Can polycystic ovary syndrome be cured?
Many patients ask this question, can polycystic ovary syndrome be cured? I have also seen literature that polycystic ovary syndrome is a lifelong disease that cannot be cured, or that it is due to genetic causes and is an inborn disease that cannot be cured, or that it is related to diabetes and therefore cannot be cured, etc.
Personally, in my research and clinical work, I am sometimes confused by such claims because based on my personal knowledge background and understanding of the information, as well as the experience or evidence during clinical diagnosis and treatment of this disease, it does not support incurability. In fact, when it comes to cure, there must be a criterion for judgment, involving diagnostic criteria, efficacy criteria, and criteria for cure of polycystic ovary syndrome, and it is only credible to be able to make a more objective judgment with respect to the characteristics of the disease. But unfortunately, these criteria are not perfect or even lacking at present. The standardized research on this disease should be based on the progress of basic research, and there is still a long way to go for systematic clinical summary of large samples.
My personal reasons for not supporting the incurability of polycystic ovary syndrome can be summarized as follows.
(1) First of all, the interrelated factors such as various factors of life and diet, and changes in the disease spectrum of social development.
One can see the fact that in China, due to economic development and affluence, the disease spectrum has also changed significantly. As a result, arteriosclerosis, hypertension, diabetes, fatty liver, metabolic syndrome and other related diseases are becoming more and more frequent. The onset of polycystic ovary syndrome is also one of the important diseases whose incidence is gradually increasing. Decreased exercise, excessive intake, high fat, high sugar, high salt and other high-energy meat and fatty foods increase, almost from the beginning of pregnancy or maternal generation, already exist; such as high weight offspring birth rate is increasingly high. In particular, chickens, ducks, fish, pigs, cattle and other meat foods in the feeding process to promote growth, weight gain hormones more use, including wheat, rice, sparse land, etc. There is a requirement to increase production; environmental pollution and other factors; in such an environment of human beings, coupled with lifestyle habits and fast-paced, high-stress work or study; can be clearly seen in the past less of these diseases, but now increased, this phenomenon itself does not support PCOS etc. exist innately, or does not support irreversibility in treatment. The fact that even fat people eat one bite at a time suggests that genetic factors must also have an acquired influence, acting together to cause easy onset.
(2) Hypoglucose tolerance (IGT) and its progression and reversibility.
Research in the last decade or so has made it clear that hyperinsulinemia and insulin resistance (IR) are closely related to the development of PCOS and are considered to be one of the underlying pathophysiologies in the development of PCOS.
Impaired Glucose Tolerance (IGT) is a special metabolic state between diabetes mellitus (DM) and normoglycemia, with potential reversibility, characterized by postprandial hyperglycemia, and IGT can be diagnosed with postprandial glucose ≥7.8 mmol/L and <11.0 mmol/L.
The incidence of IGT in adult women with PCOS is about 31%-35% (or even higher), while the incidence of type II DM is 7.5%-10%, and their probability of developing from IGT to type II DM is 5-10 times higher than that of normal women, suggesting that women with PCOS are a high-risk group for IGT and DM. It can take several years or more. (The above is quoted from Prof. Yang Dongzi’s article: PCOS diagnosis and management and abnormal glucose metabolism). This is also confirmed in our clinical work, where we come across patients with PCOS with a duration ranging from a few months to ten years, with a high rate of abnormalities when the OGTT+IRT test is performed, but not a high rate supporting the diagnosis of diabetes mellitus. This progressive, reversible and treatable nature is an important theoretical basis for the curability of PCOS. This is because PCOS is not equivalent to DM (diabetes mellitus). More precisely, PCOS will likely be or has become a prediabetic population of DM. Although some women meet the diagnostic criteria of PCOS, the OGTT+IRT test is not abnormal at the time of consultation, most of them are abnormal, and a relatively small number (those with long duration of disease or long-term obesity) already meet the diagnosis of DM.
(3) Menstrual disorders, anovulation or metabolic syndrome, etc. and the onset of PCOS.
The onset of PCOS, mostly manifested as menstrual disorders, anovulation, etc. gradually progress, weight gain, and some of the symptoms of metabolic syndrome; does not support the onset of “one day”, but a gradual process; metabolic syndrome is not the cause of polycystic ovary syndrome, nutritional imbalance or too high fat, high sugar, high salt, and lack of exercise. The further development of metabolic syndrome and even metabolic disorders can lead to a vicious circle with the pathophysiology of polycystic ovary syndrome. In general, many menstrual disorders and/or anovulation in adolescent or unmarried women can be reversed through menstrual regulation treatment to restore ovulation and regular menstruation without developing into PCOS; the same goes for metabolic syndrome, which is a gradual process and can be gradually reversed through treatment, especially when weight reduction and improvement of intake structure are more successful, which can be better reversed or prevented from progressing. In clinical practice, we have learned that “menstrual regulation” treatment is very important in adolescent polycystic ovary syndrome, the key is to promote the restoration of ovarian cycle function, which is essential to stop the progression. Progression and complications can be seen as a result of prolonged untreated disease or when inappropriate medications lead to weight changes or weight gain. In particular, the interaction between the modern endocrine metabolic state and the improvement of ovarian function and its endocrine profile facilitates the reversal of the overall pathological state.
(4) Correction of the pathophysiological state of PCOS.
The pathophysiological state of PCOS is not only hyperandrogenemia, but also includes hypoestrogenism, hyperinsulinemia and insulin resistance, metabolic syndrome, etc. Therefore, it is difficult to obtain more stable effect clinically by only targeting Kaohsiung treatment, or more rebound of Kaohsiung; to improve hyperinsulinemia and insulin resistance, the essence is to improve follicular sensitivity and facilitate the dominance of follicles The improvement of hyperinsulinemia and insulin rejection, in essence, improves follicular sensitivity and facilitates the establishment of follicular dominance and ovulation rules, thus facilitating the correction of the underlying factors of androgen production and achieving the purpose of lasting androgen reduction, which in turn facilitates the restoration of the endocrine axis and ovarian rhythm function and pregnancy maintenance.
The degree of difficulty and duration of treatment for a person with BMI or waist-hip severely overweight ratio compared with a normal weight PCOS patient is significantly different, and the rate of abnormal IGT or OGTT+IRT test, or the rate of progression to diabetes is completely different.
(5) Current treatments are misaligned with the ‘core’ of PCOS pathophysiology.
First of all PCOS is not a menstrual disorder, the pathophysiology is more different from menstrual disorders, its complexity is far more even than menstrual disorders; the current artificial cycle such as Daing 35 is but become the main method of treatment of PCOS, some do not analyze, and even abuse, the underlying pathophysiological state of the judgment and the lack of depth in the use of treatment, therefore, see many treatment is not successful. Artificial cycling methods whether it is combined estrogen and progestin such as Daing 35, MaFuLong, Eusyn, or estrogen and progestin sequential supplementation of JiaLuo or Bemelia + progesterone methods are all alternative therapies; a ‘suppression’ process of the rhythmic function of the gonadal axis and ovaries during the administration of medication, forming a pharmacological forced cycle; pathophysiological features of PCOS As mentioned above, when these aspects are not corrected in all aspects, only an artificial cycle is formed, and when the restoration of the rhythm of the gonadal axis and ovarian cycle is not achieved, it suggests that the therapeutic goal has not been achieved. This misalignment, which leads to inefficient or even completely irreversible treatment of PCOS, may be one of the reasons for the ‘incurability’.
In recent years, due to more studies on insulin rejection, metformin use studies have been reported more often and the combination with metformin has become routine. However, due to the side effects of metformin, as well as the lack of uniform standards in terms of dose and duration of treatment, some patients have difficulty in adhering to it, with the effect of treatment with artificial cycles, is not as good as it should be.
(6) Limitations of current treatment methods such as hormones.
Since hormonal drugs are less helpful in improving the metabolic syndrome, the rebound of the hypoandrogenic effect is very common, and the side effects of long-term medication, as well as the increasing thinning of the endometrium, low menstrual volume, dull or light color, a few appearing dripping bleeding, and even the risk of potential weight gain, the fear of hormonal drugs and drug dependence concerns, etc., make these drugs less trusted among patients. Due to the long-term suppression of the endocrine axis and ovarian function, we see more cases with slow recovery of gonadal axis suppression after drug discontinuation, long-term thinning of the endometrium, amenorrhea upon drug discontinuation or rapid progression to amenorrhea, etc. The establishment rate of gonadal axis and ovarian cycle rhythm is low, and the longitudinal course of treatment suggests that the therapeutic goal is not achieved. Therefore, if these drugs are used rationally, there is room for further standardization of the course of treatment and indications. For example, what is the appropriate duration of treatment? Long-term use and future abnormalities in the underlying pathophysiological state of PCOS after discontinuation of the drug, or the incidence of IGT or diabetes in the distant future, are to be further clarified. The use of artificial cycle drugs such as hormones needs to be studied in depth.
However, it cannot be denied that there are also more advantages of artificial cycle therapy such as hormones, which will be discussed later.
Some of these can also be found in my other article: “Can polycystic ovary syndrome be cured?” .
(7) Genetic and congenital factors and the “incurability” of polycystic ovary syndrome.
Some patients often ask me this question, saying that polycystic ovary syndrome is related to heredity and some doctors say that it is congenital and therefore impossible to cure. In fact, this shows that there is still a lack of knowledge about the genetics of the disease and other related issues. The occurrence of most diseases may be related to genetic factors, but we should not enter into this new “fatalism”. The cases of polycystic ovary syndrome in China were not high 30 or 50 years ago, and the gradually increasing cases are directly related to various aspects such as nutrition, living environment and lifestyle. The fact of “wolf children”, etc. The cause of this great difference is undoubtedly the result of heredity or genes, but the interaction between genes and the outside world, etc., should be more central. The theory of genetic or congenital “predestination” of this polycystic ovary syndrome does not justify the incurability of the disease, as anyone with a little knowledge of medical genetics would understand.
In introductory experiments in molecular biology, “resistance genes” are often used for screening, such as the screening of genes for “antibiotic resistance genes” in E. coli, which in fact illustrates an interaction or reaction between life genes and factors, the principle of which directly also The principle of this method directly dispels the so-called “fatalism” argument.
The relationship between genetic factors and polycystic ovary syndrome will be discussed in detail in a later section.
Good and regular habits, correct and lasting exercise, balanced and reasonable nutrition, a balanced rhythm of life, and a soothing and optimistic state of mind are the most effective ways to stop the development of polycystic ovary syndrome, even more effective than any drugs currently available; because a large sample survey was done abroad, metformin, as an excellent hypoglycemic drug, was ranked the highest in the world in terms of use. The Diabetes Prevention Program has shown that exercise and dieting are twice as effective as metformin in reducing the risk of progressive type 2 diabetes, yet such a pharmacologically reliable drug.
It is clear from the above discussion that the OGTT+IRT test is abnormal and that the chances of diabetic-prone polycystic ovary syndrome eventually developing into diabetes are as described, and that the more polycystic ovary syndrome population may only be pre-diabetic in terms of insulin refusal, which is completely reversible, although genetic factors are involved, but if you have read the above If you have read the article above, you will also understand that this disease is complex and progressive, and at the same time not incurable, but reversible. Of course, the methods of reversal still need to be more systematic and explored, but there is no shortage of reversal cases in clinical practice.
The argument of “incurable” is based on simple hormonal methods of artificial cycles or simple ovulation promotion? These treatments are misaligned with the core of the complex pathophysiology of polycystic ovary syndrome (more on the “misalignment” later in the text), so how can they cure the disease? So should the choice to take these simple hormones for a longer period of time be further thought out or explored? If the pathophysiological features of polycystic ovary syndrome are further sorted out from a molecular perspective and combined with large-scale clinical evidence-based studies, then a deeper and more accurate understanding of this disease, which exists in a large population in China and causes great psychological stress to most patients, will be achieved. We should not simply think that the “incurable” argument is a minor problem or a problem for doctors to deal with, but should see how merciless these words are to patients, and what is the significance of this rigorous assertion to be explored, which causes great stress to patients and families?
(8) Living geography, habits and polycystic ovary syndrome.
The incidence of PCOS in maritime areas may be lower than inland areas; living habits high in fat, meat, high energy, lack of exercise, and higher incidence in people in a state of chronic stress.
Seeing that the closer to the inland, i.e., the northern part of China, the livestock culture geographical PCOS patients, high weight, PCOS characteristics are obvious, such as Kaohsiung, obesity, hyperinsulinemia + insulin refusal + impaired glucose tolerance, and even diabetes; metabolic syndrome, which can be manifested as vascular endothelial cell damage, or hypertension, abnormal lipid index; this is closely related to daily living habits.
We found some differences between patients with PCOS in the south of China and those in the north, namely, patients in the north are closer to the diagnostic criteria of western PCOS, while patients in the south are less typical or have a variety of manifestations. Body weight The proportion of typical obesity was relatively higher in northern patients. Obese and long course patients, by the body fat-rich, androgen extraglandular conversion to increased estrone, amplified estrogenic effects, anovulation, metabolic disorders, these northern patients are more prone to vascular endothelial cell damage, hypertension obesity diabetes triad, increased chance of outgrowth as endometrial hyperplasia, and possibly even development of endometrial cancer. These conditions are relatively less common in the southern (rice based diet) regions. They are not as tall as patients in the north, have a high body mass index, and abdominal obesity is more pronounced although both exist. There are some differences in the manifestation and progression of polycystic ovary syndrome due to geographic differences in diet and lifestyle habits.
(9) Metabolic syndrome and polycystic ovary syndrome.
Traditionally, the components of metabolic syndrome mainly include central obesity, diabetes mellitus or impaired glucose tolerance, hypertension, lipid abnormalities and cardiovascular disease, but with in-depth research on it, its components are now expanding and now include, in addition to the above, polycystic ovary syndrome, hyperinsulinemia or hyperinsulinogenemia, hyperfibrinogenemia and fibrinogen activator inhibitor-1 (PAI-1) increased, hyperuricemia, endothelial cell dysfunction-microalbuminuria, and inflammation (increased blood CRP, IL-6, and metalloproteinase-9, etc.).
Hyperglycemia and associated lipid alterations [elevated triglycerides (TG) and reduced high-density lipoprotein cholesterol (HDL-C)] will also increase a patient’s risk of cardiovascular disease before blood glucose levels meet diagnostic criteria for diabetes. The metabolic syndrome aggregates a group of the most dangerous risk factors for heart disease: diabetes and prediabetes, abdominal obesity, high cholesterol, and hypertension. It is estimated that approximately one in four adults worldwide with metabolic syndrome has two times the risk of dying from heart disease or stroke and three times the risk of developing the disease than people without metabolic syndrome. And people with metabolic syndrome have a five-fold increased risk of developing type 2 diabetes. The metabolic syndrome is typically characterized by a clustering of cardiovascular disease (CVD) risk factors and thus is considered a contributing force to the CVD epidemic.
Diabetes is one of the most common chronic diseases, affecting nearly 200 million people worldwide (about 5% of adults), and it is the 4th or 5th leading cause of death in developing countries. If left uncontrolled, diabetes will affect 333 million people by 2025 (with prevalence rising to 6.3%). However, the increase in the number of people with diabetes is expected to occur mainly in developing countries, not because of national factors, but because of population aging, urbanization, unhealthy diets, obesity and sedentary lifestyles.
Diabetes and metabolic syndrome, which contribute to the prevalence of cardiovascular disease, affect individuals throughout their lives and determine the quality of life.
In most patients with glucose intolerance or type 2 diabetes, multiple combinations of different risk factors emerge to form what is now known as the “metabolic syndrome,” formerly known as “syndrome X,” the “death quartet “This “clustering” of multiple metabolic abnormalities occurring in the same individual appears to confer substantial additional risk on top of or in addition to the sum of the risks they each carry. This “aggregation” of multiple metabolic abnormalities in the same individual appears to confer substantial additional cardiovascular risk on top of or in addition to the sum of the risks they each carry, and has been the focus of intense debate among various academic groups such as the WHO and the National Cholesterol Education Program Adult Treatment Guidelines III (NCEP-ATP III). These academic groups have attempted to develop appropriate diagnostic and management guidelines around the combined presence of elevated blood glucose, abnormal lipid profiles, hypertension, and abdominal obesity. The metabolic syndrome is a strong predictor of its onset if diabetes is not already present, and individuals with the metabolic syndrome are five times more likely to develop diabetes.
Each individual component of the metabolic syndrome increases the risk of cardiovascular-related death, and these risks are further increased if the metabolic syndrome is already constituted. When the metabolic syndrome is already established, the more components are present, the higher the cardiovascular mortality rate.
The underlying etiology of the metabolic syndrome is still being studied by numerous experts, but insulin resistance and central obesity are considered to be obvious causative factors. Genetics, physical inactivity, ageing, inflammatory states and hormonal changes may also have a causative role, but their role may vary according to ethnicity.
Diagnostic criteria for metabolic syndrome vary from region to region around the world. Suggested diagnostic criteria for metabolic syndrome appropriate for the Chinese population (Chinese Medical Association Diabetes Branch, 2004)
Those who meet three or all of the following four components: (1) overweight or obese body mass index ≥ 25.0 kg/m2 (weight/height squared); (2) hyperglycemia: fasting blood glucose: ≥ 6.1 mmol/L (110 mg/d1), and/or blood glucose ≥ 7.8 mmol/L (140 mg/d1) after glucose loading, and/or those who have been diagnosed and treated for diabetes; (3) hypertension (3) Hypertension: systolic/diastolic blood pressure ≥ 140/90 mm Hg, and/or diagnosed and treated hypertension; (4) Dyslipidemia: fasting total cholesterol ≥ 1.70 mmol/L (150 mg/d1), and/or fasting blood HDL cholesterol: <0.9 mmol/L (35 mg/d1) in men and <1.0 mmol/L (39 mg/dl) in women.
Clinically, some obese women with menstrual disorders meeting the diagnostic criteria of polycystic ovary syndrome may show hyperinsulinemia and/or insulin refusal and/or impaired glucose tolerance during OGTT test, even directly diagnosed as diabetes mellitus, and most of the lipid tests are abnormal, and some of them may show endothelial cell damage, or hypertension, or latent thrombotic state. In cases of polycystic ovary syndrome combined with metabolic syndrome or when diabetes has progressed, or when impaired glucose tolerance has developed, or when hypertension or latent thrombotic state is present, my heart often becomes heavy whenever I perform a comprehensive analysis of the pathophysiological status of these patients. It may be due to diet, exercise, etc., or lack of accurate judgment in past treatment, and blind long-term hormone therapy, which leads to further development of the disease in the direction of deterioration. For abnormal lipid metabolism, or vascular endothelial cell damage, or when latent thrombotic state, Chinese medicine evidence to establish and formula treatment is more effective. The research we are currently conducting on the effects of Chinese medicine on the prostaglandin system and aromatase, etc. suggests, and also includes most of the existing studies confirming, the efficacy of Chinese medicine compounding for the treatment of this complex state. Traditional prescriptions are effective, and I personally experience that a familiarity with the chemistry and pharmacology of Chinese medicine, even including a knowledge of pharmacology, is very helpful in understanding these prescriptions at a deeper level, or combining them better. Although there is a lot of literature on Chinese medicine, based on long-term accumulation and reading, not to mention the classics, almost all generations of literature have been sorted out clearly. It is also possible to make full use of the knowledge of both aspects, even molecular mechanisms or factor networks, to achieve better results in disease treatment.
The in-depth knowledge of Chinese medicine (phytochemical) chemistry and pharmacology of Chinese medicine or pharmacology of Chinese medicine components, as well as the knowledge of molecular pathophysiology and the latest advances, including pathology, can enable doctors who are familiar with the traditional knowledge system of Chinese medicine to have a deeper understanding of the complexity of diseases and to grasp more accurately the main contradictions of their pathophysiological states or symptoms, so as to adopt more standardized and reasonable treatment methods or protocols and improve clinical efficacy, rather than blindly. They will not blindly or confine themselves to personal knowledge limitations, nor will they believe in any partial or secret prescriptions, or confine themselves to the gap between Chinese medicine and Western medicine, but will organically combine and integrate, and the diagnosis and treatment of diseases will become a rigorous and careful thinking process.
(10) Post-pregnancy and post-partum and polycystic ovary syndrome.
The change of physiological state during pregnancy is a wonderful prosperous state. In-depth study of it can further understand the deeper patterns of human physiology and some pathologies. After pregnancy, all human systems, tissues and organs down to every cell undergo great changes, with endocrine and metabolism as the leading factors, causing all human systems to enter a special period serving pregnancy and childbirth.
In clinical practice, we see many doctors or patients, most of whom take pregnancy as the end point of successful treatment of polycystic ovary syndrome. This is still not really clear about the complex pathophysiological features and evolution of PCOS. If a patient with PCOS only aims at pregnancy, although the pregnancy process is important for the recovery of PCOS, especially for ovarian resting, and large amounts of estrogen and progesterone environmental stimulation, improved local blood supply to the ovaries, increased ovarian maturation, further enhancement of maturation and strengthening of the gonadal axis, and improvement of lipid metabolism under estrogen action.
However, the combination of factors such as weight gain and enhanced anabolic effects during pregnancy, and decreased insulin sensitivity under the action of hormones such as HCG (chorionic gonadotropin) and HPL (placental lactogen), women with PCOS are more likely to show decreased glucose tolerance during the OGTT test in pregnancy, and in this state the pancreatic burden is further increased, and in case of loss of compensation, even gestational diabetes. The incidence of DM in pregnancy is increasing. Data prove that decreased glucose tolerance in pregnancy (IGT) and gestational diabetes mellitus (GDM), which are potential or high-risk prediabetes in a large population, may become part of the growing group of DM with lifelong implications. Therefore, early treatment of PCOS is important.
I often tell obese or non-obese PCOS patients who are eager to have children that childbearing is only a one- or two-year problem, while correction of the pathophysiological state of PCOS is a matter of lifelong health. The important thing is the correction of the pathophysiological state of PCOS (which will be described later); weight loss, reasonable exercise, lipid reduction, reasonable diet, a disciplined life, stress relief, with a comprehensive and orderly treatment of drugs, not simply blindly using hormonal methods or ovulation methods, nor relying on hypoglycemic drugs, but more comprehensive, including daily life, comprehensive conditioning, for relief or It is extremely beneficial for remission or gradual improvement. Chinese medicine prescriptions, too, can play a very important role in the treatment process. The prescription of prescription drugs, on the other hand, should not rely only on the fixed traditional literature, but the familiarity with modern chemistry and molecular mechanisms is entirely appropriate and reasonable for the safety and rationality of the prescription.
The process of pregnancy is an important remission process for the pathophysiological state of PCOS. It is also the fundamental process of final maturation of female reproduction. It is best resolved by a successful pregnancy, after which PCOS is never returned, and some women achieve this goal.
The postpartum period is also a special and important time for women. Postpartum recovery of all aspects of the reproductive system and the body is a process that is helped by the magnificent theories of Chinese medicine regarding the effects of the formula of Yimoucao and Biochemistry Tang, which are not limited to the uterus, but to endocrine and systemic hemodynamic recovery, including all aspects of urinary. Postpartum hemodynamic resistance increases not only due to endocrine metabolic factors, but also due to postpartum blood dilution during pregnancy, increased blood volume, and coagulation changes, so that postpartum women present a process of important systemic changes centered on genital restoration, and postpartum latent thrombotic state is also very common, which is the basis of the complexity of postpartum pathophysiological state in women with postpartum eclampsia and heart disease. The description of this state by TCM evidence is penetrating and graphic. The prescriptions are based on thousands of years of human trials and are effective and reliable.
The study of the postpartum physiological or pathophysiological state is an equally fascinating area.
Most women gain weight rapidly after childbirth due to low exercise and supplementation habits. However, the potential harms associated with weight gain in postpartum women seem to be significantly weaker than the potential consequences of usual weight gain. This phenomenon deserves an in-depth study.
Postpartum weight gain in women with polycystic ovary syndrome may continue to increase the pancreatic islet burden and the rate of abnormal OGTT+IRT tests. Therefore, women with PCOS should also pay attention to the three high (high protein, high vitamin, high micronutrient) and three low (low fat, low sugar, low salt) diets postpartum to avoid possible or inevitable recurrence of PCOS. This is often seen in clinical practice, where the likelihood of relapse and progression to lifelong diabetes mellitus (DM) is greatly increased, if not inevitable, in some or high weight women. It is therefore important to pay attention to the recovery of the postpartum state and to provide the necessary health education and guidance to these populations to reduce the likelihood of progression to DM. Or to delay the age of progression to DM as much as possible, two or three years, five or eight years, all of which will create a different quality of survival and life outcome.