Polycystic Ovarian - this change in the anatomy and function of the ovaries on the background of disturbed metabolism of ovarian (steroidogenesis).Primary polycystic ovary syndrome is a genetically caused disease, formed the beginning of the functioning of the ovaries, and usually occurs in puberty. Secondary polycystic ovarian disease is not independent and is represented as a set of symptoms, so it is called polycystic ovary syndrome (PCOS).Secondary polycystic formed after a period of normal menstrual function.
used phrases "polycystic ovary syndrome" is not quite correct, because the diagnosis of polycystic ovaries placed in primary anatomical and physiological changes, and polycystic ovary syndrome involves secondary violations.A phrase like polycystic ovarian syndrome unites these states together and violates the meaning of the wording of the diagnosis.
Ovary - paired female gonads.Consistency normal ovarian dense surface is slightly bumpy, but in form it resembles
size of the ovaries depends on the age and phase of the menstrual cycle.The right ovary is usually larger and heavier than the left.The ovaries of normal size during the examination can usually be palpated only in lean women.
ovary has three major functions:
1. childbearing (generative) function ensures the reproduction of ovarian eggs capable of fertilization.
2. Due to ovarian hormones developed genitals and formed female phenotype ("feminine" appearance).
3. Hormonal ovarian function along with a similar function of the endocrine glands are organically integrated into the overall system of hormonal regulation, which depends on the state of the female body.
healthy ovary produces two "female" sex hormones - estrogen and progesterone.The whole process is controlled ovarian steroidogenesis luteinizing (LH) and follicle-stimulating hormone (FSH) hormone produced by the anterior pituitary.
Along with female hormones the ovaries produce small amounts of androgens (male sex hormones).Crucial amounts of androgens produces adrenal cortex and ovarian androgens is only enough for the formation of normal during pregnancy male fetus.
At the heart of the development of polycystic ovarian hormonal dysfunction is followed by structural deformation of ovarian tissue, and persistent infertility.
reasons polycystic ovarian
girls with signs of polycystic primary born of mothers who have in the past, infertility, miscarriage, and other hormonal abnormalities.Hormonal "defect" is inherited from the mother and is transformed into the daughter of polycystic ovaries.Other causes of primary polycystic are experienced in childhood infections, especially mumps ("pig").
Polycystic ovary syndrome occurs against a background of severe endocrine disorders, complications of a normal pregnancy and / or childbirth, serious brain injury, stress and intoxication.
In almost all (40-70%) of women develop polycystic ovaries due to lower sensitivity to insulin (insulin resistance) - the hormone of the pancreas, which controls blood sugar levels.As a result, enters the bloodstream very large amounts of insulin, but in excessive amounts in the ovaries begin to synthesize the male sex hormones (androgens).Against the background of hormonal dysfunction in the ovaries destructive changes occur.
Under the influence of androgen excess outer shell of the ovary thickens.Present in her mature follicles can not be destroyed to release the egg, instead they increased and filled with a liquid that is converted into cysts.Polycystic ovaries contain a large number of cysts, thereby increasing in size.
Increased levels of androgens can cause not only excessive insulin production.In normal weight and normal physiological insulin in the blood may occur malfunction of the hypothalamus - pituitary - ovary.In this case, there is a decrease in estrogen levels, increased production of growth hormone increases the concentration of androgens.
Polycystic ovaries can cause endocrine diseases (diabetes, adrenal pathology), obesity, genetic predisposition.
Thus, the basis of polycystic ovary always lie hormonal disorders.
symptoms of polycystic ovary
symptoms of polycystic incredibly diverse, most of them are non-specific, as may be present in any dishormonal abuse.They may occur with the first menstruation or after a few years, after a period of normal menstruation.
Adequate assessment of all received clinical, laboratory and instrumental data helps to make a correct diagnosis.
Diagnostics polycystic ovary starts with a general examination of the patient.
often satellites polycystic ovary as external signs of hyperandrogenism are:
- hypertrichosis - increased growth of individual rod hair on the chin, nipples, no hips and neck.Always accompanied by a primary lesion of the ovary indicates hyperandrogenism.
- hirsutism - hair growth on the forearms, legs and face.It is noted in lesions of the adrenal glands or "hormonal" tumors.
- virilism - male pattern body hair, male figure, a low tone of voice.Accompanied by a breach of gonadotropic pituitary function.
- Acne (acne) on the face.
Almost all patients with polycystic ovarian differ overweight (the most belly fat).Women with polycystic different primary right physique, breast development, and hypertrichosis.Patients with secondary polycystic found hypoplasia of mammary glands, narrow pelvis, hirsutism.
menstruation with polycystic ovaries come on time (12-13 years).The exception is in the background polycystic dysfunction of the adrenal glands.The character of menstrual dysfunction depends on the form and causes of polycystic, presented scant (opsomenoreya) or rare (oligomenorrhea) menses, acyclic uterine bleeding or amenorrhea.
most frequent reason for seeking medical attention is a primary or secondary infertility, as without proper (not always effective) treatment of polycystic ovaries during ovulation is practically impossible.
During a pelvic exam determines the increase dense ovaries.
Laboratory diagnosis of polycystic ovary includes biochemical and general analysis of blood, determination of blood glucose and insulin sensitivity, cholesterol, the study of blood lipid profile.
important diagnostic importance is determining the level of hormones in the blood and their relationship.Hormonal examination carried out taking into account the phase of the cycle.An important criterion in the diagnosis of polycystic ovary is considered to increase the ratio of LH and FSH than 2 - 2.5 (at a rate of 1 - 1.5).It is not always the usual one-time study of the hormonal status of the patient is sufficient for the diagnosis, more research is carried out against the background of the special hormonal tests (eg, dexamethasone test).
ultrasonography (US) is very informative about the diagnosis of polycystic ovaries.Ultrasound - polycystic ovary criteria are:
- Symmetric (bilateral) a significant increase in the ovaries.
- The size of the ovaries must be such that their volume was greater than 9 cc.
- Increased stromal density of up to 25% of the volume.
- Thick capsule (a reliable sign of hyperandrogenism).
- located along the periphery of ovarian follicles neovulirovannye multiple (at least 10), a diameter of 8 - 10 mm.
diagnosis of polycystic ovary, delivered only on the basis of US - signs may not be valid without the corresponding clinical manifestations.This is especially true in the case study of women with regular ovulatory cycles and lack of characteristic symptoms.Fair to talk about "US - signs of polycystic", which implies the likelihood of developing the disease in the future.Following a further examination of these women it is advisable to monitor.
Elevated levels of insulin in the blood of patients involves a combination of polycystic ovaries with type 2 diabetes.System disturbances in polycystic ovaries leads to early onset of vascular pathologies, such as hypertension and atherosclerosis.
most alarming of all is the consequences of polycystic ovary endometrial hyperplasia (19.5%), 2.5% of cases provokes the development of malignant disease (adenocarcinoma).If you have a bleeding or permanent hyperestrogenism in some cases carried out a diagnostic laparoscopy.
Polycystic ovaries and pregnancy
At the doctor's young women interested in getting pregnant in polycystic ovaries and how to maintain a pregnancy.Answers to these questions can not be unambiguous and only right.
In most cases (85%) of infertility in PCOS is primary and may be the only symptom of it.The number of spontaneous pregnancy in polycystic does not exceed 3 - 5%, and the probability of a successful outcome is negligible.
result of hormonal dysfunction in PCOS are resistant anovulation and infertility.An exception is the polycystic ovary syndrome on the background of the defeat and the subsequent development of the adrenal hyperandrogenism, when ovulation and pregnancy is possible.However, such situations are extremely rare, and eventually end premature termination of pregnancy.
Restoration of fertility is one of the most difficult tasks of therapy polycystic ovaries.For its implementation begin only after the major neuroendocrine disorders and restore normal menstrual cycle.
If the preparatory phase is successful, proceed to the artificial stimulation of ovulation.For this purpose, a hormonal drug Clomid, it causes the egg to leave the ovary in time and prevents the formation of cysts.During the reception held clomiphene control hormonal and ultrasound examinations - control.
If clomiphene does not give the desired result, your doctor may change the treatment regimen.Usually the drug is selected from the group consisting of gonadotropins containing LH and FSH.
Unfortunately, even the most competent treatment of infertility in patients with polycystic ovary does not imply an absolute success, and even restored ovulation in polycystic ovaries does not guarantee pregnancy.For example, after clomiphene in 60 out of 100 patients returned ovulation, pregnancy occurs but only 35 of them.Admission gonadotropins increases the chances of pregnancy up to 60%.
If unsuccessful infertility treatment in polycystic ovarian surgical treatment.
If conservative and surgical treatment did not lead to the onset of the long-awaited pregnancy, and a woman in a persistent desire to have children, resorted to IVF (in vitro fertilization).
risk of complications after treatment of infertility is low, especially if the woman complies with all necessary rules.These include ectopic pregnancy and early miscarriage.The frequency of multiple pregnancies in the background increases the stimulation of hormones.
course of pregnancy after treatment of polycystic ovary is associated with risk of developing gestational diabetes, toxemia and premature birth.In order to prevent them special treatment is conducted at different stages of pregnancy.
Thus, the question of how to get pregnant with the polycystic ovaries can be only one answer: be patient and carefully follow the doctor's recommendations.
Treatment of polycystic ovary
Therapy polycystic ovary is a complex multi-step process in recovering the physiological parameters of the whole organism.Polycystic ovary is not only gynecological disease, so treatment should be directed at eliminating the violations that led to the development of ovarian pathology.
volume of therapeutic measures is determined taking into account the severity of the process and the desire of women to become pregnant.
At first, preparatory, stage of treatment is necessary to bring the weight of the patient to the physiological norm (in the case of obesity).Diet therapy helps to normalize lipid metabolism, and the necessary physical activity reduced carbohydrate metabolism.Individual nutrition plan and a set of physical exercises is made for each patient, taking into account its physical data and the severity of the disease.We can not say that this seemingly very simple step of therapy, it is possible to go without difficulties and failures.In the case of a positive effect, weight loss not only improves the external data and the overall well-being, but also conducive to good mental attitude of patients to follow-up treatment.
Elimination of hormonal disorders is carried out on the second stage of treatment of polycystic ovaries.At this stage it is necessary to restore normal menstrual cycle, eliminate hyperandrogenism (hirsutism, acne, etc.), lead to physiological norm carbohydrate and fat metabolism.
To correct menstrual cycle in the treatment of infertility using hormonal preparations with a low content of estrogen, as anovulation in polycystic ovary suggests hyperestrogenia.Modern combined oral contraceptives (COCs) are successfully used in the treatment of polycystic ovaries.Drugs such as Marvelon, Logect, Femoden, Jeanine and others similar to them in composition, appointed three-month course followed by monthly interval.The treatment process certainly is controlled by determining the level of hormones in the blood and ultrasound.
third phase of conservative treatment of polycystic ovary held for women planning pregnancy.The essence of the treatment is to stimulate ovulation.
Disturbances of carbohydrate metabolism successfully eliminated with drugs hypoglycemic effect.The good effect is observed after administration of the drug Metformin.Typically Metformin in polycystic ovarian assigned for one - two weeks, after which there is a decrease in blood glucose levels of patients.It is found that the metformin in polycystic ovary slows the absorption of glucose in the digestive tract, eliminates tissue insulin resistance and inhibits synthesis of glucose in the liver.
Eliminating effects of hirsutism by using drugs antiandrogenic action.With this task successfully copes drug Diana - 35.
secondary importance is the use of antioxidants (Methionine, Ackorbinovaya acid, etc.) and vitamins, physiotherapy and massage therapy.
It should be noted that the selection of the treatment regimen, as well as drug depends on the purpose of therapy.