sklerokistoz ovarian - it gynecological and endocrine diseases represented by the increase in ovarian formed therein small cysts.Sclerocystic reborn assumed the ovaries, which generated a lot of cysts ranging in size from small seeds to ripe cherries.Due to the formation they increase in size and formed on the surface impermeable shell.Degeneration occurs typically two ovaries.
sklerokistoz ovarian pathology is not only the structure but also the function of the ovaries, which are indicators of paramount constant lack of ovulation (chronic anovulation) and hyperandrogenism - excess of normal maintenance of male sex hormones in women.
sklerokistoz ovarian pregnancy is one of the most important issues discussed at medical conferences.Surgery for ovarian sklerokistoz occupies a leading position in the centers reprodoktologii.For the first time the disease has been described by scientists by the name of Stein and Leventhal in 1935.
reasons sklerokistoz ovarian
According to statistics 35% of patients are registered with the diagnosis of a gynecologist-endocrinologist.78% of women with ovarian sklerokistoz recorded in the structure of endocrine infertility.Unfortunately definite opinion about the causes of sklerokistoz not.
There are many points of view on the mechanism of rebirth sclerocystic ovaries.One of the main theories of the judgment was an abuse tsirhorialnogo lyuliberina rhythm of secretion - stimulating hormone and follicle-stimulating and luteinizing releasing hormone, one of the main controllers of the menstrual cycle.According to the theory, the release lyuliberina characterized by high strength and randomness, which in turn leads to increased secretion of luteinizing hormone responsible for stimulation of the secretion of estrogen and its peak is increase initiation ovulation.All this takes place at a relatively low FSH that blocks inhibin - a hormone that serves as an authorized official to the secretion of follicle-stimulating hormone.Under the influence of luteinizing hormone stimulation and hyperplasia occurs, so-called theca cells and ovarian stroma in which male hormones, androgens are produced, which leads to their increased.The result is a skin manifestations androgenization, lack of ovulation and menstruation rhythm disturbance.Androgen growth leads to proportionately increase in estrogen production from adipose tissue.This eventually leads to obesity.
total of 30 - 35 years ago, was offered a completely new approach in the debate about the mechanism of sklerokistoz ovaries.The main role of insulin resistance in the given - glucose lowering processing leads to a compensatory increase in insulin, enhances production of luteinizing hormone, thereby increasing the production of androgens in the theca cells and stroma that, as has already been stated above, results in hyperandrogenism.
It is believed that the cause lies in the ovaries sklerokistoz increased production of follicle stimulating hormone produced by the anterior pituitary gland.This hormone is responsible for the growth of follicles in the ovaries, which must reach a mature state in mid-cycle break and release the egg to float freely.The rest of the "bubbles" overripe and no longer work.If the follicle-stimulating hormone in excess, a large amount of semi-mature follicles that did not mature oocyte.They are filled with fluid and become many small cysts covered hard shell.
known cases of familial disease sklerokistoz ovaries.This was the scaffolding in molecular biology to search for defects in genes involved in this complex process.Currently sklerokistoz considered as a multifactorial disease in which the important role played by genetic disorder that causes the launch of cytochrome P-450 and steroidogenesis in the ovaries, called hereditary fermentopathy.
Scientists are looking for the cause of sclerocystic ovaries, as this is one of the leading causes of infertility.The main risk group is women, since puberty and young nulliparous women.
sklerokistoz Symptoms of ovarian
Symptoms sklerokistoz ovaries may occur at any time.May develop in puberty, while the red days on the calendar, the girl may be delayed or not to come.The main symptom is sklerokistoz ovarian failure of the menstrual cycle on the basis of oligomenorrhea (the arrival of menstruation at an interval of more than 40 days) and amenorrhea (absence of menstruation).Failure regular cycle begins with menarche - first menstruation and has no tendency to return to its normal state.15% of girls fail the regular cycle based on the principle of dysfunctional uterine bleeding - is bleeding from the uterus that is not associated with anatomical changes in the genitals.For swings of the menstrual cycle when the ovaries sklerokistoz characterized by a long delay menstruation.Long-term bleeding observed in rare cases.
young women planning first pregnancy may face to face with sklerokistoz ovaries.After all her efforts will not succeed.In such a case it will be diagnosed with primary anovulatory infertility due to lack of ovulation and pregnancy in history.This is one of the differences with similar symptoms of adrenal hyperandrogenism - a congenital disorder of the adrenal cortex functionality.In the presence of this pathology pregnancy is possible, but there is a large percentage of her miscarriage.
also sklerokistoz ovarian hirsutism shown varying degrees of severity.Hirsutism - excessive growth of this hair on the face and body of a woman of androgens (male) type.It is necessary to clearly distinguish the diagnosis of ovarian and adrenal sklerokistoz hyperandrogenism, manifested adrenogenital syndrome (AGS).Thus, when sklerokistoz ovarian hirsutism develops incrementally, from the period of menarche - first menstruation and hirsutism at AGS develops until menarche, since the start of the adrenal gormonosekretsii the phase of puberty, which is accompanied by maturation and enhance the function of the androgen at the age of 67 years.
beautiful floor with sklerokistoz ovaries in 70% of cases there is an increase in body weight before the II-III degree of obesity.
Pathology of the mammary glands is observed.Every third patient with ovarian sklerokistoz concomitant disease is fibrocystic breast disease - a benign breast lesion that develops on the background of persistently elevated estrogen and chronic absence of ovulation.
Another major symptom is insulin - insulin is ignoring tissues that are normally sensitive to this hormone, as well as an increased level of insulin production, which in turn leads to increased production of androgens.
in laboratory values lipid profile - a blood test that indicates the state of lipid (fat) metabolism in the body will be revealed dyslipidemia - metabolic cholesterol and other fats, changing their quantitative ratio in the blood.Increases the concentration of free active cholesterol.
Treatment sklerokistoz ovarian
Currently, there are two modern ways of treatment: conservative method (hormone therapy) and surgery when sklerokistoz ovaries.
final diagnosis ovarian sklerokistoz placed in the presence of the following data:
1. Timely age of occurrence of the first menstruation (menarche) usually fixed at the age of 12-13 years;
2. Failure menstrual period to the first menstrual period, mainly on the type of oligomenorrhea (menstrual period comes after more than 40 days), sometimes by the type of amenorrhea (absence of menstruation at all);
3. hirsutism and obesity from the period of the appearance of the first menstruation occurs in half of the patients;
4. Primary infertility (lack of pregnancy in the reproductive age in one year, in the presence of a regular sexual life without contraception, as well as for the lack of a history of abortion and childbirth);
5. Chronic anovulation - constant lack of ovulation;
6. Increase in ovarian transvaginal sonography according (scanned using a high-frequency probe that is inserted into the vagina);
7. Increased concentrations of LH and the ratio of LH / FSH equal to more than 2.5.
sklerokistoz purpose of conservative treatment is to restore normal ovarian ovulatory cycles.If there is any degree of obesity treatment includes 3 stages:
Stage 1 - a way to restore normal body weight.The woman is assigned a diet with the prohibition of acute and salty foods, restricted to 2000 calories a day, no more than 2 liters of fluid a day, exercise.
Stage 2 - the appointment of drugs to enhance the perception of the tissues of the insulin.For example, the drug metformin 1000-1500 mg for three months - six months.
Stage 3 is the most serious.After normalization of weight begins ovulation stimulation medication therapy.For example, clomiphene at a dosage of 50 mg 1 time / day for 5 days with night cycle for 5 days.If the menstrual cycle is absent, you can start taking the drug at any time.A month later, in the absence of the desired effect, begin to increase the dose to 150 mg / day or lengthen the course can be up to ten days.
in the absence of the effect of clomiphene is prescribed following direct ovulation stimulants:
- menogon selected for every woman.The drug is administered intramuscularly, beginning with a dose of 75-150 IU follicle stimulating hormone and luteinizing hormone 75-150 IU / day.To start ovulation injected human chorionic gonadotropin (Horagon) at a dose of 5000-10000 IU a day - two after the last dose menogon;
- hysterodynia administered intramuscularly at one of the following schemes:
1 scheme: the introduction of the drug every day during the first week of the menstrual cycle, provided that it is - at 75-150 IU / day.
2 scheme: the introduction of the drug takes place through the day.First dose - 225-375 IU for 1 week.If adequate effect is not achieved, the doctor gradually increases the dose.After the course of any of the schemes and in the presence of normal, but not high ovarian response on ultrasound and blood tests a day - two of the last taking the drug, administered once a woman Horagon - 10,000 IU intramuscularly to start ovulation;
- Menopur administered intramuscularly in the first week of the menstrual cycle, starting with 75-150 / day.When there is no response, the dose is gradually increased to 37,5 ME per week controlled clinical and biochemical parameters to achieve the desired effect, but not exceeding 75 ME.
After the cancellation of clomiphene or other of these drugs produce increased secretion of gonadotropin-releasing hormone - the hormone responsible for the secretion of FSH and LH, it leads to their release, thereby triggering the growth and maturation of new follicles.Control trace dynamics using biochemical analysis of blood and clinical indicators.When LH deficiency appointed or progestins Djufaston Utrozhestan a 16-15 day cycle.
Unfortunately, sklerokistoz ovaries and pregnancy are incompatible, because without ovulation awaited a miracle will happen.Sometimes, conservative treatment is not enough, and the ovaries do not respond to hormonal treatments.In this case it is necessary to turn to surgical treatment.
Surgery for ovarian sklerokistoz can pass on means laparotomy - a surgical incision is located on the anterior abdominal wall or laparoscopy - the operation passes through a small hole the size of a fingertip, with special laparoscopic instruments with output image on the monitor.
Operations at sklerokistoz ovaries are based on reducing the amount of ovarian stroma:
1) wedge resection is aimed at reducing the volume of the stroma of the ovary, which produces male hormones, as well as the size of the restoration to normal ovary;
2) cauterization carried out to destroy the influence of stroma point electrode.Produced from 15 to 25 electro in each ovary.Operation more forgiving, but less quickly than with wedge resection.
After these surgeries in women with ovarian sklerokistoz expect pregnancy within 1 year.Restoring ovulatory cycle after surgery is 85-89%.The occurrence of pregnancy after laparoscopic ovarian sklerokistoz average observed in 73% of cases.