Polycystic ovary syndrome is a common endocrine disorder with a prevalence of up to 10%, characterized by persistent anovulation, hyperandrogenemia and insulin resistance (R), with clinical manifestations such as hirsutism, obesity, menstrual disorders and infertility.
Diagnostic criteria.
1 Irregular menstruation and ovulation disorder
2. hyperandrogenemia, elevated total or free testosterone or androstenedione
3. ultrasound examination with increased ovarian volume, enhanced interstitial echogenicity, multiple follicles (≥10, 4-10 mm in diameter)
4. Luteinizing hormone (LH)/ follicle stimulating hormone (FSH) ratio ≥2
5. hirsutism, obesity, acne
PCOS is diagnosed when 3 of the above 5 items are present. depending on the patient’s age, it can be classified as adolescent and reproductive age. According to the presence or absence of obesity, it can be divided into obese type and wasting type.
The harm of PCOS
1, causing menstrual disorders, such as menstrual sporadic, dripping, amenorrhea
2, hyperandrogenemia causes hirsutism, obesity and acne.
3, excessive endometrial hyperplasia, endometrial cancer incidence is high.
4.Metabolic disorders cause obesity, diabetes, hypertension and cardiovascular diseases.
5.Ovulation disorders cause infertility.
Treatment of PCOS
General treatment: control weight by controlling diet and strengthening exercise.
Medication: Different medication regimens according to the patient’s age, the presence or absence of obesity, the presence or absence of hyperandrogenemia and fertility requirements.
Adolescence: Treatment principles are to adjust menstrual cycle, reduce hyperandrogenemia and reduce body weight.
1. Menstrual regulation drugs
For PCOS patients with hyperandrogenemia, TAIE-35 is preferred, with 21 days as 1 course of treatment for 3 consecutive courses. Short-acting Contraceptive Pill (OCP) Mafolone, 1 tablet, 1 time daily for 21 days for 3 consecutive courses. Daimler-35 and Maftolone can be used as premedication for ovulation promotion. In the absence of hyperandrogenemia, Clomid can be used for 3 courses of treatment.
2.Ovulation-promoting drugs
After the use of menstrual regulation drugs, ovulation-promoting drugs such as clomiphene (CC) and letrozole (LE) can be used for treatment. Ovulation-promoting drugs letrozole and CC’s control CC is a non-steroidal hormone that induces ovulation by competitively binding to estrogen receptors in the hypothalamus, relieving the negative feedback effect of estrogen on the hypothalamus and increasing the frequency of hypothalamic gonadotropin-releasing hormone (GnRH) release, acting on the pituitary gland to release FSH and LH. Ovulation mostly occurs 5 to 15 days after stopping the medication, usually around 7 days. Specific dosing: CC50-150mg (1~3 tablets) daily for 5 days starting from the 3rd to 5th day of menstruation. The maximum dose should not exceed 200mg per day to prevent ovarian hyperstimulation during the dosing period. When the follicles are 18-20 mm in diameter, induction of ovulation should be induced by intramuscular injection of chorionic gonadotropin (hCG) 5000-10000 u. About 63% of patients have ovulation with CC application, 20-25% have no response, the cumulative pregnancy rate is about 30%, and the cycle pregnancy rate is 10%.
Application of prednisone: In patients with high blood androgen levels, prednisone 5mg daily for 30-60 days starting on the second day of menstruation is effective.
Application of small doses of estrogen: To overcome the disadvantage of CC causing thickening of cervical mucus and unfavorable sperm penetration, a small dose of estrogen can be applied for 7 days starting 3 to 4 days before ovulation, such as 1 tablet of Tocopherol, for one week. Letrozole is an aromatase inhibitor, which has no antagonistic effect on estrogen and has no significant effect on endometrial thickness and cervical mucus, with high ovulation and pregnancy rates taught CC. Patients with PCOS are highly sensitive to gonadotropin stimulation, and ovulation with hMG or purified FSH may lead to multiple pregnancy and ovarian hyperstimulation syndrome.
3. Comparison of insulin sensitizing agents metformin, rosiglitazone and pioglitazone
PCOS patients mostly have insulin resistance (IR) and compensatory hyperinsulinemia, which cause androgen excess and lead to ovulation disorders. Dimethomorph (Met) and rosiglitazone can produce pro-ovulatory synergistic effects by improving insulin resistance and hyperandrogenemia and controlling body weight. 40% of PCOS patients with obesity need combined insulin sensitizer pro-ovulatory treatment.
Laparoscopic surgical treatment – ovarian perforation
1. Laparoscopic surgery is recommended for patients for whom drug therapy is ineffective. A tubal lavage test and pelvic observation can be performed under the microscope. For polycystic ovaries, microscopic perforation is performed. Ten to 15 polycystic sites are perforated in each ovary at a depth of about 3-5 mm. The postoperative ovulation rate is about 90% and the pregnancy rate is about 50%. The advantages of surgical treatment are no increase in the rate of multiple pregnancies, no occurrence of ovarian hyperstimulation syndrome and a low rate of spontaneous abortion. Application of a single treatment can cause multiple cycles of ovulation.
Mechanism: The surgery destroys the ovarian interstitium and causes the blood level of androgens to decrease and LH and FSH to return to normal. The decrease in androgen level relieves the suppressive effect of ovarian granulosa cells and the follicles can develop normally.
2. There is a possibility of adhesions and rare premature ovarian failure after laparoscopic perforation of polycystic ovaries.
Insulin resistance (IR) refers to a pathological state in which the body’s tissues or target cells lack a normal response to insulin action and their sensitivity or (and) responsiveness is reduced, often accompanied by hyperinsulinemia (HI), hypoglycemia or abnormal glucose metabolism, hypertension, and dyslipidemia with elevated LDL and reduced HDL. The resulting compensatory hyperinsulinemia is closely associated with a high incidence of type 2 diabetes, obesity, hypertension and coronary heart disease in the population. eaven referred to IR and its associated hyperinsulinemia, glucose tolerance abnormalities, hypertriglyceridemia and hypertension as “syndrome X” in 1988. DeFronzo named it as “insulin resistance syndrome”.