Polycystic ovary disease: symptoms and treatment
Polycystic ovary disease is a serious gynecological disease that is diagnosed in 65% of women with infertility. It will not be possible to become pregnant in the presence of such a pathology, since the patient does not ovulate in the body. This means that the egg does not mature and does not leave the ovaries, that is, this process remains incomplete, which means that it cannot meet with the sperm. Polycystic disease leads to the fact that the eggs stop in their development, and multiple cysts form on the ovaries.
- Forms of polycystic ovary
- Causes of polycystic ovary
- The symptoms of polycystic
- Polycystic and pregnancy
- Diagnostics of the polycystic ovary
- Treatment of polycystic ovary
Forms of polycystic ovary
Polycystic disease can be primary or secondary:
- In primary polycystic disease, symptoms appear as early as adolescence. This happens when the girl turns 12-13 years old. The therapy will be difficult, the course of the disease is difficult.
The secondary form of the disease develops in adult women who have undergone childbirth or have entered the menopause. The disease is accompanied by metabolic disruptions in the body, increased body weight, surges in insulin, which is caused by disturbances in the work of the pancreas.
Regardless of what kind of disease a woman has, she will not be able to give birth until she is cured. Therapy is reduced to the appointment of hormonal drugs. Sometimes surgery is required.
Causes of polycystic ovary
Polycystic disease can develop for the following reasons:
Hormonal disbalance. In this case, the woman forms follicular cysts. They are the result of a disruption in the work of the endocrine glands. Moreover, the pancreas, thyroid gland or adrenal glands, pituitary gland, or hypothalamus can fail. Often, polycystic disease develops against the background of an increased level of insulin in the blood with pathologies of the pancreas. When there is a lot of insulin in the body, it affects the work of the adrenal glands, which begin to produce excess androgen (male sex hormone). In the body, a shift in the balance between androgens and estrogens occurs, which becomes the main factor for the development of polycystic disease.
Infectious diseases. Frequent colds in childhood, as well as a severe course of infection in an adult woman, can become the basis for the development of polycystic disease. At a doctor's appointment, it is often possible to establish a connection between polycystic disease and tonsillitis, since the tonsils and ovaries have a certain dependence on each other.
Hereditary factor. It has been established that the disease can be transmitted at the genetic level.
Emotional upheavals. A number of experts are of the opinion that polycystic disease can be the result of stress.
The symptoms of polycystic
The main symptoms of polycystic ovary disease:
Violation of the menstrual cycle. Menstrual irregularities occur in all women with polycystic ovary disease. Sometimes they are absent altogether, and sometimes they come with a delay. The regularity of the cycle is not observed. If a woman's periods occur 9 times a year or less, then this is a reason for examination. When menstruation does not come on time, this is the first sign that the egg in the body is not maturing. Although sometimes periods may be absent for other reasons. Among those: inflammation of the genitals, polycystic uterine disease. Therefore, the patient needs a comprehensive examination to make the correct diagnosis.
Lack of pregnancy. A woman with polycystic disease cannot get pregnant. Long-term treatment will be required for conception to occur.
Excess male sex hormones. Often, with polycystic disease, a woman has an increased level of androgens in the body. This becomes the reason that the patient begins to appear male sexual characteristics, for example, excessive hair growth, acne on the face, on the back and on the chest, male-pattern alopecia.
Overweight. In women, against the background of polycystic disease, body weight begins to increase. Moreover, the increase is quite noticeable. It is 10-15 kg. Therefore, the treatment of polycystic disease is always aimed, among other things, at losing weight, since it is problematic for women with obesity to get pregnant.
Pain in the ovaries. Polycystic disease can be manifested by pulling pains in the lower abdomen. However, most patients do not pay attention to this symptom.
Polycystic and pregnancy
Women with polycystic disease cannot get pregnant because they have too many male sex hormones in their bodies. Therefore, in order for conception to occur, you need to direct efforts to reduce them.
If hormone therapy fails to achieve the desired results, the woman is referred for surgery. It is performed using laparoscopic equipment.
Provided that none of the above methods allowed to achieve conception, IVF is indicated for the patient.
Practical example. I have had a woman with polycystic disease for a long time. The diagnosis was confirmed by ultrasound and laboratory findings. Until a certain time, she believed that she could get pregnant herself, as soon as she wanted it. However, by the age of 30, she realized that her attempts at conception had not been successful and turned to help. After 3 months of hormonal therapy (she refused long-term treatment), I prescribed Clostilbegit for her. Pregnancy came in the first month. She took Dyufaston for a long time, for 2 months. However, at the next examination, it turned out that the pregnancy had stopped. I had to perform scraping. Then, for 2 years, the woman did not come to me for treatment. After this period, she appeared, with the firm intention to undergo laparoscopic intervention. The operation was performed at the regional hospital. There she underwent laparoscopic ovarian resection. She became pregnant after 4 months. In general, the gestation period went well, and a healthy baby was born.
Diagnostics of the polycystic ovary
During the appointment, the doctor pays attention to signs such as:
- The physique of the patient, the presence of excess weight.
- Hair type.
- Skin pigmentation.
- Condition of hair and dermis, their oily content.
- The condition of the mammary glands.
The doctor performs palpation of the thyroid gland and abdomen, conducts a standard gynecological examination. The ovaries in women with polycystic disease are enlarged by 2-3 times compared to the norm, they give off pain when pressed.
You can make a diagnosis based on an ultrasound scan. According to its results, it is possible to establish that the ovaries exceed 9 cubic centimeters in diameter. In addition, several small cysts are always found. There can be more than 10 of them.
The ovaries are dense, surrounded by a white capsule. This can be visualized during a laparoscopic examination.
It is imperative that a woman with suspected polycystic disease will need to undergo a blood and urine test for hormones:
- The ratio of luteinizing hormone to follicle-stimulating hormone in polycystic disease looks like 3: 1.
- Testosterone levels will be increased.
- Progesterone levels decrease during the second phase of the cycle.
- A high concentration of 17-KC is found in the urine.
Be sure to perform a study aimed at determining the level of insulin and blood glucose. Results may vary. In addition, high levels of fat in the blood are found in polycystic disease.
Endometrial hyperplasia of the uterus is determined during the diagnostic curettage, which is carried out with uterine bleeding.
Some diseases have similar symptoms to polycystic disease. These pathologies include: Cushing's disease, adrenogenital syndrome, excessive production of prolactin, androgen-producing tumors, etc. Therefore, it is so important to carry out differential diagnostics with them.
Treatment of polycystic ovary
It will not be possible to quickly get rid of polycystic ovary disease. The woman should tune in to long-term therapy. First, you need to focus on fighting obesity.
Nutrition and physical activity
Adipose tissue produces both male and female sex hormones, which negatively affects the course of the disease.
It sometimes happens that after the weight stabilizes, the menstrual cycle returns to normal. To lose weight, you will need to visit a nutritionist who will make a meal plan for a specific patient. It will be necessary to give up spicy, spicy, fatty and salty foods. Do not drink alcoholic beverages.
Sweets are excluded from the diet altogether. It is not enough just to follow a diet, you need to increase physical activity. The loads should not exhaust a woman, you need to stop at a sport that will bring pleasure. It can be swimming, yoga, jogging, body flex.
Getting rid of insulin resistance
If a woman has insulin resistance, then she is prescribed Metformin. This drug allows the body to process glucose and stabilize its level in the blood. In parallel, appetite decreases. The treatment lasts from 3 months to six months. Sometimes this therapy can help stabilize the menstrual cycle.
Normalization of the menstrual cycle
After the weight returns to normal, you need to focus on restoring your period. For this, the patient is prescribed contraceptives, medicines aimed at reducing the level of androgens in the body (Yarina, Zhanin, Diana-35, etc.). The course of treatment can last from six months or more.
To cope with hirsutism, use Veroshpiron or Flutamide.
It is important to remember that taking combined hormonal drugs doubles the risk of venous thromboembolism.
Stimulation of ovulation
When the menstrual cycle is restored, you need to focus on stimulating ovulation. This is important for those women who want to conceive a child. For this, the drug Clomiphene is prescribed, which has antiestrogenic properties. When it is canceled, the woman begins to actively produce FSH and LH, which stimulate follicle maturation and ovulation.
Clomiphene is prescribed from 5 to 9 days of the cycle. Its dosage is 0.05 g per day. The course of treatment should not last more than 3 months. If there is no effect, then the dose can be increased to 200 mg.
The danger of taking Clomiphene comes down to the risk of the formation of ovarian cysts, which can reach impressive sizes. When there is no effect of treatment, surgery is required.
In recent years, the operation has been performed using laparoscopic equipment. It is possible to perform wedge resection of the ovaries or electrical coagulation of ovarian cysts. The second option is a gentle intervention, since large areas of ovarian tissue are affected during resection.
It should be borne in mind that the more time has passed after the operation, the less chances of getting pregnant. The maximum ability to conceive remains in the first 3 months after the intervention. In a year it will be unlikely. The operation is indicated for women who suffer not only from polycystic ovary disease, but also from uterine endometrial hyperplasia.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.