- Forms of polycystic ovary
- Polycystic ovary: etiology and pathogenesis
- Symptoms of polycystic ovary
- Diseases that can mimic polycystosis
- Diagnosis of polycystic ovary
- Polycystic ovary: can I get pregnant?
- Treatment of polycystosis
- Diet for polycystic ovaries
- Complications of polycystic ovary
- Polycystic ovary: prognosis
Polycystic is a hormonal pathology that occurs as a result of disturbances in the hypothalamic regulation of the ovaries. It was carefully studied and described by American gynecologists Stein and Leventhal. This disease occurs with the occurrence of multiple cystic neoplasms on the female genital glands. They are characterized by a significant thickening, and sometimes sclerotic lesions of the belly coat. Polycystic ovarian syndrome occurs in violation of the menstrual cycle, accompanied by obesity, hirsutism (excessive hair), and often causes infertility. With the development of a pathological process on the surface of the ovaries, follicles are formed, in which liquid and unripened eggs are found.
In 1990, a conference on polycystic ovarian syndrome was held in the United States, where consensus was finally reached. Specialists came to the conclusion that when setting this diagnosis, two main signs should be taken into account:
- Unsystematic menstrual cycle;
- Clinical manifestations of hyperandrogenism (high levels of androgens in the blood, male pattern baldness, hirsutism, acne).
Due to the fact that the symptomatology of PCOS (polycystic ovary) is identical with the signs of other hormonal pathologies, at present the diagnosis is made only in the presence of hyperandrogenism.
Forms of polycystic ovary
- Primary (true) PKYA.
- Secondary PKJ (Stein-Leventhal Syndrome).
True polycystic ovary is a pathological process that occurs in women who have normal body weight, and when it develops, there is no increase in insulin levels in the blood. For primary polycystosis is characterized by a more severe course and it is poorly susceptible to conservative and surgical treatment. As a rule, the development of the disease begins during puberty (10-12 years).
Secondary polycystosis is most often found in middle-aged women suffering from excessive body weight and insulinemia. However, this form of pathology can develop against a background of extinction of the ovaries (in the climacteric period). It is much easier to treat and can often be eliminated with the help of conservative techniques.
Many experts believe that polycystic ovary and polycystic ovary syndrome are one and the same pathology, and therefore recommend a treatment aimed at normalizing the hormonal balance, while not taking into account the cause of the disease. However, there is a big difference between these pathological forms. It should be noted that the syndrome of polycystic ovaries is a pathological condition that occurs in 5-10% of women and is considered the most common cause of malfunction in the reproductive system.
To date, clinical practice has adopted the classification of the Stein-Levental syndrome. It is distinguished by:
- Ovary (typical) form;
- Ovarian-adrenal (mixed) form;
- The central form that proceeds with the defeat of the central nervous system.
Polycystic ovary: etiology and pathogenesis
Science has learned about polycystic ovaries more than 100 years ago, but until now, due to the fact that for this pathology is characterized by multiple manifestations, its etiology and pathogenesis have not been fully studied yet.
The main reasons for the PCL are:
- Increased secretion of androgens.
- Resistance to insulin.
- Overweight and obesity.
- Hormonal failures in a single integrative neurohumoral system.
- Constant stress.
- Increased levels of prostaglandins.
- Postponed infectious and inflammatory pathologies.
- Climatic aspects.
The theory of the central origin of the PCJ.
To date, the focus is on the central theory of the development of polycystosis, linking the emergence of the pathological process with damage to the hypothalamic centers and a violation of the production of gonadotropins of LH and FSH.
With insufficient FSH production, enzyme deficiency of the ovaries develops (we are talking about enzymes that catalyze the production of estrogens). As a consequence, androgens accumulate in the female sex glands, which suppress the growth and maturation of follicles and provoke their cystic degeneration.
However, increased production of luteotropin enhances the secretion of androgens, which, in turn, leads to a decrease in the secretion of follicle-stimulating hormone and the production of estrogens.
According to many authors, the development of a pathological condition provokes a violation of the secretion of neurotransmitters, which entails failures in a single integrative neurohumoral system (hypothalamus-pituitary-ovaries-adrenals). However, to this day, the root cause of this kind of violations has not been thoroughly studied.
Also, the central origin of the PCOS is evidenced by increased pituitary production of melatonin (hypermelatoninemia), increased secretion of serotonin and prolactin, and a decrease in the production of thyroid hormones.
в некоторых случаях нарушение работы щитовидной железы может спровоцировать развитие поликистоза яичников. Note: in some cases, disruption of the thyroid gland may provoke the development of polycystic ovaries.
Along with this, morphological changes in the sex glands can occur against the background of menopause, after inflammatory diseases, and also because of the primary defect of the enzyme system. As a result, the production of androgens increases, or the growth and maturation of follicles is disturbed, which leads to malfunctions in the regulatory mechanisms of the female reproductive system.
At the same time, genetic, perinatal, psychogenic and endocrine and unfavorable production factors ( poisoning with heavy metal salts, benzene, etc.), as well as long-term intake of oral contraceptives, can provoke the development of PCOS.
According to experts, 40 different genes (polygenic nature of inheritance) can provoke an increase in androgen secretion. Most often, women with the closest relatives suffering from malignant and benign tumors of the ovaries and uterus are prone to developing the disease. Also, the PCOS is detected in those patients who have a high rate of gestosis in pregnancy, those suffering from obesity, hirsutism, type 2 diabetes and various menstrual disorders. At the same time, 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 unfavorable factors on the fetal organism.
Decreased glucose tolerance
In the course of numerous studies, it was found that the PCOS is a disease that is associated with increased production of insulin. 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, provoked by increased production and resistance to insulin, form a chain of pathological changes, leading to violations of the menstrual cycle, hirsutism, the lack of menstruation and infertility.
40-60% of women who have polycystic ovary syndrome are diagnosed with insulin resistance, often accompanied by obesity. And sometimes with diabetes mellitus type II, there may be a decrease in glucose tolerance even in the absence of obesity.
The role of infectious agents
Many specialists in the development of polycystic ovaries do not exclude the role of an infectious agent. Thus, in anamnesis, patients suffering from PKI of the central genesis may have chronic upper respiratory tract diseases (65%) or childhood infections. Since the ovaries are very closely related to the tonsils, tonsillitis or ARVI can provoke the development of the pathological process.
Symptoms of polycystic ovary
Symptoms of true polycystic ovary
The main symptom of this form of pathology is the violation of the menstrual cycle. Typically, this condition is observed in adolescent girls after the onset of menarche (the first menstruation). With the development of the pathological process on the face, back and neck there is an acne ( acne ). Because of the hyperfunction of the sebaceous glands, there is a rapid contamination of the skin and hair, and therefore, even with the most careful care, they constantly shine and look fat. Gradually begins to progress hirsutism (excessive hair). It appears on the legs, hands, in the groin and even in the chest area. Next, the body weight (up to 10-15 kg) begins to increase and menstrual bleeding delays occur (from one month to six months). Patients complain of drawing pains in the lower abdomen, female sex glands increase in size, infertility develops.
Symptoms of Polycystic Ovary Syndrome
Practically for all forms of the Stein-Leventhal syndrome there are failures of the menstrual cycle, which lead to a violation of the female reproductive function.
Typical (ovarian) form of polycystosis is characterized by oligomenorrhea (short duration of menstruation), or secondary amenorrhea (absence of menstruation within six months or more). Most often this form of pathology is revealed in adolescent girls after the onset of menarche.
For the mixed form of the Stein-Leventhal syndrome, a later onset of menarche is characteristic. In this case, menstrual irregularities take the form of secondary amenorrhea and lead to the development of infertility.
With the central form of the pathological process, the first menstrual period occurs in girls aged 12-13 years, but the menstrual cycle is very unstable, leading to the development of oligomenorrhea or amenorrhoea. As a consequence, the reproductive function is disrupted, spontaneous abortions occur on the short term of pregnancy, or secondary infertility develops.
спровоцировать развитие данной гинекологической патологии могут травмы головного мозга, стрессы и даже первый половой акт (дефлорация). Note: brain injury, stress and even the first sexual act (defloration) can provoke the development of this gynecological pathology.
The main sign of the syndrome of polycystic ovaries is hirsutism (excessive growth of terminal hair according to the male type). Typically, such a siptom is detected in 50-100% of patients, and is often the only complaint with which they turn to a specialist. Excess hairiness develops gradually, after the onset of the first menstruation. Most often, hair growth is noted above the upper lip, on the chin and in the white line of the abdomen. However, for this form of the disease is not characterized by pronounced hirsuism.
In the mixed form of the Stein-Levental syndrome, increased hairiness is observed in 100% of cases. In this, the hair begins to grow on the face, on the legs and on the hips.
In 60-90% of the episodes develops hirsutism with a central form of polycystic ovaries (3-5 years after the onset of menstruation). The most pronounced symptomatology is observed in women of reproductive age. During this period, striae appear on the chest, abdomen and thighs, nails and hair begin to break strongly.
Diseases that can mimic polycystosis
- Pathological processes associated with hypothyroidism of the thyroid gland;
- Tumors of the ovaries and adrenal glands;
- Increased secretion of prolactin (hyperprolactinemia of the pituitary gland).
I would like to emphasize that in the above diseases, the symptomatology is very similar to the signs of the PCOS, and therefore much attention should be given to the diagnosis of the pathological process.
Diagnosis of polycystic ovary
Diagnosis of PCOS includes gynecological examination, ovarian ultrasound and hormonal examination, as well as other supporting techniques.
- Ultrasound scanning. During this procedure, multiple small cysts are found on the surface of the female gonads. As a rule, the affected organs increase in size, their surface becomes bumpy, the capsule thickens. Due to the chronic excess of estrogens, a thickening of the endometrium (inner layer of the uterus) is noticeable on the ultrasound monitor.
- In the analysis of blood for hormonal status, there is an increased concentration of androgens, follicle-stimulating and luteinizing hormones (as well as their ratios). Also during the hormonal examination, a violation of glucose tolerance and an elevated insulin level can be detected.
- In order to be able to "see" the ovaries affected by polycystosis, the patients were shown laparoscopic examination. To date, laparoscopy of the ovaries is the most informative diagnostic technique. With the development of the Stein-Levental syndrome, the capsule of the sexual gland thickens and smoothes, the organ acquires a pearly whitish staining, reaches a length of 5-6 and a width of 4 cm.
- To determine the violation of metabolic processes, the lipid profile of the blood is determined. In polycystic ovaries, the concentration of low-density lipoproteins increases and the concentration of high-density lipoproteins decreases.
- When carrying out the test for glucose tolerance, high blood sugar indices signal a violation of carbohydrate metabolism, that is, the development of hyperinsulinemia.
- Patients suffering from mastopathy are shown mastography or breast thermography.
при гормональных сбоях базальная температура на протяжении всего менструального цикла остается неизменной. Note: with hormonal failures, the basal temperature throughout the entire menstrual cycle remains unchanged. Coarsening of the voice, defeminization and hypertrophy of the clitoris with PCOS, as a rule, is not observed.
Polycystic ovary: can I get pregnant?
Most experts claim that it is possible to get pregnant with PCOS. In clinical practice, there are many cases of successful bearing of a child by patients suffering from polycystic disease. However, for this, during the entire pregnancy, they are recommended maintenance drug therapy.
Treatment of polycystosis
As a rule, the plan of treatment measures is made in accordance with the clinical symptoms of the disease, complaints and age of the patient. Most often, the main goal of treating Stein-Levental syndrome is to restore the female reproductive function. At the same time, therapeutic procedures are carried out in order to prevent hyperplastic processes in hormone-dependent target organs, as well as to eliminate all available signs of the pathological process.
Despite the fact that in recent years in the tactics of treatment of polycystic ovaries have undergone significant changes, until now, official medicine uses only two main treatment methods: hormonal therapy and surgical intervention. However, when the treatment is prescribed, pathogenetic mechanisms and forms of the pathological condition are taken into account.
As a rule, at the early stage of the PCOS, the patient is prescribed hormone therapy, which involves the use of oral contraceptives during three menstrual cycles. At the end of the course, the menstrual cycle normalizes, the development of hirsutism slows down, the ovaries decrease in size, and the process of ovulation is established. Many authoritative authors report that during the estrogen-progestogen therapy there is a spontaneous restoration of the processes of neurotransmitter metabolism.
However, after the abolition of hormonal treatment, the woman often finds new polycystic formations. Thus, the conclusion suggests 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 ovaries. That is why, after the abolition of hormonal treatment, all symptoms return, exacerbated by withdrawal syndrome, accompanied by deterioration of the skin and hair loss. However, not so long ago, the carcinogenic effect of combined oral contraceptives was proved, but far from all experts warn their patients that with age they may have a risk of developing malignant pathologies.
In a typical, mixed and central form of polycystic ovary, hormone therapy courses are usually conducted, depending on the phase of the menstrual cycle, a certain drug is prescribed, and corticosteroids are added.
Traditionally, the treatment process for menstrual disorders begins with a diagnostic curettage of the uterine cavity, and then, after evaluating the results of the study, further therapeutic tactics are developed.
In the case when hormone therapy is ineffective for half a year, the patient is shown surgical intervention. It can also be prescribed if there is a danger of developing endometriosis. Currently, a minimally invasive laparoscopic operation is most often performed.
Some authors note that after surgical treatment a certain number of operated women experience a rapid extinction of ovarian function. And therefore, after surgical intervention, hormonal therapy can be prescribed again.
при развитии вторичного ПКЯ эффект после операции может длиться только около года. Note: with the development of a secondary PCOS, the effect after surgery can last only about a year.
In the treatment of polycystic ovary syndrome in women suffering from obesity, a complex of procedures necessarily includes massage and diet therapy. In parallel, for normalization of body weight, acupuncture is indicated and therapeutic exercise is prescribed.
пациенткам, у которых диагностируется гипоталамо-гипофизарная дисфункция, лечебное голодание противопоказано. Note: patients who are diagnosed with hypothalamic-pituitary dysfunction, therapeutic starvation is contraindicated. Therefore, to reduce body weight, they are recommended a drug pre-medication that corrects the neurotransmitter exchange.
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 aimed at normalizing body weight and correcting primary metabolic disorders.
With the development of secondary polycystosis, as well as at the initial stage of the disease in the preparatory period before the onset of puberty, many authors do not recommend a treatment providing for the use of hormonal stimulants. And only after adjusting for metabolic abnormalities and reducing body weight by 12-15% can be prescribed hormone therapy.
Некоторые специалисты, прежде чем «подсаживать» пациентку на гормоны или назначать ей хирургическую операцию, рекомендуют испытать на себе более щадящие методы. К ним относится низкоуглеводная диета, прием фитопрепаратов, которые нормализуют обмен веществ и умеренные физические нагрузки. Хотелось бы отметить, что в некоторых случаях для восстановления менструального цикла и снятия синдрома поликистозных яичников такого лечения бывает достаточно.
Для того чтобы запустить механизм переработки жировых отложений рекомендуется ежедневно выпивать по 2-2.5 литра воды и совершать часовую прогулку. При снижении веса уменьшается инсулинорезистентность тканей и улучшается обмен веществ. Некоторые авторы подчеркивают, что именно диетотерапия, которая проводилась в стационарных условиях, 80% пациенток с ПКЯ помогла восстановить менструальный цикл, а 33% сумели забеременеть.
Хорошо себя зарекомендовали препараты GTF (пиколинат хрома), повышающие чувствительность клеточных инсулиновых рецепторов и снижающие резистентность к инсулину. Это объясняется тем, что очень часто причиной снижения толерантности к глюкозе и последующего развития сахарного диабета второго типа является дефицит хрома. Вместе с тем хром снижает аппетит, а также контролирует уровень триглицеридов и холестерина в крови. Данный препарат, являющийся активной биодобавкой, уже на протяжении нескольких десятилетий успешно используется в программах похудения
Нормализовать уровень андрогенов и инсулина, а также снизить секрецию тестостерона способны некоторые микроэлементы и витамины группы В, аскорбиновая кислота и витамин Е.
For the normalization of metabolic processes and hormonal balance, some reputable experts recommend using phytoestrogens contained in plants. They, unlike synthetic hormones, even with prolonged intake do not inhibit the production of their own products of internal secretion and do not have a carcinogenic effect. At the same time, the normalization of liver functions plays an important role in the correction of metabolic disturbances, since it is in it that hormone processing occurs, as well as the pancreatic gland and gall bladder.
It should be emphasized that it is very difficult to correctly lose weight. Typically, in different diets, weight loss occurs through loss of fluid and loss of muscle mass, whereas for effective weight loss the body must be provided with nutrients necessary to maintain muscle tone. For this purpose, it is also recommended to use special biological supplements.
In the event that metabolic disorders occur as a result of a failure in the thyroid gland, losing weight becomes very problematic, since the human body loses its ability to break up the accumulated fats. In order for the thyroid gland to function properly, it should be adequately provided with iodine.
Unfortunately, helminthic invasions have recently spread, but their role in the development of polycystic ovaries has not been sufficiently studied to date. 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 phytopreparations can not guarantee 100% of the cure for the disease, as however, traditional methods of treating polycystic ovaries can not guarantee them. But since this disease can provoke a lot of violations in various systems and organs, its treatment should be carried out simultaneously not in one but in several directions.
For patients who take hormonal drugs, herbal medicine will help to mitigate the consequences of taking such medications, as well as accelerate the rehabilitation process after a surgical operation 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, which reduces consumption of "fast" carbohydrates. They consist of easily digestible sugars, which when ingested into the small intestine, are immediately absorbed and provoke an increase in glucose in the blood. Women with polycystic ovaries are recommended a low-carb diet Atkins. It provides for the rejection of sugar, starch, white flour and confectionery. Also, it is not recommended to eat potatoes, white bread, crackers, breadcrumbs and ordinary rusks, jam, honey, puddings, etc.
Dairy products that patients can consume are not necessarily low in fat. The fact is that unsaturated and saturated edible fats, consumed in moderation, are not harmful to the body. Women who are on a low-carb diet, it is not recommended to eat cereals, pearl barley, rice, millet and corn flakes. For the period of treatment should refrain from tropical fruits, candied fruits, coconut milk and fruit canned food. You are allowed to eat apples. It puts taboos on sweet and carbonated drinks, factory juices and nectars, and also on alcohol, however in any quantities you can consume freshly squeezed juices.
From time to time you can afford dishes from pasta of solid wheat varieties, grapefruit, black chocolate, fruit bread, cheese cake, slice of pizza, unsweetened pastries, young potatoes, kiwi, gooseberries, corn, pomegranate and tangerines.
In parallel, some experts recommend using the diet of Dr. Peter, which was created with blood groups in mind. According to the author of this diet, in people who have one blood group, certain foods, causing a slowdown or a violation of the synchronism of metabolic processes, contribute to the accumulation of fatty deposits. They, in the treatment of polycystic ovaries, it is wiser to exclude from their diet.
Complications of polycystic ovary
In addition to impaired reproductive function, polycystic ovary can sooner or later provoke the development of gestational diabetes, arterial hypertension and lead to a significant increase in weight. In women with polycystic ovary syndrome, the risk of developing coronary heart failure, peripheral vascular disease, arterial occlusion and vein thrombosis, myocardial infarction and stroke increases. Those patients who are on prolonged hormonal therapy should be concerned about the development of mastopathy, endometriosis, breast cancer and cervical cancer.
Polycystic ovary: prognosis
In the event that the treatment of polycystic is scheduled in time, you can get rid of it at the earliest stages. If all medical recommendations are observed, the prognosis of the disease is favorable, and only when planning pregnancy can there be certain difficulties.