Polycystic Ovary Syndrome
Polycystic Ovary Syndrome - is multifactorial dyshormonal ovarian pathology associated with the violation of the physiological regulation of their work in the background neyroobmennyh disorders.Polycystic ovary syndrome occurs in 11% of young women and lead (70%) among the causes of endocrine infertility.
in the formation of the syndrome involves all parts of the reproductive system: central nervous system (cerebral cortex), adrenal glands, ovaries.Structural abnormalities in polycystic ovary syndrome manifested as violation of the right balance of tissues and cystic follicles atresia.
Most polycystic ovary syndrome is a primary and manifests during puberty, it is much less likely to be diagnosed as a secondary disease in women after a period of normal functioning of the ovaries.
For a proper understanding of the complex mechanism of formation of polycystic ovary syndrome, it is necessary to know how they work and how to implement the function.
Ovary - steam iron hormone, responsible for the most important function of the female body - procreation.Outside covers the ovary germ layer of epithelial cells covering the thick capsule of connective tissue, called "tunica".The stroma of the ovary is formed by two layers: an outer (cortical) and internal (cerebral).In the cortex of the adult ovary there is a huge amount (about 40,000) is similar to the bubbles formations - primordial follicles.They are unequal in size and maturity.Each of these bubbles is born and matures the egg.Every month throughout the reproductive period is fully ripe, ready to fertilize the egg, it destroys the follicle wall and beyond the ovary (ovulation) to the pelvic organs to meet the male sex cell (sperm) and conceive a new life.
As a rule, the maturation of the follicle (and hence the egg) takes 12 - 14 days (follicular phase).Then, after ovulation, the site of the destroyed follicle forms a temporary hormonal structure - the corpus luteum.In the absence of fertilization it works next 10-12 days (luteal phase) and then killed, and menstruation occurs.
result of hormonal activity of the ovaries is the secretion of estrogen (estradiol) and progestin (progesterone).Typical pofazovaya, cyclic hormonal products: the dominance of estrogen in the first, follicular, and progesterone - the second, luteal, phase of the cycle.
The work of the ovaries to "watch" the cerebral cortex, namely the hypothalamus and pituitary gland.The pituitary gland synthesizes the first phase of the cycle, follicle stimulating hormone (FSH), and the second - luteinizing (LH) hormones involved in the hormonal regulation of the ovaries.
in polycystic ovary transformation mechanism is perverted the proper formation of the menstrual cycle, ovulation appears stable, changing the structure of the ovaries.According symptoms accompany endocrine and metabolic disorders.
clinical signs of polycystic ovary syndrome, in addition to infertility and menstrual dysfunction, depending on which of the parts of hormonal regulation fails.Often there is severe obesity (50%), hirsutism.
Treat Polycystic Ovarian Syndrome is extremely difficult.The success of the therapy depends on the age, shape and degree of diseases of hormonal disturbances.
addition to hormone therapy designed to eliminate hormonal dysfunction and restore ovulation, used surgical techniques.
reasons polycystic ovary syndrome
sources of polycystic ovary transformation are not well understood.In the formation of the syndrome involved in virtually all the major body systems, the mechanism of its development is incredibly complex.The main stages of the formation of pathogenic polycystic ovary syndrome are:
1. The level of the hypothalamus.Violation of rhythmic generation of biologically active substances that control the function of the pituitary hormone.
2. The level of pituitary hormone.Under the influence of hypothalamic dysfunction stops right cyclic production of FSH and LH.
for polycystic ovary syndrome is characterized by increased secretion of LH with normal or low numbers of FSH.Instead, quantitative cyclical fluctuations in the level of LH, it begins to produce a monotone.As a result, necessary for normal menstrual cycle phase relationship of LH / FSH changes abruptly, and in the ovaries of the pathological process starts cystic transformation.
3. The level of ovarian hormones.Incorrect ratio of LH / FSH stimulates abnormal steroidogenesis in the ovaries.In a healthy ovarian follicles respond to the effects of LH synthesis of androgens.To their concentration does not exceed the physiological norm, with the participation of FSH, they metabolize their excess into estrogen.When LH levels become too high, the ovaries no longer cope, and develops hyperandrogenism.It is a persistent increase in the number of androgen stimulates all patients reduction in the size of the uterus.
In turn, FSH deficiency stops the growth and maturation of follicles, they seemed to "freeze" and stop growing.In the context of hormonal imbalances persist long follicles, and then undergo atresia.Cystic ovarian atresia diagnosed in all patients, it is a source of chronic anovulation.
ovarian tissue symmetrical (in both ovaries) is compacted, increases in volume.The higher the level of hormonal imbalance, the more pronounced become structural damage.
proved that virtually all women with signs of polycystic ovary syndrome, there insulinorezistenstnost, ie reduced sensitivity to insulin - is responsible for the blood sugar hormone pancreas.Excess insulin stimulates the ovaries to the increased secretion of androgens.
Androgens adversely affect the physiological process of ovulation.They literally transform the shell of the ovary in a thick dense armor, which does not allow the eggs leave the ovary.As a result, the follicles are not destroyed, and filled with a liquid and increases, forming cysts.Persistent anovulation makes it difficult to plan a pregnancy in polycystic ovary syndrome.
Contributing to the formation of polycystic syndrome factors, in addition to hormonal, are also considered:
- genetic predisposition;
- endocrine disorders (diabetes);
- overweight or severe obesity;
- strong psycho-emotional stress.
symptoms of polycystic ovary syndrome
list of symptoms as part of polycystic ovary syndrome is not different specificity.The pathological process is not confined to the limits of the ovaries, and therefore its manifestations are very diverse.
If cystic degeneration of ovarian tissue back in puberty started (primary polycystic), clinically it begins with menstrual dysfunction.Typical duration (sometimes up to six months) delay the next menstruation or amenorrhea after puberty do not get regular monthly.
Secondary polycystic ovary syndrome appears after a period of normal menstrual and generative functions.Patients say that the first pathological symptoms appeared after obstructed labor, abortion, infections, brain injuries.
According to the mechanism of development of polycystic ovary syndrome, there are three clinical forms of the disease:
1. Ovarian (typical and most frequent).Among the symptoms of menstrual dysfunction leads different nature: primary or secondary amenorrhea, acyclic bleeding hypomenstrual syndrome.It is also characterized by infertility.
2. Adrenal.Characteristic changes in the external shape of the "male" type (broad shoulders, narrow hips), poorly developed breasts, as well as hirsutism (chest, abdomen, face, thigh), oily skin, hair and acne.
Menses scanty.There may come a pregnancy (rarely), which ends in early miscarriage.
3. Central.Changes in the hypothalamus: psycho-emotional disorders, episodes of hypertension, excessive appetite.
characterized by excessive deposition of fat in the area of the shoulders, chest and abdomen.Skin pigmentation reinforced visible "stretching".Excessive body hair, but it expressed softly.
Menstrual disturbances are expressed oligomenorrhea or dysfunctional bleeding.
diagnosis of polycystic ovary syndrome
After a conversation with the patient and gynecological examination established the fact of menstrual dysfunction and increase ovarian palpation (two).Visual assessment of the phenotype and condition of the skin reveals signs of virilization and obesity.
symptoms of polycystic ovary syndrome are similar to many hormonal diseases clinic.Therefore it is required to hold the following detailed laboratory and instrumental examination:
- A study of the ratio of hormones (LH / FSH) in blood plasma according to the phases of the cycle.In polycystic indicates its increase above 2.5.It is also determined by the level of testosterone, prolactin.
- Biochemical analysis of blood.In polycystic ovary syndrome increases the level of cholesterol, triglycerides and glucose.
- Determination of Glucose Tolerance for diagnosing sensitivity to insulin.
- vaginal ultrasound scanning sensor.In polycystic ovary syndrome indicates the symmetrical enlargement of the ovaries (volume of more than 9 cc), a thickening of the capsule and the seal of the stroma.In the ovaries visualized multiple (at least ten) small (8-10 mm) follicles located under the capsule like a "necklace".
- Computed tomography and laparoscopy.
- Consultation (and if necessary - symmetrical treatment) endocrinologist.
It should be noted that the diagnosis of polycystic ovary syndrome is made only on the basis of a combination of clear clinical, laboratory and ultrasound criteria.Often, the physician ultrasound diagnosis gives the conclusion "of ovarian cystic change" (multifollikulyarnye ovaries), which indicates the presence of follicular cysts in the ovaries and the stroma is not identical to the process of polycystic degeneration.Multifollikulyarnye ovaries often diagnosed in young women come into puberty and in women taking hormonal contraceptives.
treatment of polycystic ovary syndrome
Treatment of polycystic ovary syndrome - a lengthy, multi-step and complicated process.It depends on the list of available clinical symptoms and survey data.Usually treatment begins with conservative measures, and in case of inefficiency is solved the question of surgical treatment.
presence of obesity, the patient is crucial in determining treatment strategy, because without pre-correction weight and the elimination of metabolic disorders, polycystic therapy may not be effective.
Diet for polycystic ovary syndrome is aimed at bringing to normal carbohydrate and fat metabolism.Provision:
- reduction in total daily calorie food (no more than 2000 kcal);
- maximum approximation ratio carbohydrate / protein / fat to 52% / 16/32%;
- saturated fat content of no more than 1/3 of the total amount of consumed;
- limiting salt and spicy food (they retain fluid in the body);
- the presence of fasting days, but not starvation;
- correctly dosed physical activity.
Sometimes diet in polycystic ovary syndrome not only fulfills its purpose - to reduce body weight, but also greatly facilitates the subsequent treatment, and reduces its terms.
After elimination of metabolic disorders begin to Elimination of hormonal disorders according to laboratory studies.Planning for pregnancy in polycystic ovary syndrome begins at this stage.If pregnancy is not planned, it is sufficient to recreate the normal menstrual cycle.For this approach, combined contraceptives antiadrogennogo action (Yasmin, Diane-35, Janine, Jess).It inhibits the synthesis of androgens and non-hormonal drug Veroshpiron.
If a woman needs the full menstrual cycle with the presence of ovulation (to get pregnant), hormone therapy is similar to that in the hormonal infertility.Appointed ovulation stimulating drugs (clomiphene and analogues).
for surgical elimination of polycystic ovary syndrome often resort to treatment of infertility.Effective two methods:
- wedge resection of ovarian tissue.Small piece is cut in the form of a wedge from the ovary, which produces in excess androgens.
- Electrocautery ovaries.Also part of the ovary is removed, but with the help of an electric impact point.
Both methods are exclusively laparoscopically.