Polycystic ovary syndrome (PCOS) is an endocrine disorder syndrome in which reproductive dysfunction coexists with abnormal glucose metabolism. Persistent anovulation, multiple follicular immaturity, androgen excess and insulin resistance are important features and are the most common causes of menstrual disorders in fertile women. It is characterized by menstrual disorders, amenorrhea, anovulation, hirsutism, obesity, infertility and bilateral enlargement of the ovaries in a cystic fashion. Patients may have these typical symptoms or only some of them, but infertility due to ovulation disorders is the main clinical manifestation of polycystic ovary syndrome.
The exact cause of polycystic ovary syndrome is unknown, but it is believed that the ovaries produce too much androgen, and that the excessive production of androgen is the result of the abnormal function of various endocrine systems in the body.
2.Clinical manifestations
1. Obesity
About half of the patients have this performance, which is related to excessive androgens, increased proportion of unconjugated testosterone and long-term stimulation of estrogen.
2.Menstrual disorders
After menarche, menstruation is sporadic, secondary amenorrhea and anovulatory uterine bleeding.
3.Bilateral ovarian enlargement
The volume of ovaries can be determined by direct laparoscopic view of ovaries or ultrasound examination.
4.Hirsutism
Abundant body hair, male pubic hair distribution, oily skin, acne, caused by androgen concentration.
5.Infertility
Infertility after marriage, mainly due to menstrual disorders and anovulation.
6.Echinodermia nigricans
This is a symmetrical gray-brown pigmentation of the skin on the back of the neck, underarms, under the breasts and groin, such as velvet-like, flaky hyperkeratosis.
3.Check
1.Hormone measurement
Gonadotropins: LH is elevated in about 75% of patients, LH/FSH blood LH to FSH ratio and concentration are abnormal, non-cyclic secretion, most patients have increased LH, while FSH is equivalent to early follicular phase level, LH/FSH ≥ 2.5 to 3.
2.Imaging examination
(1) Pelvic ultrasound The ovaries are enlarged with at least 10 follicles of 2-6 mm diameter in each plane, mainly distributed in the periphery of the ovarian cortex, with a few scattered in the interstitium and increased interstitium.
(2) Pneumoperitoneum The ovaries are 2 to 3 times larger bilaterally, or relatively smaller if the main source of androgens is the adrenal glands.
(3) Laparoscopy (or surgery) shows full ovaries with a pale, smooth surface, thick peritoneum, and sometimes a capillary network underneath. Because of its pearl-like appearance, it is commonly called an oyster ovary, and multiple cystic follicles are seen on the surface.
(4) Ultrasonography Polycystic ovaries are usually enlarged, but there are also normal sized polycystic ovaries, and the ultrasound phase can be normal in patients with PCOS.
(5) CT, MRI for examination of ovarian morphology.
3.Cesarean exploration
To diagnose ovarian tumors or to perform ovarian wedge resection.
4.Other tests
(1) Vaginal exfoliative cell maturation index is a simple way to understand the status of sex hormones in the body. Smears with excessive testosterone often show a pattern of 3 layers of cells at the same time, and the number of cells in the 3 layers is almost equal when it is significantly increased, but it must be distinguished from inflammation. Estrogen levels can be estimated from the percentage of superficial cells, but do not reflect the amount of hormones in the blood.
(2) Basal body temperature measurement determines the presence or absence of ovulation, which is biphasic in those who ovulate and generally monophasic in those who do not ovulate.
4.Diagnosis
1. Clinical diagnosis
Irregular menstruation, scanty menstruation and/or amenorrhea for many years after menarche, along with obesity, hirsutism and infertility after marriage, should be suspected. Atypical cases may include: simple amenorrhea without obesity, hirsutism and ovarian enlargement, excluding other diseases, and positive progesterone test; ovulatory dysfunctional bleeding; menstrual abnormalities combined with hirsutism; menstrual abnormalities with masculine symptoms without obvious obesity; dysfunctional uterine bleeding with infertility.
For atypical cases, detailed medical history such as age of onset, growth and development, history of onset, medication history, family history, personal habits, and previous systemic diseases should be inquired. Combine with the auxiliary examination to exclude other diseases, and make a clear diagnosis by ultrasound and other examinations.
2.Diagnostic criteria
Based on pubertal onset, abnormal menstruation and ovulation, hirsutism, elevated blood LH and/or LH/FSH ratio, combined with a high level of androgens, signs of polycystic ovaries on ultrasonography, and exclusion of other similar diseases, the diagnosis of this disorder can be determined.
Treatment
1. General treatment
You should actively exercise, reduce the intake of high-fat and high-sugar foods and lower your body weight. This can promote the decrease of androgen level, which is beneficial to restore ovulation.
2.Medication
To counteract the effect of androgens and promote ovulation.
3.Surgical treatment
Under laparoscopy, the follicles are surgically punctured to bring down the androgen level, thus achieving the purpose of treatment.
Patients can usually resume ovulation after their symptoms are controlled, leading to pregnancy. However, some patients also relapse, which requires regular check-ups at the hospital. It should be noted that the longer the polycystic ovary syndrome lasts the more difficult it is to treat. Therefore, once you have the relevant symptoms, you should visit the hospital in time to avoid delaying the condition.