Ovarian sclerocytosis is the process of their regeneration, accompanied by the formation of small cystic formations up to 1 cm in size.
When sclerocystic ovaries are enlarged, and sealed shells are formed on their surface.
Sometimes this syndrome is called Stein- Leventhal syndrome. Typically, sclerocystic disease is formed as a result of polycystic ovarian disease as the disorder progresses.
The incidence of 3-5% of all gynecological diseases, in about 30% of them sclerocystic ovary causes persistent infertility.
The main role in the development of sclerocystosis of the ovaries is attributed to the disruption of the processes of synthesis and release of sex hormones. In addition, they play the role of a disruption in the work of all endocrine organs, one way or another involved in the regulation of the menstrual cycle.
Some doctors are of the opinion that sclerotosis is caused by excessive production of follicle-stimulating hormone ( FSH ). This leads to the suppression of the normal functioning of the ovary and the formation in it of small immature cysts, covered with a dense membrane.
In the development of sclerocytosis, the role is also assigned to the violation of the synthesis of luteinizing hormone ( LH ).
Another theory identifies the main cause of excessive activity of the adrenal cortex, as well as defects in the formation of steroid hormones and estrogen deficiency. For this reason, the maturation of follicles is disrupted, the level of male sex hormones rises and infertility occurs.
Sclerocystic can be hereditary and acquired, usually occurs in girls after puberty and in young women who have not given birth.
Sclerocystic can be with enlarged or polycystic ovaries, or with reduced or shrunken ovaries. In both cases, their surface is covered with a dense sheath under which cystic-regenerated follicles can be contoured .
The sclerocystic disease is characterized by the following symptoms:
- a sharp and bilateral enlargement of the ovaries,
- violation of the menstrual cycle,
- increased body hair, often with male features,
- hypoplasia of the uterus, genitals and breasts,
- weight loss,
- problems with hormonal metabolism.
Very often, sclerocystosis accompanies obesity and overweight , although this is not necessary.
There may be violations of general well-being due to an imbalance of androgens and adrenal hormones: general lethargy and weakness, headaches, apathy, neurasthenia, insomnia, decreased sexuality.
One of the most frequent manifestations of sclerotosis is the absence of menstruation or their violation: first, menstruation lengthens, becomes very abundant, or vice versa, scarce, then completely disappear.
Sclerocytosis is manifested by infertility, it usually occurs in 90% of patients. At the same time, the phenomena of hirsutism gradually increase – excessive hair growth, hair grows over the lip, on the cheeks and chest, there are many of them on the arms and legs, on the stomach. At the same time there is hypoplasia (underdevelopment) of the uterus, or its atrophy, the mammary glands may be underdeveloped.
The basis of the diagnosis of sclerocystic is the patient’s complaints, described above, and long-term infertility.
The main examination – examination on the gynecological chair – the doctor probes a normal or diminished uterus, with enlarged, hilly and dense ovaries, usually on both sides. In rare cases, the ovaries are reduced.
Functional tests with basal temperature measurement, colpocytogram and endometrial scraping show a single-phase cycle, which indicates the absence of ovulation.
The basis of instrumental diagnostics – ultrasound, which is visible condensed ovaries, covered with a dense shell and filled with cysts.
Also shown is the holding of a gas pelveogram – it usually shows a decrease in the uterus and an enlarged ovary with the formation of an oval or round shape.
For invasive diagnosis, the method of diagnostic laparoscopy is used (sometimes simultaneously with treatment).
Laboratory diagnosis is to determine the level of hormones in the serum – examine sex hormones, pituitary hormones, adrenal hormones and thyroid hormones.
With an increase in the level of adrenal hormones exclude adrenal tumors and pituitary tumors.
The gynecologists and endocrinologists are engaged in the treatment of sclerocytosis. Allocate conservative and operational methods of treatment.
Conservative treatment of sclerocytosis includes:
- Clomiphene therapy in the first 5 days of the cycle from the fifth day of menstruation. This leads to the stimulation of ovulation.
- cyclofenil therapy is used to increase the level of luteinizing hormone,
- For the treatment of increased hairiness, ovysiston is used to regulate steroid metabolism, which leads to a reduction in the growth of unwanted hair. The course is sometimes supplemented with metronidazole.
- for problems with the adrenal glands, prednisone is prescribed according to a regimen, sometimes with the addition of hydroxyprogesterone to the second phase. If there is no menstruation, they can be called bisequin, hCG is effective.
Today they are actively using the surgical method of treatment – the method of complete or partial ovarian decapsulation. Dense shells are laparoscopically cut off from the ovaries, dissected and stitched, wedge excised.
Due to such operations, it is possible to remove the oppression of follicles, which leads to the restoration of menstrual function and enables the conception of a child. Excised cysts that produce estrogen, which leads to the normalization of ovarian function. Before the operation, curettage of the uterine cavity is performed in order to prevent mucosal rebirth.
However, the results of surgical treatment are unstable, on average, the effect without further treatment lasts up to six months. Surgical treatment is prescribed in the absence of results with conservative therapy.