PCOS with high PRL.
(4) Bilateral ovarian wedge resection: suitable for patients with elevated blood testosterone, bilateral ovarian enlargement with normal DHEA and PRL (suggesting that the main cause is in the ovaries). Removing part of the ovaries and removing excessive androgen production by the ovaries can correct the disorder of hypothalamic-pituitary-ovarian axis regulation, but the site of resection and the amount of tissue removed are related to the efficacy, with varying efficiency and high recurrence rate after surgery. not favorable for pregnancy. Laparoscopic ovarian cautery or resection can also be effective.
5. Treatment of hirsutism: Periodically cut off or apply “hair remover”, avoid plucking to prevent overgrowth of hair follicles, or electrolysis treatment or application of androgen inhibiting drugs such as oral contraceptives, progestin, GnRH-a, dexamethasone, spironolactone, etc.
6.Artificial menstrual cycle: For patients who are not hairy and have no fertility requirements, progestin can be given to perform artificial cycle therapy to avoid excessive hyperplasia and cancer of the endometrium.
After so much introduction, do you have some understanding of polycystic ovary syndrome? However, we would like to remind you once again that you should not make your own diagnosis or even treatment, because the choice of drugs, the dosage, the combination of different drugs, etc. all need to be done under the guidance of an experienced gynecologist.