Other

Polycystic ovary syndrome is possible. Polycystic ovary syndrome, what is it? Symptoms and treatment

Treatment of polycystic ovary syndrome is a long process and not always effective. The form of the disease and provoking factors play an important role.

The main reason forcing a patient with PCOS to seek medical help is infertility.

PCOS is a disease of the reproductive system accompanied by an increase in androgens. Polycystic ovary syndrome has different causes, but one way or another leads to the formation of many follicular cysts in the ovary.

Polycystic ovary syndrome is called Stein-Leventhal syndrome, in which multiple cysts form in the gonads.

The pathology is diagnosed in 5 women out of 100 who are of reproductive age.

Polycystic ovary syndrome has various manifestations that form a clinical picture, culminating in infertility.

Both girls and women who have already given birth are susceptible to the disease. In accordance with individual characteristics, the type of PCOS is determined:

primary – formed during puberty and is accompanied by menstrual dysfunction from menarche;
secondary – develops after the establishment of regular menstruation under the influence of external and internal factors.

Despite the prevalence of the disease, its causes remain unknown to this day.

However, almost all women with polycystic ovaries have hyperandrogenism and insulin resistance.

Factors of occurrence

The etiology and pathogenesis of the disease are being studied by specialists to this day. It is impossible to name clear reasons for the formation of PCOS. However, we can talk about the prerequisites for the disease:

infectious processes occurring in the genitals;
surgical interventions (curettage, abortion, operations);
excess body weight;
diabetes mellitus, pancreatic diseases;
endocrine disorders;
hereditary predisposition;
use of intrauterine contraceptives;
injuries and damage to the pelvic organs.

The pathological process is based on hormonal and endocrine abnormalities, involving the ovaries, adrenal glands, hypothalamic-pituitary system, and pancreas.

Complex changes in the functioning of the body, dependent on each other, are accompanied by an increase and thickening of the capsular covering of the ovary.

As a result of gynecological changes, a hormonal imbalance occurs and a persistent increase in the level of male hormones - androgens.

Symptoms of PCOS

Signs of a hormonal disorder may have a pronounced clinical picture or be mild.

The period of onset of the disease in women with a secondary form of PCOS is clearly noticeable.

The following manifestations of multicystic disease can be distinguished:

menstrual irregularities (lack of ovulation, high levels of androgens lead to a delay in monthly bleeding for up to six months, which is replaced by heavy periods);
a change in the girl’s appearance that is not the type of woman (the greasiness of the hair increases, the face becomes covered with acne, and symptomatic treatment of hirsutism and acne does not give positive results);
obesity (distortion of carbohydrate-lipid metabolism leads to the formation of a fat layer according to the male type or evenly throughout the body, often accompanied by diabetes mellitus);
hirsutism - excessive on the face, groin area, chest and thighs (caused by the result);
abdominal pain (caused by enlargement of the ovarian capsule, proliferation of gonad tissue and displacement of neighboring organs);
lack of ovulation (accompanied by the following signs - stability of BT, negative tests, infertility and a corresponding ECHO picture).

In the primary form of PCOS, it can be difficult for a girl to catch the first manifestations of the disease, since after menarche the cycle may be irregular, which is a natural process of formation.

In addition, this form of pathology is not accompanied by obesity, hair growth and distortion of the skin structure.

First of all, parents should suspect the disease based on signs such as cycle disturbances and abdominal pain.

Diagnosis of the syndrome

If there is a suspicion of polycystic ovary syndrome, an ultrasound will be the first diagnostic procedure that the doctor will prescribe after a manual examination.

A gynecological examination may show enlargement of the gonads and a discrepancy between the size of the reproductive organ and the day of the menstrual cycle.

Based on the patient’s additional complaints, already at this stage of diagnosis it is possible to assume the nature of the pathology.

However, it can only be confirmed using ultrasound scanning. The ECHO picture for PCOS has the following indicators:

the volume of the gonads is more than 9 cm;
the capsule is thickened;
the stroma is hyperplastic;
there are more than 10 cyst-shaped ones, the size of which is up to 10 cm;
the endometrium is thin and does not correspond to the day of the menstrual cycle.

An ultrasound sign of secondary polycystic ovary syndrome is the formation of cysts along the periphery of the gonad, which is often compared to a necklace.

In the primary form of PCOS, cysts do not have a specific localization and form chaotically, forming multiple clusters.

An additional criterion in establishing the diagnosis of PCOS is laboratory blood tests: FSH and LH (ratio), progesterone, androgen, testosterone, estradiol, sugar level.

Treatment of polycystic disease

PCOS is treated using different methods. The effectiveness of the same procedure may be different for each patient.

Therefore, based on the etiology, pathogenesis, clinical picture and examination results, the doctor chooses the most appropriate therapeutic method.

In the secondary form of PCOS, drug therapy gives good results. It includes hormonal correction and the use of symptomatic medications.

In the case of the formation of primary polycystic disease, surgical treatment is usually resorted to.

However, for both forms of the disease, it is advisable to carry out measures aimed at the general improvement of the female body.

Treatment of excess hair growth

Modern cosmetology offers effective ways to eliminate it.

However, they all involve eliminating the consequences, not the root causes.

Normalization of body weight

Diet for PCOS is an important point in treatment. With a decrease or even a slight decrease in weight, the condition of the female body improves significantly.

There are cases where proper nutrition alone helped normalize hormonal levels and cure secondary polycystic ovary syndrome.

Moderate physical activity and adherence to the following rules will help to cope with the problem:

limit the amount of kcal consumed to 1500;
eat 5-6 times a day;
lean on low-calorie foods (vegetables and fruits);
consume a lot of protein (lean meat, fish, dairy products);
replace animal fats with vegetable ones;
give up sweets and carbohydrate foods;
exclude alcohol in any form;
Arrange fasting days 2-3 times a week.

If this is necessary, then drugs that regulate metabolism are additionally prescribed: Sibutramine or Orlistat.

For reference!

Establishing a normal weight contributes to the proper functioning of the endocrine system and hormone-producing organs. A healthy body mass index also helps medications be better absorbed.

Regulation of menstrual function

After the correct body weight has been restored or at least the first steps have been taken towards this, the patient is prescribed drug therapy that involves restoring menstrual and reproductive function.

Clomiphene – a drug to stimulate ovulation, creates conditions for the possibility of becoming pregnant with secondary PCOS. It has virtually no effectiveness if the disease develops in its primary form.

HCG-based products – are introduced to stimulate rupture of the follicle, if its size is at least 18 mm. Preferably used in primary PCOS.

Medicines with progesterone are prescribed to maintain the second phase of the cycle and regulate the timing of menstruation.

To restore menstrual function, gestogens and progestogens are prescribed.

If insulin resistance is diagnosed, then its analogues are prescribed.

The lack of a positive result with drug treatment and nutritional correction is a reason for surgical intervention.

Operation

Surgical treatment of PCOS shows good results, especially in patients with the primary form of the disease.

The treatment method chosen is laparoscopy, and less commonly, laparotomy.

The procedure involves wedge resection of the ovaries, which is most effective. Also in certain cases, electrocautery of the ovaries or decapsulation is practiced.

Surgical treatment is performed under general anesthesia, and the operation lasts no more than 1-2 hours.

Traditional methods

Alternative remedies rarely help cure PCOS.

Folk remedies can cope with increased levels of insulin in the blood, normalize metabolism, slightly affect hormonal levels and establish proper endometrial growth.

At the same time, it will be difficult to eliminate the dense capsule, cause the resorption of the resulting cysts and restore fertility.

Inept and uncontrolled use of herbs and phytohormones can aggravate the course of the pathology.

The effect of PCOS on pregnancy

Polycystic ovary syndrome has a bad effect on pregnancy. The disease does not allow ovulation to occur, and this, in turn, creates a state of infertility.

Some women manage to miraculously become pregnant with polycystic glands. However, problems begin already during gestation.

The main one is hormonal imbalance and lack of progesterone.

If you manage to get pregnant with polycystic disease, you should immediately seek help from a doctor. Otherwise, there is a high probability of miscarriage in the early stages.

Features of the functioning of FSH and LH

Possible complications, prognosis and prevention

The prognosis for treatment of polycystic ovaries is favorable. Women who have undergone drug therapy have a greater chance of conceiving naturally.

If treatment with drugs does not help, then decortication of the ovaries, at least temporarily, will eliminate the symptoms of the disease and increase the likelihood of pregnancy. Complications of PCOS include:

persistent infertility;
breast or endometrial cancer;
type 2 diabetes;
arterial hypertension;
cardiovascular diseases;
inflammation and fatty liver;
gestational diabetes and preeclampsia in case of pregnancy.

There is no specific prevention for PCOS.

To reduce the likelihood of disease, you should lead a healthy lifestyle, moderate physical activity, treat diseases of the genital organs in a timely manner and regularly visit a gynecologist.

Polycystic ovary syndrome (PCOS) is the most common problem associated with hormonal imbalance, although the manifestations of this condition are not always the same among women. Polycystic ovary syndrome is not one disease, but a set of symptoms. It is diagnosed based on a number of signs, the main one being the absence of regular ovulation.

Other common symptoms women experience with PCOS are hair loss and hirsutism (excessive hair growth on the body and face). Also, with PCOS, women very often have problems conceiving, since ovulation occurs extremely irregularly, which can also affect the quality of the eggs. Inability to ovulate occurs due to insufficient amounts of estradiol and progesterone. Because of this, testosterone rises and secondary symptoms of polycystic ovary syndrome develop, such as hair loss, acne and infertility.

If you have been diagnosed with PCOS, determine which type of polycystic disease you suffer from. Thanks to this, you can radically change the method of therapy and achieve faster success in treatment.

To be correctly diagnosed with polycystic ovary syndrome, the patient must have any two of the following three signs (according to established criteria, Rotterdam, 2003):

Oligomenorrhea, amenorrhea (menstrual dysfunction) or anovulation (lack of regular ovulation).
Excess androgens (“male hormones”) – measured through laboratory testing (testosterone, DHEA and androstenedione) and based on symptoms such as acne and hair loss.
Polycystic ovaries are visualized using ultrasound: follicles grow but do not ovulate (“pearl necklace”).

The main rule: you should never make or accept from a doctor a diagnosis of “polycystic ovary syndrome” based only on ultrasound data. It is better to consult an experienced doctor who can correctly diagnose all the symptoms and identify the cause of the disorder.

Polycystic ovary syndrome is useless to treat until the root cause of the lack of ovulation in each specific case is established. The causes of polycystic disease may vary from girl to girl. This is why so often natural remedies work well for one woman with polycystic ovary syndrome and are not suitable for another.

Below is a brief overview of the four types of PCOS, thanks to which you can first determine whether you have this disorder and what caused it.

TYPES OF PCOS: CAUSES OF POLYCYSTIC OVARIAN DISEASE

Insulin-resistant polycystic ovary syndrome

This is the “classic” and most common option. The culprit in the development of this type of PCOS is that the body becomes less sensitive to insulin, causing levels of sugar and this hormone in the blood to become unbalanced. High insulin and leptin prevent ovulation and stimulate the ovaries to produce testosterone.

What is the reason? Insulin resistance is caused by obesity, excessive consumption of sugar and trans fats, smoking, and environmental toxins.

Diagnostics. Check your fasting insulin and glucose levels. LH (luteinizing hormone) or cholesterol levels may also be elevated. Obesity may be present. Normal weight with insulin resistance can occur after dieting or eating disorders.

Treatment. The first step is to avoid high consumption of sugars. The best supplements for insulin resistance are magnesium, lipoic acid, alpha lipoic acid or R-lipoic acid, and berberine. OCs are not a treatment for this type of PCOS because they only worsen insulin sensitivity. Improvement in this type of polycystic ovary syndrome begins to appear gradually, after about six months of treatment.

Immune system related PCOS

This is the second type of polycystic ovary syndrome, which occurs due to chronic inflammation. Inflammation interferes with ovulation and disrupts hormone receptors, stimulating the production of adrenal androgens such as DHEA sulfate. Women who have a history of immune dysfunction and autoimmune conditions (including family members) are more likely to develop this type of PCOS. Inflammation, or chronic activation of the immune system, can result from stress, environmental toxins, gut permeability, and inflammatory foods such as gluten or A1 casein.

Cause. Dysfunction of the immune system causes chronic inflammation, which ultimately leads to elevated androgens. Usually in such cases, someone in the family has autoimmune diseases or the woman herself has a history of skin diseases, recurrent infections or joint pain. Symptoms such as recurring infections and headaches may also occur.

Diagnostics. Blood tests for inflammatory markers such as CRP (C-reactive protein), ESR, vitamin D deficiency, thyroid antibodies (anti-TPO), and food sensitivities/allergies should be considered first. There may be deviations in the general clinical blood test. Also, the girl in this case may have elevated DEA-S04 and adrenal androgens.

Treatment. Reduce stress and exposure to environmental toxins such as pesticides and plastics. Eliminate inflammatory foods from your diet - wheat, dairy products and sugar. Treat gut permeability with zinc, berberine and probiotics. Take magnesium supplements - they are anti-inflammatory and normalize adrenal hormones. Improvement occurs slowly and gradually over 6-9 months.

Polycystic ovary syndrome after taking hormonal contraceptives

This type of polycystic disease is one of the most common and to some extent easier to treat. At least it's easier to diagnose and the cause is pretty obvious. In addition, such polycystic disease can be treated much better and faster using natural remedies. It occurs after the use of oral contraceptives. Birth control pills suppress ovulation. For most women, the body returns to normal function within about the first six months, but for some this period drags on for years and requires treatment.

This is the second most common type of PCOS. And since there is a reason why it occurs, it must be reversible.

What is the reason? After taking pills for a long time and being forced to “rest,” it is difficult for the body to restart its own process of producing estrogen and progesterone.

Diagnostics. It often happens that a girl had regular periods before taking COCs, and the pills were prescribed to her for contraception or to fight acne. These women may also have elevated levels of LH (luteinizing hormone) and possibly prolactin.

Treatment. If LH is elevated, it is best to use natural treatments with herbs such as peony and licorice. If prolactin is high, then grass helps. However, you should not take Vitex if your LH levels are elevated! Vitex stimulates LH, so the situation with PCOS can only get worse. Because of this, many women with polycystic ovary syndrome feel even worse after Vitex. Do not take it if your blood luteinizing hormone is already high.

Both peony and chasteberry work on the pituitary-ovarian axis and are powerful herbs. They are not recommended to be used too early in the morning or late in the evening. Do not take them if you have not yet completed puberty or are just stopping drinking OK. Wait at least 3-4 months after stopping the pills. Do not use peony or chasteberry for more than 10-12 weeks at a time. They shouldn't take that long. If they suit you, they will start working fairly quickly (within 3-4 months). Further, after stopping their use, menstruation should remain regular. Do not take licorice if you have high blood pressure. It is best to consult an experienced doctor before starting treatment.

Polycystic ovary syndrome associated with poor ecology and external circumstances, or PCOS of unknown etiology

In this case, it is important to find the exact cause of polycystic ovary syndrome. You need to find out what foods, drugs or habits affected hormonal levels and ovulation. Usually in this case there is one reason that blocks it. Once found, PCOS usually goes away within 3-4 months. Common hidden causes of polycystic disease most often include:

too much soy in the diet, because it is also an anti-estrogen and can block ovulation in some women (a small amount is not harmful);
diseases of the thyroid gland, since the ovaries require the hormone T3;
a vegetarian diet because it causes zinc deficiency;
iodine deficiency - iodine is needed by the ovaries;
artificial sweeteners, as they worsen sensitivity to insulin and leptin;
too little starch in the diet, as the hormonal system needs a low-carbohydrate diet.

If the cause is found correctly, treatment should quickly help restore the functioning of the endocrine system.

Cause. These women have increased sensitivity, so even food choices can affect the body's ability to ovulate. There are girls who restore ovulation after giving up all soy products or sweeteners. It is also important to rule out thyroid disease, as hypothyroidism can interfere with normal ovulation.

Diagnostics. If you don't fit into any category of other types of PCOS or don't respond well to treatment, it may be due to your thyroid or lifestyle/habits.
Of course, it's not always possible to know exactly what type of PCOS you have, and symptoms can be mixed. Therefore, to accurately determine the cause, a woman may need to undergo an ultrasound and donate blood for hormones for some time. Don't accept the diagnosis of polycystic ovary syndrome too quickly. Proper diagnosis requires a blood test to show high levels of testosterone and other male hormones such as androstenedione and DHEA. Never accept this diagnosis if it was made from only one ultrasound examination (without a blood test for hormones).

The diagnosis of PCOS in gynecology has become quite common over the past ten years. A similar diagnosis is made to many women with infertility and irregular menstrual cycles. Many doctors consider it a peculiar disease of the 20th century. Is this really true?

Even in past centuries, many doctors paid attention to certain women who complained of “infertility” and irregular menstrual cycles. These women had a very typical appearance: overweight, with excess male-pattern hair, oily, acne-prone skin and a rough voice. Therefore, it is difficult to call PCOS a modern disease. The widespread diagnosis of PCOS is due to its frequent and unjustified use. In fact, there are quite clear criteria for making such a diagnosis, which we will discuss below.

PCOS: what is it?

The historical name of the disease PCOS is Stein-Leventhal syndrome. The decoding of the abbreviation in gynecology sounds like polycystic ovary syndrome. The disease is named so because of the typical appearance of the ovaries, which in ancient times doctors paid attention to at autopsies of patients who died from other diseases, and today’s doctors see altered ovaries on ultrasound or during operations.

No one yet knows the true causes of the disease. It is assumed that there is a relationship with the characteristics of a woman’s carbohydrate metabolism, since a low-carbohydrate diet and weight loss leads to a significant improvement in the clinical picture.

Symptoms of PCOS

Classic PCOS syndrome is accompanied by a triad, or three main symptoms.

Firstly, against the background of a chronic lack of ovulation. Taking into account anovulatory cycles, these patients experience menstrual irregularities such as long delays (up to six months or more). It is the chronic absence of ovulation that determines the characteristic appearance of the ovaries:

the ovaries are enlarged in volume;
their tissue consists of many small cystic inclusions;
these cysts are formed in place of follicles that were “trying” to mature, but which froze due to excess luteinizing hormone.

Secondly, virilization or changes in appearance according to the male type:

excess hair growth on the body and face,
deepening of the voice
increased skin greasiness,
acne (pimples),
deepening of the voice.

Thirdly, obesity. Along with excess weight, the patient necessarily has signs of carbohydrate metabolism disorders:

increased amount of insulin
borderline or elevated blood glucose values,
decreased glucose tolerance.

With PCOS, this triad of symptoms may be present in full, although in some cases the patient may experience one or two symptoms. In patients, a similar picture may be present since adolescence or appear against the background of stable menstrual function and even after a successful pregnancy and childbirth.

Diagnosis of PCOS

Recognition of the syndrome is truly the cornerstone of modern gynecology. We can safely say that every second patient with infertility and cycle disorders is diagnosed with PCOS.

In fact, there are clear criteria for making such a diagnosis, defined by the World Congress of Obstetricians and Gynecologists.

First, the presence of at least one symptom from the triad:

infertility due to anovulation;
hyperandrogenism;
obesity.

Secondly, the presence of the following laboratory indicators:

increasing testosterone levels,
increased levels of adrenal hormones;
high insulin levels
high blood sugar levels and low glucose tolerance.

An important laboratory criterion for sex hormones is a monotonous increase in the level of luteinizing hormone (LH).

Thirdly, the ultrasound picture. It is precisely in this matter that the most stringent diagnostic criteria exist, since many ultrasound doctors take responsibility for this diagnosis without following the order of the study:

The ovaries with PCOS are always enlarged on both sides;
The ovaries have a volume of at least 10 ml or cm 3;
The ovary contains at least 12 follicles with a diameter of 2 to 9 mm in volume;
When examining the patient over time, there is no growth of the dominant follicle and ovulation does not occur.

The patient must have all these ultrasound signs, only then can the doctor make such a conclusion. In practice, the diagnosis of PCOS is often made to patients whose ovarian volume was not even measured by ultrasound.

Treatment of PCOS

The main criteria by which one or another treatment regimen is selected are the woman’s reproductive plans. It is very important to consider whether a woman is planning a pregnancy and, if so, in what time frame.

If the patient does not currently intend to become pregnant, she should still receive treatment. Treatment in this case will be aimed at:

stabilization of hormonal levels;
weight loss;
reduction of external “male” signs, which often psychologically traumatize patients.

Such women are usually prescribed hormonal contraceptives to stabilize hormonal levels and reduce the volume of the ovaries.

If a woman, then all efforts of doctors should be aimed at creating ovulatory menstrual cycles. As a rule, in this case they resort to ovarian stimulation with special drugs:

clomiphene or

Before stimulating the ovaries, it is necessary to ensure that there are no other causes of infertility, such as thyroid dysfunction or blocked fallopian tubes. It is also important to test your spouse's sperm for fertility.

A very important step for both treatment options is a diet aimed at reducing glucose levels. Normalizing weight and reducing carbohydrate load in some cases without any medications lead to spontaneous recovery and pregnancy.

At this stage, contact and joint work of the gynecologist and endocrinologist are very important. The endocrinologist must carefully examine the patient and describe in detail how to lose weight. Some patients are even advised to take glucose-lowering medications. The gold standard for such therapy is metformin. The regimen for taking this drug is purely individual and is determined by the doctor after a detailed examination.

Alexandra Pechkovskaya, obstetrician-gynecologist, especially for the site

PCOS (PCOS) in gynecology stands for and is translated as. Women with PCOS have problems with hormonal balance and metabolism, which can affect their overall health and appearance. PCOS is also a common cause of infertility due to lack of ovulation - the egg does not develop or release properly.

SLEEP SYMPTOMS

PCOS is characterized by many symptoms, including menstrual irregularities or absence of periods, bleeding and pelvic pain, acne, increased facial and body hair growth, ovarian cysts, and (sometimes) metabolic problems related to insulin sensitivity and sugar regulation. in the blood. It is the most common endocrine disorder among women. Polycystic ovary syndrome affects approximately 5–10% of women aged 18–44 years (among them), that is, approximately 1 in 10 women of childbearing age.

Although PCOS, as the name suggests, is characterized by the presence of ovarian cysts, this symptom alone does not make a diagnosis. Cysts are a consequence of a disruption in the endocrine system, and not its cause. In addition, some women diagnosed with PCOS do not find cysts at all during ultrasound.

How is PCOS diagnosed?

There is no single test to diagnose PCOS. Typically, your doctor will do the following to rule out other causes of your symptoms:

Physical examination

The endocrinologist measures blood pressure, body mass index (BMI) and waist size, and also examines the skin to detect acne or pigmentation. Your doctor may order additional thyroid function tests to rule out this disorder.

Gynecological examination

If PCOS is suspected, the gynecologist should examine the girl to identify signs such as an enlarged clitoris or enlarged ovaries.

Ultrasound examination

The presence of cysts on the ovaries and the condition of the endometrium are checked.

Blood test

Blood tests for PCOS check the levels of androgen hormones, thyroid hormones, and other sex hormones. Your doctor may also order cholesterol checks and tests to screen for diabetes.

CAUSES OF SLEEP

Currently, when women are suspected of having insulin, they first measure their insulin and subsequently treat or prevent type 2 diabetes mellitus.

HOW TO TREAT SLEEP

Many of the symptoms of PCOS, such as acne and increased facial hair growth, as well as menstrual irregularities, are a consequence of increased levels of male hormones - androgens. Therefore, treatment for PCOS most often consists of hormonal therapy, which should restore the balance between male and female hormones in the girl’s body. In addition, medication is often used to regulate blood sugar levels.

Since millions of women suffer from diabetes around the world, insulin resistance is indeed the main cause of polycystic ovary syndrome in many of them. Elevated insulin levels stimulate the ovaries to increase the production of androgens, disrupting the ratio of male and female hormones in the body, which subsequently leads to many manifestations of PCOS.

While there is no specific treatment for PCOS, the goal of treatment is generally to manage symptoms and reduce the risk of long-term health problems such as diabetes and heart disease.

Weight loss

Healthy eating habits and regular physical activity can help relieve symptoms associated with PCOS. Losing weight often helps lower blood glucose levels and reduce insulin resistance. Even a 10 percent loss of body weight can make your menstrual cycle more regular and increase your chances of getting pregnant.

Hair removal and retardation of hair growth

Creams, laser hair removal or electrolysis are used to remove excess hair. Prescription creams such as eflornithine HCl (Eflora, Vaniqa) can slow the growth of new hair in unwanted areas.

Treatment of PCOS with medications

In this case, birth control pills, patches, vaginal rings and intrauterine devices (IUDs) are used. may be prescribed to block the action of androgens, reduce hair loss on the head, reduce hair growth on the face and body, and treat acne. They are not a cure for PCOS and do not treat the cause of the hormonal disorder. As a rule, they only work when taken. come back and sometimes appear stronger than before. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. Drugs containing metformin improve insulin sensitivity and can, in addition to this hormone, reduce androgens. After several months of use, metformin may restart ovulation, but it usually has little effect on acne and excess hair. However, it may have other beneficial effects, including reducing body weight and cholesterol levels.

How to treat PCOS to get pregnant

Weight loss and diet

If a woman is overweight or obese, a healthy diet, the right amount of calories and physical activity can help make her menstrual cycle regular and improve her fertility.

Medicines

To stimulate ovulation, your doctor may prescribe certain medications, such as clomiphene (Clomid).

In Vitro Fertilization (IVF)

In this case, the egg is fertilized in a laboratory and then placed in the uterus. IVF has high pregnancy rates even in women with severe PCOS.

Surgery

Surgery is considered when other options fail. Laparoscopy usually restores ovulation, but usually only for a period of six to eight months.

Pregnancy with PCOS

Having PCOS does not mean that a woman cannot become pregnant. Polycystic ovarian disease is one of the most common but treatable causes of infertility. In PCOS, a hormonal imbalance interferes with the growth and release of eggs (ovulation). If a woman does not ovulate, she cannot become pregnant.

How does PCOS affect pregnancy?

PCOS can cause problems during pregnancy for both the woman and the baby. Women with PCOS have a higher chance of:

miscarriage,
gestational diabetes (diabetes mellitus during pregnancy),
preeclampsia (complication of pregnancy),
caesarean section.

How can you prevent problems with PCOS during pregnancy?

A woman can reduce her risk of problems during pregnancy by:

Healthy weight. You need to reach your optimal weight before becoming pregnant.
Achieving normal blood sugar levels before pregnancy. It can be done. by combining good nutrition with regular physical activity, weight loss and medications such as metformin.
Taking folic acid. To prescribe the dosage, you must consult your doctor.

Consequences of PCOS and impact on health

Research has found a link between PCOS and other health problems, including:

Diabetes

More than half of women with PCOS develop diabetes or prediabetes before age 40.

High blood pressure

Women with PCOS are at greater risk of hypertension (high blood pressure) compared to women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke.

High cholesterol

Women with PCOS often have high LDL (“bad”) cholesterol and low HDL (“good”) cholesterol. This ratio increases the risk of cardiovascular disease and stroke.

Sleep apnea

This term refers to short-term and repeated stops in breathing during sleep. Many women with PCOS are overweight or obese, which can cause sleep apnea, which increases the risk of heart disease and diabetes.

Depression and anxiety

Depression and anxiety are more common among PCOS sufferers than among healthy women.

Endometrial cancer

Obesity, insulin resistance and diabetes, as well as problems with ovulation, increase the risk of developing endometrial cancer.

PCOS and menopause

PCOS affects many systems in the body. Some women with PCOS experience more regular menstrual cycles as they approach menopause. However, hormonal imbalance does not change or go away with age, so even during menopause, PCOS symptoms may persist. Additionally, risks associated with PCOS, such as diabetes, stroke, and heart attack, increase with age. They are higher in women with PCOS than in healthy women.

A woman’s ability to conceive largely depends on how her ovaries function, in which an egg must mature each menstrual cycle.

Stable functioning of the female reproductive glands ensures regular menstruation and ovulation, but some women are forced to struggle with the diagnosis of PCOS, which not only becomes a serious obstacle to pregnancy, but also provokes the appearance of other endocrine pathologies.

What is it? PCOS - this disease stands for polycystic ovary syndrome and involves the presence of many small follicles that significantly increase the volume of the female reproductive gland.

Clinical picture on ultrasound

Ultrasound examination reveals multiple follicles up to 10 mm in diameter. They are localized along the edge of the ovary and resemble a necklace in their arrangement.

When measuring the parameters of this reproductive organ, it turns out that its width is more than 30 mm, its length is more than 37 mm, and its thickness is more than 22 mm. In general, the volume of the polycystic ovary exceeds 10 cm3. The follicle capsule is often thickened, which prevents it from rupturing during the LH surge before ovulation.

Symptoms of PCOS (polycystic ovary syndrome)

Signs of ovarian dysfunction and the presence of polycystic disease will be noticeable to every woman, since this pathology cannot be asymptomatic. To provide a more complete picture of the clinical picture, the doctor, in addition to the ultrasound results, will also take into account the patient’s complaints.

Symptoms of polycystic ovary syndrome include the following:

Infertility – is a consequence of the lack of ovulation. They may not occur at all, or may occur very rarely: 2-3 times a year. The inability to conceive a child may also be due to the fact that the dominant follicle in PCOS tends to either regress or develop into a follicular cyst.

The latter option is much more common, because the follicle capsule with this diagnosis is significantly thickened.

Large delays in menstruation – are associated either with anovulatory cycles or with prolongation of the first phase of the cycle, when a dominant one does not stand out from the many antral follicles for a long time.

High testosterone levels – is formed as a result of dysfunction of the ovaries and adrenal cortex, which begin to produce too much androgens. Exceeding the norm of these hormones slows down the maturation of the egg, prevents the growth of the endometrial layer and causes thickening of the capsule of the dominant follicle.

In addition, an increase in the level of androgens also affects a woman’s appearance in the form of hirsutism and male-type obesity.

Regular pelvic pain - have an aching character and appear due to the fact that enlarged ovaries compress the pelvic organs.

Pain can be intense towards the middle of the cycle, when multiple follicles in the ovaries begin to increase and exceed a volume of 10 cm3.

Chest pain – throughout the entire cycle, the mammary glands are sensitive, sometimes there is a tingling sensation and a feeling of swelling. Normally, these symptoms may be present in a woman several days before menstruation, but with polycystic ovary syndrome they are constant.

PCOS is considered one of the most important diseases in gynecology. And if, for example, in case of obstruction of the fallopian tubes, IVF can help, then in the case of ovarian dysfunction, even conception in a test tube often becomes impossible: either it is not possible to stimulate superovulation, or improper production of hormones will kill the implanted embryo that has already attached to the uterus.

Types of PCOS

Gynecologists, based on the results of ultrasound examination, distinguish 2 types of polycystic disease: diffuse and peripheral. They have different symptoms and have different effects on the well-being of patients.

Diffuse location of follicles (type I polycystic disease) - suggests that the follicles do not have a specific location in the ovary and are scattered in the stroma.

Such patients often have normal body weight, mild manifestations of hirsutism, secondary amenorrhea and resistance to the drug Clomiphene (stimulates ovulation). In 10–12% of women with type I polycystic disease, the ovaries are able to ovulate regularly.

Peripheral location of follicles (II polycystic disease) is more common and in obstetric practice is considered classic PCOS.

The follicles are located along the edge of the stroma and look like a necklace. Such patients are often obese and have a history of pregnancies that ended in early miscarriages.

From time to time, women even experience ovulation, but almost always luteal phase deficiency (LPF) is diagnosed.

The type of polycystic disease can only be determined using ultrasound. A treatment regimen for PCOS should be prescribed only after studying the location of follicles in the ovaries and the frequency of ovulation.

To determine how much polycystic ovary syndrome can affect the process of bearing a child, you need to keep in mind two main effects that such a pathology has on the reproductive sphere:

Increased androgen levels;
Presence of thin endometrium.

Both pose a danger to the embryo. High testosterone can cause miscarriage in both early and late stages of pregnancy.

Therefore, the woman is prescribed special hormonal therapy and is recommended to constantly monitor the concentration of androgen levels in the blood.

Thin endometrium can be an obstacle to the implantation of the fertilized egg and the cause of its detachment in the first 3-4 weeks of pregnancy. The mucous layer of the uterus, which is thin, is not always able to sufficiently nourish the embryo and create a good network of blood vessels for it.

Diagnosis of PCOS

Currently, it is customary in the world to diagnose polycystic ovary syndrome if the doctor detects two of the three following symptoms:

Oligomenorrhea (rare menstruation) - occurs with PCOS against the background of anovulation. Confirmed by the results of folliculometry, which is carried out over 7-8 months.
Hyperandrogenism – occurs in PCOS due to dysfunction of the ovaries and adrenal cortex. Confirmed by blood tests for androgens (testosterone and dehydrotestosterone).
Sonographic signs of polycystic ovaries require an assessment of the results of ultrasound diagnostics. Moreover, this diagnosis must be carried out at least twice per cycle: at the beginning and at the end.

The presence of two out of three conditions gives rise to a diagnosis of PCOS if a woman has excluded any other reasons why polycystic disease could have formed.

Treatment of PCOS (polycystic ovary syndrome)

Ovarian dysfunction is quite difficult to treat. After all, we have to work to restore the normal functioning of not only the female reproductive glands, but also the entire endocrine system.

Otherwise, PCOS treatment will only bring temporary results. Therefore, the gynecologist-endocrinologist faces the following tasks that require consistent solutions:

Normalization of the patient’s metabolism and body weight;
Restoration of regular menstruation against the background of ovulatory cycles;
Restoration of the endometrial structure in the uterus;
Fight against hirsutism,

Previously, doctors actively used surgical treatment to treat polycystic disease, in addition to prescribing medications. But over time, it became clear that operations are not always possible, and gynecologists focused on improving drug therapy. Currently, both conservative treatment methods and surgical methods are used to combat PCOS.

Drug therapy for PCOS

Stage 1 of treatment: normalization of metabolism and body weight

The better the body can absorb food, the fewer problems there will be with excess body weight - this is what many patients with PCOS suffer from. For this, the following drugs may be prescribed:

Sibutramine - the action is aimed at increasing the feeling of satiety, as a result of which the patient gets rid of the constant desire to eat food. Taking the drug is contraindicated in patients with cardiovascular diseases, even if they have occurred before.
Orlistat – interferes with the absorption of fats. This has a positive effect on the process of losing weight.

Normalizing body weight forces the pituitary gland and hypothalamus to work in a new way, produce hormones in the required concentration, or allow the body to be receptive to further treatment.

Stage 2 of treatment: restoration of menstruation, ovulation cycles

After the body has ceased to be burdened with excess weight, it becomes possible to improve the functions of the endocrine glands. To restore ovulation in PCOS, the following drugs are used:

Clomiphene is a drug that has proven its effectiveness for a long time, and therapy with its participation is actively used by gynecologists to this day. However, it must be taken into account that only representatives of the classical (second) type of PCOS are susceptible to it.
HCG drugs are administered if the patient has the first type of polycystic ovary syndrome, as well as in situations where ultrasound reveals a thickened follicle capsule, the integrity of which cannot be damaged without special stimulation. HCG preparations are administered intramuscularly when the dominant follicle reaches a size of 18 mm.
Synthetic analogs of progesterone are prescribed to maintain the second phase of the menstrual cycle.
Puregon (analogue - GonalF) is a follicle-stimulating hormone (FSH) drug prescribed to patients with clomiphene resistance. The peculiarity of these drugs is that while taking them, the smallest number of cases of ovarian hyperstimulation syndrome (OHSS) was observed.

Stage 3 of treatment: restoration of endometrial structure

The choice of drugs will depend on the success of stage 1 of treatment for PCOS, which involved reducing the patient’s body weight.

Estrogens are prescribed to patients who are not overweight. These can be COCs (combined oral contraceptives): Zhanine, Novinet, Regulon.
Progestogens are prescribed to patients whose body weight is higher than normal. Among them are Duphaston, Megestron, Medroxyprogesterone-LENS, Utrozhestan. It is important that progestogen drugs are selected that do not have androgenic activity.

Stage 4 of treatment: combating hirsutism

The last stage of treatment for PCOS is often carried out simultaneously with the restoration of the endometrial structure; it also involves taking a COC with an antiandrogenic effect.

Dexamethasone – regulates the activity of the adrenal cortex, has a strong antiandrogenic effect. The dosage should only be prescribed by a doctor. It should be borne in mind that if high doses of dexamethasone are suddenly discontinued, androgen production may increase.
Diane-35 – contraceptives. For the treatment of hirsutism, 1 tablet per day is used for 21 days. Has a pronounced antiandrogenic effect.
Cortisol is a steroid hormone that regulates the functioning of the adrenal cortex. The hormone itself begins to be actively secreted by the adrenal cortex when stressful situations occur.

Surgical treatment of polycystic ovary syndrome

It is used mainly for patients who have clomiphene resistance. In this case, it is not possible to stimulate ovulation with medications, so women undergo laparoscopy.

During surgery, a wedge-shaped resection of the ovary is performed, as well as cauterization (destruction of the ovarian stroma). However, most often conservative methods are used in the treatment of PCOS, and even surgical intervention is supplemented by the prescription of Clomiphene.

With a competent approach to the treatment of polycystic ovary syndrome, this diagnosis is not a death sentence. Appropriate therapy will provide at least a temporary effect and will help stabilize the state of the reproductive system for several months so that conception can occur.