How to deal with the variable polycystic ovary syndrome
The incidence of polycystic ovary syndrome (PCOS) is as high as 5% to 10%. The main effects of the disease include.
(1) Menstruation and reproductive function.
(2) Glucose metabolism and lipid metabolism. PCOS is a chronic disease that affects women’s health for almost all their lives and is not curable, but can be managed.
I. Hazards of polycystic ovary syndrome
Recent harms: including menstrual disorders, infertility, acne, hirsutism, obesity, etc. Most people know the disease only in the near future, and it is wrong to think that adjusting menstruation and curing infertility is the ultimate goal.
Obstetric harms: 2-fold increase in the rate of miscarriage, 3-4 times increase in the incidence of gestational diabetes and gestational hypertension. One of my studies found a prevalence of gestational diabetes of about 40% in patients with PCOS assisted conception.
Long-term hazards: including increased incidence of endometrial cancer, diabetes, metabolic syndrome, cardiovascular disease, etc. These are the invisible killers lurking in the body of PCOS patients, which come insidiously and have serious consequences!
Second, the need for long-term management
Because of its far-reaching impact on women’s health, the disease requires long-term management.
The immediate goal of long-term management is to adjust the menstrual cycle, treat hirsutism, and acne, control weight, and assist in fertility; the long-term goal is to protect the endometrium to prevent endometrial cancer, prevent diabetes, cardiovascular disease, etc.
Myths of polycystic ovary syndrome treatment
Misconception 1: Only testing sex hormones without understanding the changes of metabolic indexes;
Misconception 2: Only regulating menstruation, once diagnosed, it is Daing 35 treatment;
Misconception 3: As long as the infertility is caused by PCOS, as soon as the diagnosis is made, ovulation will be promoted, regardless of whether there are metabolic abnormalities, regardless of how high the androgen level is, and regardless of the impact on obstetric complications;
Myth 4: Ignore the long-term health effects of the disease;
Myth five: treatment course is arbitrary and lack of regular testing; ……
IV. Long-term management of polycystic ovary syndrome
The long-term management of PCOS includes: regular testing, development of a reasonable treatment plan, and timely adjustment of the treatment plan according to the situation, and long-term management should last a lifetime.
Regular testing
(1) What to test: The test indexes include hormones (FSH, LH, PRL, T, E2, SHBG, etc.), glucose metabolism (OGTT, INS release test), lipid metabolism, changes in liver and kidney function, etc;
(2) When to test: The purpose of pre-treatment testing is to develop an individualized treatment plan; the treatment process is tested once every 3-6 months to understand the effect of treatment; pre-conception testing to determine the presence of obstetric risks and the need for pre-conception treatment.
Individualized treatment plan: Since PCOS patients are highly heterogeneous and each patient behaves differently, individualized treatment is needed according to each individual’s situation and requirements.
Lifestyle modification: including exercise, diet modification, stress reduction and regular life can help restore ovulation and menstruation, and prevent long-term complications such as cancer and metabolic disorders;
★ Androgen lowering: Oral contraceptives (OC) are preferred, as well as spironolactone and dexamethasone;
★ Progestin: used for those with less severe symptoms of hyperandrogenism and regular withdrawal to protect the endothelium from cancer;
★ Treatment of insulin resistance: Metformin is preferred.
★ Infertile patients: ovulation promotion for pregnancy is indicated for patients with pregnancy requirements.
Timely adjustment of treatment regimen: PCOS patients treatment must be adjusted considering different age stages, different requirements, different disease stages, etc.
Adolescent patients should pay attention to their specific stage of physiological Kaohsiung, unless androgens are particularly high, excessive intervention is not recommended;
★ For those who do not have fertility requirements, the efficacy of treatment should be tested periodically to determine whether to discontinue, continue treatment, or adjust the regimen;
For those who have fertility requirements, ovulation should be promoted as soon as possible after controlling hormonal and metabolic disorders;
★ Women of childbearing age still need regular testing and treatment after completing their fertility plan;
★ Postmenopausal women still need to be aware of the risk of metabolic disorders and should be tested regularly and treated promptly
For the management of this disease, this is only a general discussion, and specific issues need to be analyzed one by one ……