The “flower” girl, full of beard, thighs a stretch, the leg hair can be strangled to death, “menstruation” or something certainly will not be normal to where, is simply the most successful spokesman for “polyovarian syndrome”.
Why do girls look “like flowers”?
Polyovarian syndrome (PCOS) is a very common gynecological endocrine disorder. It is characterized by clinical or biochemical manifestations of hyperandrogenism, persistent anovulation and polycystic ovarian changes, often accompanied by insulin resistance and obesity. Due to
It is also known as Stein-Leventhal syndrome because it was first reported by Stein and Leventhal.
1. Endocrine changes in polycystic ovary syndrome.
(1) Excess androgens and estrone;
(2) Increased luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio;
(3) Increased insulin secretion;
(4) Endocrine features are elevated serum LH, elevated androgens, and E1/E2>1.
2. Ovarian changes.
(1) Bilateral ovaries were uniformly enlarged, 2-5 times the size of normal women, with grayish white color, thickened and tough envelope;
(2) In the cross-sectional view, the white membranes of the ovaries were uniformly thickened and submembranous, often with ≥12 cystic follicles of 2-9 mm in diameter;
(3) Microscopic thickening and sclerosis of the white membranes, cortical superficial fibrosis, few cells, and significant presence of blood vessels.
(4) Multiple cystic dilated follicles and atretic follicles in immature stages were seen under the white membranes, with no signs of mature follicle production or ovulation.
3. Endometrial changes.
The endometrium is stimulated by stimulating hormones for a long time, showing different degrees of proliferative changes.
4. “Flower-like” manifestations.
(1) Menstrual disorders: This is the main symptom of “flower-like” women. Most of the symptoms are sporadic menstruation or amenorrhea, often preceded by a small amount of too little or sporadic menstruation. It can also be manifested as irregular uterine bleeding with irregular menstrual cycle or period/volume.
(2) Hirsutism and acne: High expression of androgens results in luxuriant growth of body hair; at the same time, excessive androgens in the body will stimulate the sebaceous glands to secrete excessively, resulting in oily skin and acne.
(3) Infertility: Infertility is caused by ovulation disorders in women during their reproductive years.
(4) Obesity: associated with insulin and leptin resistance, excess androgens, and increased proportion of free testosterone in patients.
(5) Acanthosis nigricans: gray-brown pigmentation in the skin folds, often symmetrical, with thickened skin and soft texture.
How can we tell if a girl has “flower-like disease”?
In clinical practice, the Rotterdam criteria proposed by the European Society for Reproductive and Embryological Medicine and the American Society for Reproductive Medicine in 2003 are used to determine whether a girl has “echinococcosis”.
The Rotterdam criteria proposed by the European Society for Reproductive and Embryological Medicine and the American Society for Reproductive Medicine in 2003 are used to diagnose POCS (polycystic ovary syndrome). The diagnostic criteria are as follows.
1. Sporadic ovulation or anovulation;
2. Clinical manifestations of hyperandrogenism and/or hyperandrogenemia;
3, polycystic ovarian changes: ultrasound indicates ≥ 12 follicles of 2-9 mm in diameter in one or both ovaries, and/or ovarian volume ≥ 10 mL;
The diagnosis can be made when 2 of the above 3 items are met and other causes of hyperandrogenism are excluded.
How to treat a girl’s “flower-like syndrome”?
1.Regulate menstrual cycle
(1) Oral contraceptives are combined estrogen and progestin cycle therapy.
Progestin inhibits abnormally high secretion of pituitary LH through negative feedback, reduces the production of androgens by the ovaries, and can act directly on the endometrium to inhibit excessive endometrial hyperplasia and regulate the menstrual cycle.
(2) Post-progestin semi-cycle therapy: protects the endometrium, and at the same time can inhibit the high secretion of LH.
2.Reducing androgen level
(1) Commonly used drug dexamethasone, oral dexamethasone 0.25 mg per night to suppress the concentration of dehydroepiandrosterone sulfate. It should be noted that the dose of oral dexamethasone should not exceed 0.5 mg per day to avoid excessive inhibition of pituitary-adrenal axis function.
(2) Ciproterone, which has a strong anti-androgenic effect, can inhibit the secretion of pituitary gonadotropins and decrease the level of testosterone in the body. It has good effect on reducing hyperandrogenemia and treating hyperandrogenic signs in combination with ethinyl estradiol as oral contraceptives.
(3) Spironolactone, a competitive inhibitor of aldosterone receptors, is recommended at a daily dose of 40-200 mg for the treatment of hirsutism for 6-9 months.
(4) Improve insulin resistance: insulin sensitizer metformin, commonly used dose is 500 mg per oral dose, 2~3 times daily.
(5) Ovulation induction: first-line ovulation-promoting drugs such as clomiphene; second-line ovulation-promoting drugs such as gonadotropins can be given to patients with clomiphene resistance; ovulation induction is prone to ovarian hyperstimulation syndrome, so close monitoring is needed when using the drugs.
3.Surgical treatment
(1) Laparoscopic ovarian perforation, which is more effective in patients with elevated LH and free testosterone;
(2) Ovarian wedge resection, in which one third of each ovary is wedged, can reduce androgen levels, alleviate symptoms of hirsutism, and increase pregnancy rate; however, after surgery, perivitelline adhesions are likely to occur and are rarely used in clinical practice.