Polycystic ovary syndrome (PCOS) is a common clinical disorder in gynecological endocrinology. the clinical manifestations of PCOS are heterogeneous and not only seriously affect the reproductive function of patients, but also increase the incidence of estrogen-dependent tumors such as endometrial cancer, and the associated metabolic disorders including hyperandrogenemia, insulin resistance, abnormal glucose metabolism, abnormal lipid metabolism, and increased risk of cardiovascular disease. The etiology of PCOS is still unclear, the diagnostic criteria are not uniform, the use of therapeutic drugs is confusing, and there is a lack of reasonable measures to prevent and treat long-term complications.
I. Overview of PCOS
PCOS accounts for 5% to 10% of women of childbearing age (no exact prevalence reported in China) and 30% to 60% of patients with anovulatory infertility.
1, genetic factors
2, environmental factors: intrauterine hyperandrogenism, antiepileptic drugs, geography, nutrition and lifestyle, etc.
Second, the diagnosis of PCOS
1, PCOS diagnostic criteria: (1) sparse ovulation or anovulation; (2) clinical manifestations of hyperandrogenemia and/or hyperandrogenemia; (3) polycystic ovarian changes: ≥ 12 follicles of 2-9 mm in diameter in one or both ovaries, and/or ovarian volume ≥ 10 ml; (4) 2 of the above 3, and exclude other etiologies that cause elevated androgen levels
2, the criteria for determining.
(1) Sporadic ovulation or anovulation: (1) Judgment criteria: 2-3 years after menarche, regular menstruation cannot be established; amenorrhea (menopause for more than 3 previous menstrual cycles or ≥6 months); sporadic menstruation, i.e., those with ≥35 d cycles and ≥3 months per year without ovulation (WHO Class II anovulation); (2) regular menstruation cannot be used as evidence to judge ovulation; (3) basal body temperature (BBT), ultrasound monitoring of ovulation, menstruation (3) Basal body temperature (BBT), ultrasound monitoring of ovulation, and progesterone measurement in the second half of menstruation can help determine whether ovulation is present;
(2) Clinical manifestations of elevated androgen levels: 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 midline of the lower abdomen).
(3) Biochemical indicators of elevated androgen levels: total testosterone, free testosterone index or free testosterone above laboratory reference normal values;
(4) Diagnostic criteria for polycystic ovaries (PCO): ≥12 follicles of 2-9 mm in diameter in one or both ovaries, and/or ovarian volume ≥10 ml.
3. Exclusion criteria for the diagnosis of PCOS.
Exclusion criteria are mandatory for the diagnosis of PCOS, such as significantly elevated prolactin levels, pituitary tumors should be excluded
4, adolescent PCOS diagnostic criteria: due to the difficulty of identifying the difference between the physiological state and the state of PCOS, and the lack of evidence of evidence-based medicine, there is a lack of uniform diagnostic criteria.
Third, PCOS comorbidities
PCOS is often associated with obesity, metabolic syndrome and insulin resistance.
Fourth, the treatment of PCOS
1.Lifestyle adjustment Quit smoking, quit drinking. Obese patients through a low-calorie diet and energy-consuming exercise, reduce the total weight of 5% or more, you can change or reduce menstrual disorders, hairy, acne and other symptoms and conducive to the treatment of infertility. Reducing body weight to the normal range can improve insulin resistance and stop the long-term development of PCOS with adverse consequences such as diabetes, hypertension, hyperlipidemia and cardiovascular disease and other metabolic syndromes.
2.Adjustment of menstrual cycle Irregular menstruation in PCOS patients can be manifested as irregular menstrual cycle, scanty menstruation, low volume or amenorrhea, and some bleeding is unpredictable. Adjusting menstrual cycle can protect the endometrium and reduce the occurrence of endometrial cancer.
1)Oral contraceptive pills
2)Progestin
3)Treatment of hyperandrogenemia
Various short-acting oral contraceptives can be used for the treatment of hyperandrogenemia
4) Treatment of insulin resistance
Metformin is suitable for the treatment of patients who are obese or have insulin resistance.
Whether to apply it or not needs to be decided carefully according to the patient’s specific situation and endocrinologist’s recommendation.
5.Ovulation promotion therapy
In order to promote ovulation and obtain normal pregnancy in patients with anovulation, ovulation promotion therapy is often required