ICD-10 Code : E28.2
Polycystic ovary syndrome is a disease in which benign cystic formations of the woman begin to actively form on the ovaries of the woman, leading to various malfunctions of these organs. PCOS may be due to various factors, but in most cases this is a consequence of disruptions in the neuro-enocrine system. PCOS is manifested by menstrual disorders, weight gain, infertility, skin problems, active male-type hair growth. Treatment is based on the use of hormonal drugs, as well as surgical intervention in case of failure of conservative therapy.
PCOS is a disease known for its diverse clinical presentation, difficulties in diagnosis and treatment. However, in any form of the disease, its main feature is that cysts begin to actively form in the ovaries – benign, often hollow structures of various sizes. The presence of cysts inevitably leads to the fact that there are failures in the ovaries.
In the reproductive phase, an average of 5 to 10% of women suffer from PCOS. Moreover, the disease can for a long period of time does not remind of itself.
Polycystic ovarian disease is the most dangerous from the point of view of infertility. Women who are unable to conceive or bear a child in 25% of cases suffer from this disease. And while the PCOS cannot be compensated, the probability of conception is very small.
The basis of the development of PCOS is a variety of endocrine disorders. Moreover, various deviations are observed not in one, but in several organs at once. Most often noted:
- improper regulation of the adrenal glands and ovaries still at the level of the pituitary or hypothalamus;
- incorrect work of the cortical layer of the adrenal glands, because of which they produce a very large number of androgens that negatively affect the work of the ovaries;
- malfunctions in the work of the ovaries themselves (improper secretion of estrogen and, as a consequence, the appearance of irregularities in the structure of the organ);
- malfunction of the pancreas, in which it secretes a lot of insulin, and the tissues of the body lose sensitivity to it.
Among the risk factors that increase the likelihood of PCOS, are:
- excess insulin;
- traumatic brain injury;
- diseases of the pituitary and hypothalamus;
- adrenal gland diseases;
- constant negative psycho-emotional effects;
- diseases of the reproductive system.
Since the ovaries, being the organ of the endocrine system, are themselves forced to submit to other hormones produced by higher-standing organs, it turns out that PCOS develops mainly as a multifactorial disease. In this case, the incorrect hormonal regulation leads to the fact that the ovarian capsule becomes more dense, the follicles no longer develop properly, and this, in turn, leads to the formation of cysts.
The cause of endocrine disorders, pulled for a development of PCOS, can be any negative effects on the body. Stress, cardinal climate change, acute or chronically occurring infectious diseases can cause the endocrine system organs to stop working in accordance with the demands of the body.
Polycystic ovary syndrome is a disease that has a small classification. It is based on where the pathology originated from. Allocate:
This group includes, first of all, the congenital form of polycystosis. It occurs due to various disorders that appear at the stage of development of the fetus in the womb. Additionally, this also includes a disease in which structural disorders in the body are primary, but endocrine disorders already have a secondary origin. This situation is rare.
Polycystic is called secondary if it has developed against the background of already existing endocrine disorders. In clinical practice, the secondary form of polycystic ovary is more common than the primary (95% of cases).
PCOS is a disease that may be asymptomatic. Although if signs of illness still appear, it is rather difficult to ignore their women. Attention is drawn to:
Various irregularities in the menstrual cycle
Most women include only the irregularity of the menstrual cycle. However, in practice, this group of violations also includes the complete absence of menstruation or their excessive number. There are situations when there is no menstruation for a long period of time, and then full uterine bleeding develops, which can be life threatening.
Due to the imbalance of hormones, women often complain of acne, acne, acne. Excessive dryness of the skin may also be noted.
Inadequate sebaceous and sweat glands
Excessive greasiness of hair, excessive sweating can also be a consequence of PCOS.
Obesity in one form or another is observed in at least 40% of women suffering from polycystic ovary. Moreover, obesity is not only a rather characteristic symptom, but also one of the risk factors. This means that women and girls who are overweight are more likely to get PCOS.
Under this term is understood too active hair growth i. the appearance of male hair distribution. In this case, the hair grows on the chest, legs, may appear on the face in the form of rare antennae or beards.
As with menstrual irregularities, fertility problems can be very diverse. Some women are simply not able to become pregnant against the background of having PCOS, and some are able to get pregnant, but they cannot bear the fetus before the time it takes to become viable.
This syndrome also includes many symptoms. Most often it is, first of all, the change of a figure from a female type to a male one. It can also be an androgenic form of alopecia, that is, a gradual loss of hair on the head. The bald patches are mainly defined on the top of the head, as well as in the area of the forehead, along its lateral sides.
The appearance of striae
Striae – bands where the skin is overly stretched. They appear due to a sharp increase in body weight, and are localized mainly on the abdomen, thighs, chest. The hormonal imbalance contributes to the formation of stretch marks, against the background of which the skin looses its elasticity.
All symptoms can also be supplemented by pronounced premenstrual syndrome, depression, drowsiness, increased nervousness, decreased performance, blurred thinking.
Important criteria for diagnosis
In order to diagnose a woman with PCOS, the doctor must understand whether the clinical picture is consistent with a number of indicators. The criteria for issuing a specific diagnosis are:
- the onset of the first menstruation (menarche) in a timely manner;
- the appearance of disruptions in the menstrual cycle of the oligomenorrhea type from the menarche period;
- the presence of overweight and body hair on the male type even with menarche (observed in half of cases);
- infertility of the primary type – all attempts to get pregnant were unsuccessful;
- lack of ovulation;
- an increase in the size of the ovaries according to a transvaginal ultrasound study;
- a large amount of LH in the blood, an increase in the ratio of LH / FSH by more than 2.5 times.
Diagnosis of PCOS begins primarily with the evaluation of patient complaints. Additionally, the data include a picture obtained by instrumental and laboratory diagnostics. Hold:
- examination on the gynecological chair, through which you can determine the enlargement and hardening of the ovaries;
- Ultrasound of the small pelvis, on which follicular cysts can be seen on the periphery of the ovaries, their increase in diameter or length, compaction of the organ capsule;
- doplerometry, the task of which is to show that blood flow is increased in the ovaries;
- MRI scans required to exclude malignant tumors in the ovaries that can give a similar clinical picture;
- diagnostic laparoscopic examination, which will show whether there are changes in the structure of the ovaries.
What tests need to pass
Evaluation of the hormonal profile with the help of a blood test:
Evaluation of the lipid profile in the composition of the biochemical analysis of blood, designed to show whether there are violations in the lipid metabolism.
PCOS therapy is carried out by a gynecologist-endocrinologist or gynecologist with an endocrinologist in tandem.
Treatment of PCOS can vary greatly depending on whether a woman has obesity. When present, efforts are initially directed at eliminating obesity as one of the risk factors, and only then prescribing the main therapy. If the patient does not have excess weight, the transition to treatment of the disease is possible immediately.
In the treatment of polycystic ovaries using two methods:
In the early stages of the disease, a conservative approach is recommended. It is based on the selection of hormonal drugs, such as combined oral contraceptives ( Duphaston, Yarin, Jess, etc.), antiestrogens ( Clomiphene ), gonadotropins. It is also recommended to normalize the diet in order to lose weight or prevent its further set, to increase physical activity.
The duration of therapy with contraceptives varies from 3 to 6 months to see if there is an effect from conservative treatment.
Laparoscopy for PCOS
If conservative methods do not produce an effect (the symptoms of the disease persist, the reproductive function is not restored, weight is not normalized), they resort to surgical intervention. Today, in the treatment of PCOS, low-impact laparoscopy is used , unlike in earlier years, when laparotomy was used.
Laparascopy is an operation where instead of a full cut , several punctures with a diameter of up to 1 cm are made through which tools are inserted. This is how it differs from laparotomy when a full cut is made. The intervention takes place under the control of a small video camera. Recovery after surgery takes 4 to 6 weeks and requires compliance with a number of recommendations. among them:
- restriction on physical activity;
- restriction on sex for 30 days;
- rejection of the use of salty, fatty, fried, spicy dishes, spices;
- refusal of alcohol.
During laparoscopy, the preferred option for surgery is a wedge resection of the ovary with cautery. In this case, the patient is removed part of the ovary in the form of a wedge, the most severely affected by cysts, perform cauterization. As a result, partially the amount of hormones is normalized, it is possible to achieve normal ovulation and the onset of pregnancy in more than 65% of cases. However, the operation is not a panacea, since it solves problems only for 1-3 years, and then cysts grow again from the remaining ovarian tissue.
If you want to have a child, you should consult a doctor in order to get preparatory recommendations in the first six months. In this case, women are prescribed pills that have a stimulating effect on the maturation of the egg, and it is also recommended to start sex life without protection.
If necessary, the operation can be done again, but the effect of it will not be so pronounced.
Polycystic ovarian disease is a dangerous disease that, if improperly treated, can lead to complications. Among them:
- severe obesity;
- dyslipidemia i.e. violation of fat metabolism;
- development of type II diabetes due to tissue resistance to insulin produced by the pancreas;
- oncological changes in the endometrium of the uterus;
- breast cancer;
- pathological changes in the blood coagulation system up to the tendency to increased thrombosis;
- atherosclerotic lesions of blood vessels;
- pathology of the cardiovascular system.
Due to the large number of complications that PCOS can cause, its treatment on its own, without the supervision of a specialist, is absolutely not recommended. Also not recommended is the use of folk remedies in the treatment of the disease.
PCOS is a disease that is based on regular scheduled visits to the gynecologist. Polycystic disease, if detected at an early stage of development, is easier to correct, which avoids most of the complications, including infertility. It is worth to pay attention to prevention abo mouths , the proper use of contraceptives, prevention of inflammatory diseases of the genital organs. Indirect prevention in the presence of risk factors are the avoidance of stress, the maintenance of a healthy lifestyle.
Polycystic ovary is a disease that cannot be fully cured today . The disease can be taken under control, to reduce the severity of its manifestations in order to improve the quality of life of the patient. You can also undergo a course of correction, so that a woman can become pregnant. However, since PCOS progresses with age, it is worth planning a pregnancy as early as possible.