- Polycystic ovarian forms
- Polycystic ovarian disease: etiology and pathogenesis
- Symptoms of polycystic ovary
- Diseases that can mimic polycystic
- Diagnosis of polycystic ovary
- Polycystic ovary: is it possible to get pregnant?
- Treatment of polycystic
- Diet for polycystic ovaries
- Complications of polycystic ovary
- Polycystic ovary: a prognosis
Polycystic is a hormonal pathology that occurs due to a violation of the hypothalamic regulation of ovarian function. She was carefully studied and described by American gynecologists Stein and Leventhal. This disease occurs with the appearance of multiple cystic tumors on the female genital glands. They are characterized by significant thickening, and sometimes sclerotic lesion of the tunica. Polycystic ovary syndrome occurs in violation of the menstrual cycle, is accompanied by obesity, hirsutism (excessive hair growth), and often becomes the cause of infertility. With the development of the pathological process, follicles form on the surface of the ovaries, in which there is a liquid and immature eggs.
In 1990, a conference was held in the United States on polycystic ovary syndrome, where consensus was finally achieved. Experts concluded that when making this diagnosis should take into account the presence of two main features:
- Unsystematic menstrual cycle;
- Clinical manifestations of hyperandrogenism (high level of androgens in the blood, male pattern baldness, hirsutism, acne).
Polycystic ovarian forms
- Primary (true) PC.
- Secondary PCO (Stein-Leventhal syndrome).
True polycystic ovarian disease is a pathological process that occurs in women who have normal body weight, and during its development no increase in the level of insulin in the blood is observed. For primary polycystosis, a more severe course is characteristic and it is poorly amenable to conservative and surgical treatment. As a rule, the development of the disease begins in puberty (10-12 years).
Secondary polycystic is most often found in middle-aged women suffering from overweight and insulinemia. At the same time, this form of pathology can develop against the background of ovarian extinction (during menopause). It is much easier to treat and can often be eliminated with the help of conservative methods.
Many experts believe that polycystic ovary syndrome and polycystic ovarian syndrome are the same pathology, and therefore they recommend treatment aimed at normalizing hormonal balance without taking into account the cause of the disease. However, there is a big difference between these pathological forms. It should be noted that polycystic ovary syndrome is a pathological condition that occurs in 5-10% of women and is considered the most common cause of malfunctioning of the reproductive system.
To date, the classification of Stein-Leventhal syndrome has been adopted in clinical practice. It highlights:
- Ovarian (typical) form;
- Ovarian-adrenal (mixed) form;
- The central form, occurring with a lesion of the central nervous system.
Polycystic ovarian disease: etiology and pathogenesis
Science learned about polycystic ovaries more than 100 years ago, but so far, due to the fact that this manifestation is characterized by multiple manifestations, its etiology and pathogenesis are still not fully understood.
The main causes of PCL are usually attributed to:
- Increased secretion of androgens.
- Insulin resistance.
- Overweight and obesity.
- Hormonal disruptions in a single neurohumoral integration system.
- Constant stress.
- Increased prostaglandins.
- Transferred infectious and inflammatory diseases.
- Climatic aspects.
The theory of the central origin of PCL.
To date, the focus is on the central theory of polycystic development, which associates the occurrence of the pathological process with damage to the hypothalamic centers and impaired production of gonadotropins LH and FSH.
With insufficient production of FSH, ovarian enzyme deficiency develops (we are talking about enzymes catalyzing the process of estrogen production). As a result, androgens accumulate in the female genital glands, which suppress the growth and maturation of follicles and provoke their cystic regeneration.
However, the increased production of luteotropin increases the secretion of androgens, which, in turn, leads to a decrease in the secretion of follicle-stimulating hormone and the production of estrogen.
According to many authors, the development of the pathological state provokes a violation of the secretion of neurotransmitters, which leads to failures in a single integration neurohumoral system (hypothalamus - pituitary - ovaries - adrenal glands). However, to this day, the root cause of such violations has not been thoroughly studied.
Also, the pituitary melatonin production (hypermelatoninemia), increased secretion of serotonin and prolactin and reduced production of thyroid hormones also indicate the central origin of PCL.
в некоторых случаях нарушение работы щитовидной железы может спровоцировать развитие поликистоза яичников. Note: in some cases, a malfunction of the thyroid gland can trigger the development of polycystic ovary.
Along with this, morphological changes in the sex glands can occur against the background of menopause, after inflammatory diseases, and also due to the primary defect of the enzyme system. As a result, the production of androgens increases, or the growth and maturation of follicles are disrupted, which leads to malfunctioning of the regulatory mechanisms of the female reproductive system.
At the same time, genetic, perinatal, psychogenic and endocrine and unfavorable production factors ( poisoning with salts of heavy metals, benzene, etc.), as well as long-term administration of oral contraceptives can provoke the development of PCL.
According to experts, 40 different genes can provoke an increase in the secretion of androgens (polygenic nature of inheritance). Most often prone to the development of the disease are women in whom the immediate family suffered from malignant and benign tumors of the ovaries and uterus. PSC is also detected in those patients who had a high incidence of gestosis during pregnancy, those suffering from obesity, hirsutism, type 2 diabetes mellitus and various menstrual disorders. However, many authors draw attention to the existing relationship between the age of the patient's parents. So, the older the parents, the higher the influence of various adverse factors on the body of the fetus.
Decreased glucose tolerance
Numerous studies have shown that PCOS is a disease that is associated with increased insulin production. Somehow, the increased secretion of this hormone is associated with an increase in the secretion of male sex hormones. Most experts argue that women suffering from obesity, triggered by increased production and insulin resistance, form a chain of pathological changes, leading to menstrual disorders, hirsutism, lack of menstruation and infertility.
In 40-60% of women diagnosed with polycystic ovary syndrome, insulin resistance is detected at the same time, often accompanied by obesity. And sometimes with diabetes of the second type, a decrease in glucose tolerance can be observed even in the absence of obesity.
The role of infectious pathogens
Many experts in the development of polycystic ovaries do not exclude the role of infectious pathogen. For example, a history of patients with PCA of central origin may have chronic upper respiratory tract diseases (65%) or childhood infections. Since the ovaries are very closely associated with the tonsils, tonsillitis or ARVI can trigger the development of the pathological process.
Symptoms of polycystic ovary
Symptoms of true polycystic ovary
The main symptom of this form of pathology is a violation of the menstrual cycle. As a rule, this condition is observed in adolescent girls after the onset of menarche (first menstruation). With the development of the pathological process on the face, back and neck acne appears ( acne ). Due to the hyperfunction of the sebaceous glands, the skin and hair are quickly contaminated, and therefore, even with the most careful care, they constantly shine and look oily. Gradually, hirsutism (excessive hair growth) begins to progress. It appears on the legs, arms, groin and even in the chest area. Then the body mass begins to increase (up to 10-15 kg) and menstrual bleeding is delayed (from one month to six months). Patients complain of nagging pain in the lower abdomen, the female sex glands increase in size, infertility develops.
Symptoms of Polycystic Ovary Syndrome
In almost all forms of Stein-Leventhal syndrome, the menstrual cycle fails, leading to impaired female reproductive function.
For a typical (ovarian) form of polycystic is characterized by oligomenorrhea (short duration of menstruation), or secondary amenorrhea (absence of menstruation for six months or more). Most often, this form of pathology is detected in adolescent girls after the onset of menarche.
The mixed form of Stein-Leventhal syndrome is characterized by a later onset of menarche. In this case, menstrual disorders take the form of secondary amenorrhea and lead to the development of infertility.
With the central form of the pathological process, the first menstrual periods in girls begin at the age of 12-13 years, however, the menstrual cycle is very unstable, which leads to the development of oligomenorrhea or amenorrhea. As a result, reproductive function is impaired, spontaneous abortions occur on small periods of pregnancy, or secondary infertility develops.
спровоцировать развитие данной гинекологической патологии могут травмы головного мозга, стрессы и даже первый половой акт (дефлорация). Note: to provoke the development of this gynecological pathology can brain injury, stress, and even the first sexual intercourse (defloration).
The main symptom of polycystic ovary syndrome is hirsutism (overgrowth of terminal hair of a male type). As a rule, such a symptom is detected in 50-100% of patients, and is often the only complaint with which they turn to a specialist. Overweight hair develops gradually, after the onset of the first menstruation. Most often there is a growth of hair above the upper lip, on the chin and in the area of the white line of the abdomen. However, pronounced hirsuitism is not characteristic of this form of the disease.
In the mixed form of Stein-Leventhal syndrome, increased body hair is observed in 100% of cases. In this, hair begins to grow on the face, on the legs and on the hips.
In 60-90% of episodes, hirsutism develops in the central form of polycystic ovaries (3-5 years after the onset of menstruation). The most pronounced symptoms observed in women of reproductive age. During this period, stretch marks appear on the chest, abdomen and thighs, nails and hair begin to break down strongly.
Diseases that can mimic polycystic
- Pathological processes associated with hypothyroidism;
- Tumors of the ovaries and adrenal glands;
- Increased secretion of prolactin (pituitary hyperprolactinemia).
Diagnosis of polycystic ovary
Diagnosis of PCOS includes gynecological examination, ultrasound of the ovaries and hormonal examination, as well as other auxiliary methods.
- Ultrasound scan. During this procedure, multiple small cysts are detected on the surface of the female genital glands. As a rule, the affected organs increase in size, their surface becomes bumpy, the capsule thickens. Due to the chronic excess of estrogen, the endometrial thickening (the inner layer of the uterus) is clearly visible on the ultrasound monitor.
- In the analysis of the blood for hormonal status, an increased concentration of androgens, follicle-stimulating and luteinizing hormones is noted (as well as their ratios). Also during the hormonal examination can be revealed impaired glucose tolerance and elevated insulin levels.
- In order to be able to "see" the ovaries affected by polycystic, a laparoscopic study is shown to patients. To date, ovarian laparoscopy is the most informative diagnostic technique. With the development of Stein-Leventhal syndrome, the capsule of the reproductive gland thickens and smoothes, the organ acquires pearl-whitish coloration, reaches a length of 5-6 and 4 cm wide.
- To detect violations of metabolic processes, the lipid profile of blood is determined. In case of polycystic ovaries, the concentration of low-density lipoproteins increases and the concentration of high-density lipoproteins decreases.
- When conducting a glucose tolerance test, high blood sugar levels signal a violation of carbohydrate metabolism, that is, the development of hyperinsulinemia.
- Patients with mastopathy are shown breast mast or thermography.
при гормональных сбоях базальная температура на протяжении всего менструального цикла остается неизменной. Note: with hormonal disruptions, the basal temperature throughout the entire menstrual cycle remains unchanged. The coarsening of the voice, defeminization and hypertrophy of the clitoris in PCOS, as a rule, are not observed.
Polycystic ovary: is it possible to get pregnant?
Most experts say that getting pregnant with PCOS is quite possible. In clinical practice, there are many cases of successful childbearing by patients suffering from polycystic disease. However, for this throughout the pregnancy, they are recommended supportive drug therapy.
Treatment of polycystic
As a rule, the treatment plan is drawn up in accordance with the clinical symptoms of the disease, complaints and the age of the patient. Most often, the main goal of the treatment of Stein-Leventhal syndrome is the restoration of female reproductive function. However, therapeutic procedures are carried out in order to prevent hyperplastic processes in hormone-dependent target organs, as well as to eliminate all the existing signs of the pathological process.
Despite the fact that in recent years, significant changes have occurred in the tactics of polycystic ovarian treatment, until now official medicine has applied only two main treatment methods: hormonal therapy and surgery. However, when prescribing treatment, pathogenetic mechanisms and forms of the pathological condition are taken into account.
As a rule, hormone therapy is prescribed to the patient at an early stage of the PCE, which involves the use of oral contraceptives for three menstrual cycles. Upon completion of the course, the normalization of the menstrual cycle occurs, the development of hirsutism slows down, the ovaries decrease in size, and the ovulation process is improved. Many authoritative authors report that during estrogen-progestin therapy, spontaneous restoration of neurotransmitter metabolism occurs.
However, after the abolition of hormonal treatment, a woman often finds new polycystic formations. Thus, the conclusion suggests itself that oral contraceptives can temporarily eliminate hormonal imbalance and normalize the menstrual cycle, but at the same time, they are not able to eliminate the causes that provoked the development of polycystic ovarian disease. That is why after the cancellation of hormonal treatment, all the symptoms return, aggravated by the withdrawal syndrome, accompanied by deterioration of the skin condition and hair loss. However, not long ago, the carcinogenic effect of combined oral contraceptives was proven, but not all experts warn their patients that with age they may increase the risk of developing malignant pathologies.
With a typical, mixed and central form of polycystic ovarian, as a rule, courses of hormonal therapy are given, in which a certain drug is prescribed and corticosteroids are added depending on the phase of the menstrual cycle.
Traditionally, the medical process in violation of the menstrual cycle begins with diagnostic curettage of the uterus, and then, after evaluating the results of the study, further treatment tactics are developed.
In the case when hormonal therapy is ineffective for half a year, surgical intervention is indicated to the patient. It can also be prescribed at risk of developing endometriosis. Currently, minimally invasive laparoscopic surgery is most often performed.
Some authors note that after surgical treatment, a certain number of operated women experience a rapid extinction of ovarian function. Therefore, after surgery, they may be given hormone therapy again.
при развитии вторичного ПКЯ эффект после операции может длиться только около года. Note: with the development of secondary PCOS, the effect after the operation can last only about a year.
When treating polycystic ovary syndrome in obese women, massage and diet therapy are mandatory in the complex of procedures. In parallel, for the normalization of body weight, acupuncture is shown and physical therapy is prescribed.
пациенткам, у которых диагностируется гипоталамо-гипофизарная дисфункция, лечебное голодание противопоказано. Note: patients who are diagnosed with hypothalamic-pituitary dysfunction, medical fasting is contraindicated. Therefore, for weight loss, they are recommended to use prem drugs that correct neurotransmitter metabolism.
Can I do without hormones?
It has long been known that metabolic disorders play a significant role in the development of the pathological process. Therefore, at the very first stage of treatment, efforts should be directed to the normalization of body weight and the correction of primary metabolic disorders.
With the development of secondary polycystic disease, as well as at the initial stage of the disease in the preparatory period before the onset of puberty, many authors do not recommend treatment with the use of hormonal stimulants. And only after adjusting for metabolic abnormalities and reducing body weight by 12–15% can hormone therapy be prescribed.
Some experts, before “sitting down” the patient on hormones or prescribing a surgical operation for her, recommend testing more benign methods. These include low-carbohydrate diet, taking herbal remedies that normalize metabolism and moderate exercise. I would like to note that in some cases it is enough to restore the menstrual cycle and relieve polycystic ovary syndrome.
In order to start the mechanism of processing fat deposits, it is recommended to drink 2-2.5 liters of water daily and take an hour's walk. With a decrease in weight, the insulin resistance of the tissues decreases and the metabolism improves. Some authors emphasize that it was diet in particular that 80% of patients with PCOS helped to restore the menstrual cycle, while 33% managed to get pregnant.
GTF (chromium picolinate) drugs that increase the sensitivity of cellular insulin receptors and reduce insulin resistance have proven themselves well. This is explained by the fact that very often the reason for the decline in glucose tolerance and the subsequent development of type 2 diabetes mellitus is chromium deficiency. However, chromium reduces appetite, and also controls the level of triglycerides and cholesterol in the blood. This drug, which is an active dietary supplement, has been successfully used in weight loss programs for several decades.
Normalize the level of androgens and insulin, as well as reduce the secretion of testosterone capable of some trace elements and vitamins of group B, ascorbic acid and vitamin E.
For the normalization of metabolic processes and hormonal balance, some reputable experts recommend the use of phytoestrogens contained in plants. They, unlike synthetic hormones, even with long-term use do not suppress the production of their own internal secretion products and do not have a carcinogenic effect. At the same time, an important role in the correction of metabolic disorders is played by the normalization of hepatic functions, since it is in it that the hormones are processed, and also the work of the pancreatic gland and the gall bladder is adjusted.
It should be emphasized that it is very difficult to lose weight correctly. As a rule, in various diets weight loss occurs due to fluid loss and due to loss of muscle mass, whereas for effective weight loss the body must be provided with the nutrients necessary to maintain muscle tone. For this purpose, it is also recommended to use special biological additives.
In the case when metabolic disorders occur due to a malfunction of the thyroid gland, it becomes very problematic to lose weight because the human body loses its ability to break down accumulated fats. In order for the thyroid gland to function normally, it should be adequately supplied with iodine.
Unfortunately, worm invasions have become very common lately, however, their role in the development of polycystic ovaries today is not well understood. Therefore, in the case when there is a suspicion of the development of a disease of an infectious nature, antiparasitic therapy is recommended.
Of course, the use of herbal remedies can not guarantee 100% healing from the disease, as indeed, they can not guarantee the traditional methods of treatment of polycystic ovaries. But since the disease can provoke many disorders in various systems and organs, its treatment should be carried out simultaneously in more than one direction and in several directions.
Phytotherapy will help patients who take hormone preparations to mitigate the effects of taking such drugs, as well as speed up rehabilitation processes after surgery and prevent the development of relapse.
Diet for polycystic ovaries
Patients with polycystic ovary syndrome who suffer from insulin resistance are prescribed a diet based on the glycemic index that reduces the consumption of “fast” carbohydrates. They are composed of easily breakable sugars, which, when released into the small intestine, are instantly absorbed and cause an increase in blood glucose. Women suffering from polycystic ovaries are recommended to use the low-carbohydrate Atkins diet. It provides for the rejection of sugar, starch, white flour and confectionery. It is also not recommended to eat potatoes, white bread, crackers, breadcrumbs and ordinary crackers, jam, honey, puddings, etc.
Dairy products that patients can eat do not have to be low in fat. The fact is that unsaturated and saturated dietary fats consumed in moderation are not harmful to the body. Women who are on a low-carb diet are advised not to eat cereals, barley, rice, millet, and corn flakes. For the period of treatment should refrain from tropical fruits, candied fruits, coconut milk and canned fruit. It is allowed to eat apples. Imposes a taboo on sugary and carbonated drinks, industrial juices and nectars, as well as alcohol, but in any quantities you can consume freshly squeezed juices.
From time to time you can afford pasta dishes of durum wheat, grapefruit, dark chocolate, fruit bread, cheese cake, a slice of pizza, savory pastries, new potatoes, kiwi, gooseberries, corn, pomegranate and tangerines.
In parallel, some experts recommend to use the diet of Dr. Peter, which was created taking into account blood groups. According to the author of this diet in people with the same blood group, some products, causing slowing or disruption of metabolic processes, contribute to the accumulation of body fat. They, in the treatment of polycystic ovaries, it would be more reasonable to exclude from their diet.
Complications of polycystic ovary
In addition to impaired reproductive function, polycystic ovarian disease may sooner or later provoke the development of gestational diabetes, arterial hypertension and lead to a significant increase in weight. Women suffering from polycystic ovary syndrome increase the risk of developing coronary heart failure, peripheral vascular disease, clogged arteries and vein thrombosis, myocardial infarction and stroke. Those patients who are on long-term hormonal therapy should be wary of the development of mastopathy, endometriosis, breast cancer and cervical cancer.
Polycystic ovary: a prognosis
In the case when the treatment of polycystic will be appointed in a timely manner, you can get rid of it at the earliest stages. If all medical recommendations are followed, the prognosis of the disease is favorable, and only when planning a pregnancy can certain difficulties arise.