Polycystic ovary syndrome is a common problem that many women face. The formation and growth of multiple cysts is usually associated with hormonal disorders. If left untreated, the disease leads to infertility. That is why it is worth learning more about this pathology.

Why does polycystic ovary syndrome occur? How to treat such a pathology? What symptoms should not be ignored? Is it possible to get pregnant with such a disease? The answers to these questions are of interest to many women.

What is the disease?

What information about pathology does the ICD contain? Is polycystic ovary syndrome dangerous? What symptoms does it accompany? Many patients are looking for this information.

So, polycystic ovary syndrome (ICD-10 assigned pathology code E28.2) is a disease in which multiple small cysts form in the ovarian tissues. As a rule, the disease is associated with hormonal problems.

What is the mechanism of development of polycystic ovary syndrome? The pathogenesis of the disease is well studied. Increased secretion of insulin leads to disruption of the processes of growth and maturation of eggs. Cystic structures begin to form from immature follicles.

The neoplasms themselves are small, with a dense shell and liquid contents inside. In most cases, cysts appear in two ovaries. The presence of such structures in approximately 25% of patients leads to infertility.

Depending on the origin, two forms of pathology are distinguished.

• Primary polycystic ovary syndrome is the result of congenital abnormalities. This form can also occur in girls during the formation of menstrual function.
• The secondary form of the disease develops in adulthood and is usually associated with acquired pathologies of the endocrine glands or previously suffered inflammatory lesions of the reproductive system.

Polycystic ovary syndrome: causes

Unfortunately, this is a very common pathology. Why does polycystic ovary syndrome develop in women? In fact, the reasons may be different.

• Often the disease develops against the background of pathologies of the hypothalamic-pituitary system. The fact is that the pituitary gland synthesizes follicle-stimulating and luteinizing hormones, which are responsible for the growth and development of follicles and the processes of ovulation. Against the background of an increase in the level of these hormones, hyperproduction of androgens is observed in the ovarian tissues, which leads to the appearance and development of cysts.
• Polycystic ovary syndrome may be associated with cell resistance to insulin. An increase in insulin levels affects the functioning of the entire endocrine system. In particular, the amount of synthesized androgens and luteinizing hormone increases. Such changes lead to active growth of follicles. However, none of these structures mature - premature aging of the follicles occurs, which increases the likelihood of the formation of multiple cysts.
• Risk factors also include an excess of male sex hormones, which also disrupts the processes of growth and maturation of eggs in the ovaries.
• There is a genetic predisposition. To date, there is no data that would confirm the hereditary transmission of the disease. However, women who have a family history of people with a similar illness are at risk.
• It is worth noting that risk factors also include taking certain medications. It has also been proven that against the background of obesity, polycystic ovary syndrome occurs in a more severe form. By the way, according to statistics, about 40% of patients suffer from excess weight.
• Risk factors also include stress, sudden climate change, and previous infectious diseases (if the patient has prerequisites for the development of pathology).

Polycystic ovary syndrome: symptoms

Sometimes the pathology occurs without the appearance of any specific signs - in some patients the disease is diagnosed by chance. But in most cases, a number of disorders appear that indicate the presence of polycystic ovary syndrome. Symptoms may vary among women.

• Pathology primarily affects the menstrual cycle. It becomes irregular - long delays in menstruation are possible, up to their complete absence (amenorrhea). There are disturbances and sometimes even disappearance of ovulation. Sometimes long delays in menstruation are replaced by full uterine bleeding.
• Since the processes of egg maturation are disrupted and ovulation is absent, women develop infertility.
• Increased androgen levels lead to increased sebum production. Patients suffer from seborrhea, increased greasiness of the hair. The skin becomes covered with pimples and blackheads. Such disorders are permanent and practically do not respond to symptomatic treatment.
• A very characteristic symptom of polycystic disease is obesity. The patient's body weight sharply increases by 10-15 kg for no apparent reason (the woman continues to eat as usual). Sometimes fat deposits are distributed evenly throughout the body. But due to an increase in androgen levels, male-type obesity is possible. Excess fat accumulates in the waist and abdomen.
• Obesity, metabolic disorders of carbohydrates and lipids sometimes lead to the development of type 2 diabetes mellitus.
• Increased growth of body hair is possible: an increase in the level of male sex hormones leads to male-type hair growth - “moustaches” appear above the upper lip, hair growth is observed on the chest, abdomen, and inner thighs.
• Many women complain of chronic pain in the lower abdomen. The pain is moderate and nagging in nature. Sometimes the pain spreads to the pelvic region and lower back.

The presence of such violations cannot be ignored. If left untreated, the pathology leads to complications.

Possible complications

How dangerous can polycystic ovary syndrome be? Reviews from experts indicate that with early diagnosis and proper treatment, the disease can be managed. However, in some cases the disease leads to the development of certain complications.

Diagnostic measures

What to do if you suspect polycystic ovary syndrome? The symptoms described above are a good reason to see a doctor. You should not self-medicate or try to determine the problem yourself, as this can be dangerous.

How to determine polycystic ovary syndrome? Diagnostics in this case includes a number of procedures.

Based on the results obtained, the doctor may make a diagnosis of polycystic ovary syndrome. Treatment in this case will depend on the form and stage of development of the disease, the presence of concomitant pathologies.

Conservative treatment

Unfortunately, it is impossible to completely get rid of a disease such as polycystic ovary syndrome. Treatment in this case is aimed at restoring the normal cycle, stimulating the ovulation process (if the patient wants to get pregnant), reducing the external manifestations of the disease (skin inflammation, hairiness), and normalizing carbohydrate and fat metabolism.

• If there is a violation of carbohydrate metabolism, then patients are prescribed hypoglycemic drugs, for example, Metformin. The drugs help normalize blood glucose levels.
• If the patient is trying to get pregnant, then ovulation stimulation is necessary. For this purpose, as a rule, the drug Clomiphene is used, which ensures the release of the egg from the ovary. As a rule, the medicine begins to be taken 5-10 days from the start of the menstrual cycle. Statistics show that such therapy ends in ovulation in 60% of cases. In approximately 35% of patients it ends in fertilization.
• To restore the normal menstrual cycle, combined hormonal contraceptives are used.
• Sometimes the drug Veroshpiron is included in the treatment regimen. This is a potassium-sparing diuretic, which also reduces the level of androgens in a woman’s body and blocks their effects. This therapy lasts at least six months and helps get rid of uncharacteristic hair growth and normalize the functioning of the sebaceous glands.

Proper diet

A sharp increase in body weight is one of the symptoms of polycystic ovary syndrome. also concerns nutrition. During therapy, it is very important to normalize metabolism and maintain body weight within normal limits.

Physiotherapy

It is worth noting that taking medications is not the only thing required for a disease such as polycystic ovary syndrome. Doctors' recommendations also apply to the patient's lifestyle.

Of course, an important part of therapy is proper nutrition. In addition, physical activity is recommended. We are talking about feasible activity, be it swimming, Pilates or long walks. The fact is that subcutaneous fat deposits are an additional source of androgens. Losing weight will not only have a positive effect on your figure and well-being, but will also help normalize hormonal levels.

Galvanophoresis using lidase is effective. This procedure allows you to activate the ovarian enzymatic system. It also improves organ function. The course of treatment usually consists of fifteen daily procedures.

It is worth understanding that therapy for such a disease must be comprehensive. You should not count on a quick and complete cure.

Surgical intervention

In most cases, drug treatment, coupled with physical therapy and a proper diet, is enough to maintain normal functioning of the endocrine system. However, sometimes surgery is unavoidable. Surgery is usually used to treat infertility. Laparoscopy is most often performed. Special equipment is inserted inside through small incisions. There are two methods of performing the operation.

• Wedge resection of the ovaries involves the removal of ovarian tissue in which androgenic hormones are synthesized.
• Electrocauterization of the ovaries involves the targeted destruction of ovarian structures that are responsible for the synthesis of “male” sex hormones. This is a less traumatic procedure that allows you to preserve the maximum amount of healthy tissue.

It is worth noting that during laparoscopic surgery, the doctor has the opportunity to eliminate mechanical causes of infertility, for example, to cut adhesions between the walls or eliminate obstruction of the fallopian tubes. The operation is performed under general anesthesia and is considered safe.

In the future, conservative treatment is carried out. Often, two weeks after the operation, the first ovulation occurs. However, it sometimes takes 6-12 months to restore a normal menstrual cycle. If ovulation is still absent within 2-3 cycles, then the patient is prescribed the same Clomiphene.

It is worth noting that even after successful fertilization and birth of a child, the risk of relapse is high. According to statistics, polycystic disease often activates 5 years after treatment. That is why the patient must be registered with a doctor, undergo examination and tests twice a year. The earlier a relapse is detected, the easier it is to relieve its symptoms and prevent the development of possible complications.

Preventive measures and forecasts

It is worth noting that it is impossible to completely get rid of such a pathology. However, therapy started in the early stages allows women to avoid such an unpleasant consequence as infertility (which inevitably results in polycystic ovary syndrome). IVF, taking hormones, stimulating ovulation - all this helps a woman become a mother.

Unfortunately, there is no specific prevention. Women are advised to monitor their health and cycle regularity, and if they have any alarming symptoms, consult a doctor immediately. Remember that once every six months you need to undergo a preventive gynecological examination. It is also important to monitor your diet, maintain good physical shape, and treat inflammatory and infectious diseases in a timely manner.

During puberty, a girl must be explained what should happen to her body. Since cysts often begin to form during the formation of the menstrual cycle, girls are also recommended to undergo preventive examinations and undergo periodic tests.

(PCOS) is a hormonal disease in which the size of the ovaries increases, and small but numerous cysts form along their outer edge. The pathology entails chronic anovulation or menstrual irregularities and ovarian hyperandrogenism. Menstrual irregularities over time provoke an increase in height up to the last stages of obesity and impaired fertility. Other symptoms that indicate the risk of polycystic ovary syndrome include excess hair growth and acne.

Causes of polycystic ovary syndrome ambiguous. The etiology of the syndrome is hereditary, that is, a tendency to pathology inherent at the gene level. Dysfunction can occur from several genes involved in the biosynthesis of insulin and steroid hormones. Today, a fairly impressive list of candidate genes has already been considered, but many years of research into the genetic mechanisms of functional hyperandrogenemia in PCOS have not made it possible to establish the genetic basis of the disease.

The pathogenetic basis for the formation of clinical manifestations of PCOS is the excessive production of androgens in the ovaries. With a decrease in the sensitivity of peripheral tissues to the action of insulin, compensatory hyperinsulinemia develops. However, a paradoxical fact is observed: a decrease in sensitivity to insulin in peripheral tissues is combined with the preservation of the same relative to the stimulating effect of insulin in the ovaries.

Increasing concentrations of androgens in the ovary cause gradual elimination of estrogen-producing granulosa cells followed by thecal cell hyperplasia, which leads to follicular atresia. Thus, stimulation of ovarian steroidogenesis by insulin results predominantly in hyperandrogenism. Due to impaired insulin sensitivity, hyperproduction of androgens can provoke the development of type 2 diabetes mellitus, which must be taken into account when examining patients with symptoms of hyperandrogenism.

One of the mechanisms of decreased insulin sensitivity in PCOS is considered to be increased insulin-independent serine phosphorylation of the insulin receptor. A similar defect in the early stages of insulin signaling may be the cause of insulin resistance in women with PCOS. Obesity is an independent factor that worsens tissue sensitivity to insulin and contributes to the development of carbohydrate metabolism disorders.

The leading predisposing factor for PCOS is obesity, and the only sure way to prevent it is to maintain a consistently normal body weight. Obesity usually has a strong family history. There should be a critical attitude towards obesity as a diagnostic criterion; in many ways, the success of therapeutic measures in patients with PCOS and obesity is determined by a noticeable decrease in body weight.

PCOS can be aggravated by diabetes. The presence of such diagnoses may indicate the need to be evaluated for PCOS. Moreover, early diagnosis and treatment based on its results prevents the development of complications, because dysfunction of polycystic ovaries determines changes in hormonal balance, against which type 2 diabetes mellitus, cardiovascular diseases, and stroke easily develop. No specific screening methods have been identified today, but women with regular menstrual irregularities are at risk. Examinations to determine the cause of delayed menstruation are advisable for a woman who has fewer than nine menstrual cycles per year. If menstrual irregularities are combined with male pattern hair growth or androgenic dermopathy, the likelihood of PCOS increases.

The development of PCOS occurs during adolescence or early reproductive age. Thus, after timely menarche, oligo- and opsomenorea is formed (the duration of the menstrual cycle is more than 35 days, but less than 6 months). In conditions of anovulation, the cause of proliferative processes and periodic bleeding is low estrogen levels. Secondary amenorrhea develops over several years in 14-20% of patients. The main criterion for diagnosis is ovulation disturbance and, as a consequence, anovulatory infertility, which is one of the main symptoms of PCOS.

However, it is necessary to distinguish polycystic ovary syndrome from infertility, the latter is observed in only 16% of patients with PCOS. Periodic ovulatory cycles allow spontaneous pregnancies to occur with the corresponding pathology. If a woman with PCOS becomes pregnant after ovulation stimulation, then success is not assessed as absolute, since after childbirth a return of clinical manifestations is likely, which is considered to be remission. Therefore, and for other reasons, patients with PCOS need long-term observation.

Symptoms of androgen-dependent dermopathy, which include hirsutism, acne, seborrhea, alopecia, are a direct consequence of the saturation of the body with androgens. These symptoms are considered manifestations of masculinity in patients with PCOS.

Hirsutism or excessive male pattern hair develops when there is an imbalance in androgen concentrations and reflects the different individual sensitivity of hair follicles to testosterone.

Acne is usually represented by a wide variety of manifestations - open and closed comedones, papules, pustules, cysts. Inflammatory forms of acne are usually accompanied by an inflammatory process, and after elimination they leave pigmented spots and scars.

Alopecia is not very common among patients with PCOS - about 6-10% of patients complain of hair loss from the scalp in androgen-dependent areas.

The psyche is also subject to changes, and symptoms of depression are often observed. Patients feel a sense of depression and usually associate this with an unattractive appearance; they turn out to be sociopaths and prefer to avoid social connections.

How to treat polycystic ovary syndrome?

Sets several goals, the achievement of which defines therapy as successful:

• restoration of fertility;
• solving cosmetic problems and stabilizing external attractiveness;
• weight loss and treatment of complications of PCOS (such as type 2 diabetes, cardiovascular diseases, etc.)

To treat PCOS, it is better to use a set of methods, which may include medications, non-drug treatments, and surgery.

Non-drug treatment of PCOS used to reduce body weight. The programs used differ little from other methods of losing weight, but they are adjusted by a specialist.

It is noteworthy that moderate or slight weight loss is accompanied by an improvement in biochemical parameters, and after 4-6 months there is a restoration of ovulatory processes in 55-80% of women. Measures to reduce the energy value of food and increase physical activity are not always sufficient, and if such methods fail, it is advisable to prescribe medications. Measures to correct body weight are not at all considered as a mandatory preparatory stage for restoring fertility in case of anovulatory infertility in obese patients. However, non-drug procedures for removing unwanted hair (various hair removal methods) can be used in the treatment of hirsutism.

Tactics and sequence of application of therapeutic medicinal methods, the choice of medications or combinations thereof is determined not only by the dominant symptoms, various combinations of clinical signs, but also by the preferences of the patient herself. For example, in adolescence, correction of cosmetic problems (acne and prevention of hirsutism) and regulation of the menstrual cycle may be a priority; in reproductive age, patients focus on restoring fertility (treatment of anovulatory infertility), and in late reproductive age, ovarian function can recover on its own, while carbohydrate metabolism disorders, type 2 diabetes mellitus or impaired glucose tolerance develop, and it is the treatment of diabetes that becomes a priority .

The goal of treatment for anovulatory infertility is primarily to restore a woman’s fertility and, in fact, conceive. In order for the processes to be as close to natural as possible, the implementation of the following components is necessary: ​​induction of follicle development, ovulation, the onset and development of a singleton pregnancy. In case of mixed forms of infertility or the need for pre-implantation diagnostics, intrauterine insemination and in vitro fertilization are advisable. The problem is the fact that in PCOS, the sensitivity of the ovaries to drugs that have a stimulating effect on folliculogenesis is increased, which determines the high probability of ovarian hyperstimulation and the development of multiple pregnancies.

Surgical treatment of polycystic ovary syndrome represented by cauterization of the ovaries using laparoscopic access. Surgical intervention Laparotomy access carries a risk of developing adhesions in 40-90% of patients, however, restoration of ovulation is also observed in the vast majority of operated women (80-90%). Ultimately, the probability of pregnancy is estimated at 50-60%. Endoscopic methods are more gentle - they are less traumatic and allow you to avoid the development of an extensive adhesive process. Surgical treatment of PCOS is prescribed mainly in the absence of effect from the use of conservative methods of stimulating ovulation.

What diseases can it be associated with?

Diseases with which differential diagnosis of polycystic ovary syndrome should be carried out

Idiopathic - excessive male-pattern hair growth in women, that is, excessive growth of dark, coarse hair on the chin, sternum, upper back and abdomen; probable with a confirmed family history of PCOS.

Congenital - excessive hair growth in an area of ​​the skin that is not intended for it, at an inappropriate age or gender; Clinical features include sometimes a family history of hypertrichosis and generalized excess hair growth.

Non-classical form - often accompanied by oligomenorrhea or aminorrhea, hyperandrogenemia. Characterized by a family history of infertility and/or hirsutism, the disease is common among Ashkenazi Jews. There is an increase in basal level 17 -hydroxyprogesterone in the blood and according to the results of the stimulation test.

Androgen-producing or adrenal gland - accompanied by oligomenorrhea or aminorrhea, hyperandrogenemia. Severe hirsutism and/or androgenetic alopecia, clitoromegaly. With an ovarian tumor, an increase in the level of testosterone in the blood is observed several times (the diagnosis is undoubted when the testosterone level is less than 12 nmol/l). With an adrenal tumor, there is an increase in the content of DHEA-S, a steroid secreted by it.

Accompanied by oligomenorrhea or aminorrhea, hyperandrogenemia. The patient suffers from arterial hypertension, stretch marks, and a characteristic appearance (matronism). Hormonal features include an increase in the content of free cortisol in daily urine; a small dexamethasone test is negative.

Body weight deficiency is often accompanied by oligomenorrhea or aminorrhea. Hormonal features are a decrease in SHBG levels and an increase in free testosterone.

Iatrogenic conditions (taking androgens, anabolic steroids, danazol, cyclosporine, some gestagens) are often accompanied by hyperandrogenemia, probably oligomenorrhea or aminorrhea. Clinical features depend on the duration and mechanism of action of the drug, hormonal - on the mechanism of action of the drug

Premature ovarian failure syndrome - oligomenorrhea or aminorrhea is often accompanied. Possible association with other autoimmune endocrine diseases. An increase in the level of follicle-stimulating hormone in the blood above 40 mIU/l is typical.

Alpha reductase deficiency - rapid defeminization during puberty (development of male secondary sexual characteristics). It is characterized by a sharp decrease in the level of dihydrotestosterone (DHT) with normal testosterone levels, which is determined by conducting a test with hCG.

With a violation of synthetic function - accompanied by oligomenorrhea or aminorrhea, mild hyperandrogenemia. There are no typical signs; a history may indicate liver disease with impaired protein synthetic function. Decreased SHBG levels and increased free testosterone.

Treatment of polycystic ovary syndrome at home

Treatment of polycystic ovary syndrome possible at home, but this is not the same as self-medication. The diagnosis is so thorough, and the treatment of the disease is so multifaceted and complex, that constant monitoring of the patient’s condition by a physician is necessary, for which it is necessary to periodically visit a medical facility.

The reason for hospitalization and further surgical treatment is the lack of effect of conservative therapy. At home, a woman with polycystic ovary syndrome, in addition to taking medications prescribed by a doctor, is recommended to work on losing body weight, for which the diet should not include:

• sodas and packaged juices;
• any products containing a lot of sugar (sweets, cakes, chocolate);
• sweeteners;
• products based on wheat flour (white pasta, white bread, etc.; whole grain products should be an alternative;
• grocery products and non-organic meats, which have a high risk of containing hormones and antibiotics;
• high fat dairy products;
• products containing caffeine (tea, coffee).

PCOS is a chronic disease for which conservative treatment methods usually have temporary effects. Resumption of clinical symptoms of PCOS is a reason for re-therapy. With all this, the course of the disease is somewhat determined by the age of the patient. For example, in late reproductive age, the manifestations of acne disappear on their own, at the same time the severity of hirsutism decreases and the regular menstrual cycle may even be restored. On the other hand, by the age of 40, about half of sick women face various forms of carbohydrate metabolism disorders (impaired glucose tolerance or type 2 diabetes) and atherosclerosis. Patients with such a diagnosis at any age (including during the period of subsidence of the clinical manifestations of the disease) should remain under the supervision of an endocrinologist and gynecologist, since cosmetic and reproductive problems with age tend to transform into no less dangerous and undesirable metabolic disorders.

What medications are used to treat polycystic ovary syndrome?

Nonsteroidal estrogen receptor antagonist, first-line drug to stimulate ovulation in PCOS. Used for 5 days, usually from the 5th to the 9th day of the menstrual cycle. The initial dose is 50 mg/day, in each subsequent cycle it increases by 50 mg/day and reaches a maximum of 150 mg/day. The duration of treatment with Clomiphene is limited: the maximum period is 6 months, with 75% of pregnancies observed in the first 3 months of treatment. In 20% of women, resistance to Clomiphene is observed and the results of ovulation stimulation are improved by a preliminary course of treatment with Metformin at an average dose of 1500 mg/day or the use of combined oral contraceptives for six months.

Used for the treatment of type 2 diabetes mellitus, which develops against the background of PCOS. Used as part of combination therapy (for example, with the above-mentioned Clomiphene) in case of resistance to monotherapy. Metformin is taken 1-2 times a day, the maximum dose should be taken in the evening, the maximum daily dose is significantly higher than in the treatment of type 2 diabetes - 2550 mg. Used to restore fertility with subsequent withdrawal upon pregnancy.

Pioglitazone is used to treat type 2 diabetes mellitus that develops against the background of PCOS. Taken once a day, the average daily dose is 30 mg, the maximum is 45 mg. During treatment, it is advisable to monitor transaminase levels. Enzyme levels are determined before treatment, two months after, and then annually.

A powerful non-steroidal anti-inflammatory drug with antiandrogenic action, it blocks the binding of dihydrotestosterone to androgen receptors, and high concentrations suppress the synthesis and accelerate the metabolism of androgens. Usually this is a six-month course of therapy.

Eflornithine hydrochloride - the effect of the drug is to inhibit cell growth and the synthesis of polyamines. A hair growth suppressant, the effect is observed after 6-8 weeks of use. The drug acts locally, no more than 1% of the applied product enters the blood. It is not subject to metabolic transformations and is excreted unchanged by the kidneys. After stopping the course of treatment, restoration of the previous intensity of hair growth is observed after 8 weeks.

Treatment of polycystic ovary syndrome with traditional methods

The use of folk remedies for treatment of polycystic ovary syndrome should not be carried out as part of self-medication; it is recommended to discuss the advisability of taking such prescriptions with your doctor and certainly combine them with traditional medicine methods. The following may be effective:

• basil- 2 tbsp. pour 250 ml of boiling water over fresh basil and bring to a boil again; when the broth has cooled, strain; apply twice a day in half a serving, regardless of meals;
• licorice root- 1 tbsp. Brew the medicine with a glass of boiling water and leave for an hour; strain; take 2 tbsp. before each meal;
• red brush- 1 tbsp. Brew red brush herbs with a glass of boiling water, leave for an hour, strain; take 1/3 cup half an hour before meals three times a day;
• peony tincture- alcohol tincture of peony can be purchased at any pharmacy; 1 tsp dilute the tinctures with the same amount of drinking water and take three times a day at the same time;
• burdock juice- take freshly squeezed burdock juice in the amount of 1 tbsp. three times a day for one month;
• viburnum juice- freshly squeezed viburnum juice seasoned with a small amount of flower honey and taken according to the following scheme: for four months, the first week in the morning before meals on the tip of a teaspoon, the second week 1/3 teaspoon, the third week morning and evening 1 tsp, for the fourth week 1 tbsp. morning and evening.

Treatment of polycystic ovary syndrome during pregnancy

Polycystic ovary syndrome is a complex of disorders that, among other things, affect fertility. However, this is not a verdict. The cause of infertility is usually the lack of ovulation in women with PCOS. If a doctor is faced with the task of restoring fertility to his patient, then all therapeutic measures will be aimed specifically at stimulating ovulation. This is usually enough for a woman to become pregnant and, under the careful supervision of specialists, give birth to a healthy baby.

The drug of choice in this case may be, for example, Clomiphene, along with which Metformin may be prescribed. When taking Metformin, the dose of Clomiphene is usually smaller. As part of therapy to restore reproductive function in a mature woman, gonadotropins are used in low doses (considered to be stronger substances for stimulating ovulation). If ineffective, women with PCOS undergo IVF or ovarian cauterization using laparoscopic access.

Therapeutic therapy is prescribed by the doctor who is treating a particular patient, and the methods he chooses may differ significantly depending on the individual reaction of the body to them.

Which doctors should you contact if you have polycystic ovary syndrome?

Polycystic ovary syndrome is a disease within the competence of several specialists. Diagnosis of the disease can begin in the office of a gynecologist or uzist, when the patient complains of menstrual irregularities and inability to become pregnant. Ultrasound examination of the pelvic organs allows you to see pathology. At the same time, an endocrinologist can also prescribe diagnostic procedures, to whom women with polycystic ovary syndrome turn with complaints about their appearance and general well-being.

The diagnostic criteria today are the following manifestations of the syndrome:

• ovulation disorders (oligo- and anovulation), changes in the menstrual cycle in the form of oligo- and amenorrhea;
• clinical and laboratory manifestations of hyperandrogenism.
• identifying signs of polycystic ovaries using ultrasound (in the absence of other diseases with a similar clinical picture).

The diagnosis of PCOS has the right to exist only if at least two of the three diagnostic criteria are identified.

The medical history is clarified during a conversation, where it is necessary to pay attention to possible iatrogenic causes of hirsutism, to clarify the likelihood of taking certain medications (anabolic steroids, male sex hormones, cyclosporine, interferons) or drugs whose side effect is hyperprolactinemia.

Examination of the patient allows one to distinguish normal hair growth from hirsutism and hypertrichosis. The amount, features and distribution of hair growth should be noted. Terminal hair is localized mainly on the face (upper lip, chin, sideburns), chest, around the nipples, along the linea alba, in the lumbar region and on the inner thighs. The degree of hirsutism is assessed using the Ferriman-Galwey scale.

The severity of acne is usually assessed based on the number of rashes on one side of the face. In practice, it is sufficient to divide the severity of the condition into three forms: mild, moderate and severe.

Laboratory research are limited to tests for the concentration of total testosterone (it is advisable to carry out the analysis in the early follicular phase - on the 5-7th day of the menstrual cycle) and the concentration of sex hormone binding globulin (SHBG).

– this is an enlargement of the gonads due to cystic atresia of the follicles. It is one of the signs of polycystic ovary syndrome and is often used as a synonym for this pathology. Other symptoms of the disease include menstrual and reproductive dysfunction, signs of virilization, and obesity. The diagnosis is based on medical history, results of general and gynecological examination, ultrasonography, and hormonal analysis. Treatment is complex and includes correction of metabolic and endocrine disorders, wedge resection or cauterization of the ovaries.

ICD-10

E28.2 Polycystic ovary syndrome

General information

The term “polycystic ovary syndrome” can be interpreted as an ultrasound sign, polycystic changes in the gonads, observed normally or in a number of pathologies, or as a specific disease - polycystic ovary syndrome (PCOS, PCOS, scleropolycystic syndrome). Its historical name is Stein-Leventhal syndrome, named after the Chicago gynecologists who most clearly described the symptoms of the classic form of the disease in 1935. Polycystic disease is detected by ultrasound at 16-30 years of age; the incidence rate is up to 54% among women of fertile age. Scleropolycystic disease is registered in 5-20% of women.

Reasons

Common causes of asymptomatic transient polycystic ovary syndrome (multifollicular gonads), which is the norm, are stress, physical activity, and taking hormonal contraceptives. The provoking factors of secondary polycystic diseases that arise against the background of known diseases are different and are associated with the mechanism of development of these pathologies. The etiology of PCOS is poorly understood. It is assumed that in 80% the causes are congenital, in 20% they are acquired. Possible risk factors:

• Exogenous: infectious and inflammatory diseases suffered in childhood and puberty (chronic tonsillitis, childhood infections, chronic inflammation of the internal genital organs), TBI (concussions, bruises, contusions), prolonged psycho-emotional stress (information stress, increased study load).
• Endogenous: adverse effects on the fetus (androgens, epigenetic factors, consequences of the pathological course of pregnancy or childbirth), low birth weight, congenital genetically determined defect of the enzymatic systems of the gonads.

A special role is played by hereditary predisposition. There are known cases of familial scleropolycystic disease. There is a high probability of pathology in women whose mothers or sisters suffer from this disease. The genetic risk of having a daughter with a tendency to PCOS in a sick mother is aggravated due to another reason - the fetus develops with an excess of testosterone. A risk factor for inheritance through the male line is early baldness in male blood relatives.

Pathogenesis

Polycystic ovary syndrome is characterized by the accumulation of immature follicles due to anovulation. With occasional anovulatory cycles, such “cysts” dissolve over time without consequences, but with regular ones they provoke the development of pathology. The pathogenesis of PCOS has not yet been clarified; there are several theories on this matter. The primary defect in the feedback mechanism can come from the hypothalamic-pituitary system, ovaries, and adrenal glands.

Desynchronization of the functions of the endocrine glands leads to increased synthesis of androgens by the gonads without their further aromatization into estradiol, lack of ovulation (as a consequence, infertility), progesterone deficiency, polycystic changes in the follicles, and thickening of the ovarian capsule. Androstenediol is aromatized by adipose tissue and the adrenal glands into estrone, and relative hyperestrogenism occurs, leading to endometrial hyperplasia.

The level of free testosterone in the blood increases, the result of hyperandrogenism is virilization. Hyperglycemia that develops as a result of insulin resistance aggravates the imbalance, promoting increased synthesis of ovarian androgens and disruption of testosterone binding, which further increases the level of this hormone and estrone.

Classification

Based on its origin, polycystic ovary syndrome is classified as primary (PCOS) and secondary (accompanying known nosological forms). Scleropolycystic disease is divided into two forms - with obesity and with normal or reduced body weight. In addition, there are 4 phenotypes of PCOS, which are based on symptoms that are diagnostic criteria (ESHRE/ASRM, 2007):

• Phenotype A (classical). Combination of hyperandrogenism with anovulation, polycystic disease. Frequency of occurrence: 54%.
• PhenotypeB(anovulatory). With hyperandrogenism, ovulatory dysfunction, without polycystic disease. Prevalence 29%.
• PhenotypeC(ovulatory). Hyperandrogenism and polycystic disease. Frequency of occurrence 9%.
• PhenotypeD(non-androgenic). Anovulation and polycystic disease. Occurrence 8%.

Symptoms of polycystic ovary syndrome

Transient cystic changes usually occur without external signs. With scleropolycystic disease, symptoms may appear at menarche, or less often against the background of an established cycle. 85% of women experience menstrual irregularities: first, proyomenorrhea alternates with opsomenorrhea, acyclic bleeding, hypo- and oligomenorrhea are recorded. Then the intervals between bleeding lengthen, hypomenstrual syndrome and amenorrhea develop.

A few years after the onset of menstruation, hirsutism and skin symptoms of hyperandrogenism occur: seborrhea, acne. Obesity develops in 30-40% of patients. Persistent anovulation leads to infertility. In 10-15% of patients, spontaneous pregnancy may occur, which most often ends in miscarriage. Symptoms such as galactorrhea, psychoemotional and vegetative-vascular disorders similar to menopausal syndrome may be observed.

Complications

The most serious complication of untreated scleropolycystic disease is hormone-dependent endometrial cancer, which develops in 19-25% of patients. Other long-term consequences include various types of cerebrovascular insufficiency (the risk increases by 2.8-3.4 times), glucose tolerance, which occurs in 40% of patients after 40 years of age and progresses in half of them to type 2 diabetes mellitus over six years .

Patients of reproductive age are characterized by obstetric complications - gestational diabetes mellitus, preeclampsia, premature birth (the risk of these pathologies increases threefold, fourfold and twofold, respectively). The risk of perinatal mortality increases threefold. Some methods of treating the disease often lead to complications: after ovulation induction, ovarian hyperstimulation syndrome develops; surgical intervention entails tubo-peritoneal infertility.

Diagnostics

Polycystic ovary syndrome as a morphological change is not a diagnosis, but a sign of a possible pathology. The diagnosis is established by a gynecologist with the participation of an ultrasound doctor and endocrinologist. The following symptoms (at least two must be present) indicate PCOS: laboratory or visual signs of hyperandrogenism; oligo- or anovulation; polycystic changes. Diagnostic methods include:

• Clinical examination. During a conversation with the patient and a general examination, scleropolycystic disease can be assumed based on complaints of menstrual irregularities and infertility, the presence of PCOS in close relatives, increased body mass index, virilization (hirsutism, hypertrichosis, oily, acne-prone skin). During gynecological examination - enlarged ovaries.
• Ultrasonography. With transvaginal ultrasound of the ovaries, polycystic disease is characterized by an increased (over 9-10 cubic cm) volume of the gonads; located under a thickened capsule enlarged (2-10 mm) atretic follicles (more than 10) without a dominant one; hyperplastic (up to a quarter of the total volume) stroma. Folliculometry reveals less than 6 ovulations per year.
• Laboratory research. With androgenemia, hormone analysis confirms an increase in the level of luteinizing hormone and its ratio to follicle-stimulating hormone (more than 2.5), an increase in the free testosterone index. Concomitant insulin resistance is indirectly indicated by the results of a biochemical blood test - increased triglycerides, decreased HDL, hyperglycemia.

Additionally, a biochemical blood test, hysteroscopy with endometrial biopsy, ultrasound of the adrenal glands, thyroid gland, radiography or MRI of the sella turcica are prescribed. Some clinicians recommend distinguishing polycystic ovaries according to ultrasound from multifollicular ovaries, characterized by smaller “cysts”, an unchanged capsule and stroma, normal volume and echogenic structure of the gonads. Such changes are often a variant of the norm.

Primary polycystic ovary syndrome should be differentiated from secondary polycystic disease, the most common causes of which are congenital pathologies (adrenogenital syndrome, congenital adrenal hyperplasia), neurometabolic-endocrine syndrome, Itsenko-Cushing disease, as well as virilizing tumors of the ovaries and adrenal glands. To exclude a tumor process, it may be necessary to consult a gynecological oncologist or urologist.

Treatment of polycystic ovary syndrome

The choice of treatment tactics depends on the cause of this condition and the existing symptoms. Polycystic ovary syndrome, which does not manifest itself with any disorders, does not require treatment. In case of secondary polycystic disease, correction of disorders caused by the underlying disease is prescribed. Therapeutic measures for PCOS are determined by the clinical picture of the pathology.

Conservative therapy

Treatment of PCOS includes several stages, aimed at normalizing metabolic disorders, restoring the ovulatory cycle and generative function, eliminating endometrial hyperplastic processes and manifestations of hyperandrogenism. First of all, metabolic syndrome and endometrial hyperplasia (if present) are treated, then, if the patient wishes to have children, ovulation induction is started.

• Correction of metabolic disorders. All obese patients are recommended to modify their lifestyle - exercise, diet with limited spicy and salty foods, fluids - up to 1.5 liters per day. The calorie content of the daily diet is up to 2,000 kcal, 52% of calories should come from carbohydrates, 16% from proteins, 32% from fats, two thirds of the latter being unsaturated. For insulin resistance and hyperinsulinemia, insulin sensitizers are prescribed.
• Therapy for endometrial hyperplasia. In case of obesity, recurrent hyperplastic processes, adenomyosis, it is preferable to use gestagens; in case of normal body weight and initially diagnosed hyperplasia, estrogen-gestagens are preferable. Drugs can be prescribed cyclically or continuously. Adenomyosis is also treated with GnRH analogues.
• Infertility treatment. Not the most effective, but the safest method is the use of estrogen-progestin drugs (the “rebound effect” after their withdrawal can lead to ovulation). In case of anovulatory infertility, ovulation induction is carried out with clomiphene, letrozole, and in case of their ineffectiveness - with gonadotropic agents. IVF technologies can be used to achieve pregnancy.
• Treatment of hirsutism and acne. To eliminate the external manifestations of hyperandrogenism, hormonal contraceptives (orally, in the form of patches or vaginal rings) spironolactone are used. Preference is given to combined hormonal drugs without androgenic effects or with antiandrogenic effects. To enhance the cosmetic effect, laser and photoepilation are used.

Surgical treatment

In most cases, only surgical treatment can restore menstrual and reproductive function. Interventions on the ovaries are performed laparoscopically, which minimizes the risk of adhesions. Surgical treatment for recurrent endometrial hyperplasia is also prescribed for women who are not planning a pregnancy.

• Ovarian drilling. Destruction of hyperplastic stroma with a point electrode. Used to stimulate ovulation with a slight increase in gonads. Includes various techniques - electro-, laser-, diathermocauterization. The disadvantage of this method is the relative short duration of the therapeutic effect.
• Wedge resection. Excision of a wedge-shaped area, including the cortical and medulla layers. It is performed to induce ovulation in cases of pronounced enlargement of the ovaries or to prevent relapses of endometrial hyperplasia. Disadvantage: decreased ovarian reserve, possible early or premature menopause.

The success of surgical intervention is indicated by the restoration of ovulatory function in the first weeks after surgery. If ovulation does not occur within two or three cycles, drug stimulation is carried out. Pregnancy usually occurs within 6-12 months. The likelihood of a favorable outcome decreases in direct proportion to the time since the operation.

Relapse Prevention

Existing methods of treating polycystic ovary syndrome most often do not achieve a permanent cure. The reason is the impossibility of eliminating the main pathogenetic links of the disease. Symptoms and structural ovarian changes recur within five years after surgery, necessitating maintenance treatment.

To regulate the menstrual cycle, prevent endometrial hyperplasia, hirsutism and hyperandrogenic dermatopathy on an ongoing basis until menopause, patients are prescribed combined hormonal contraceptives or gestagens in the second phase of the cycle. This tactic also helps preserve reproductive function in some patients.

Prognosis and prevention

With polycystic ovary syndrome, the prognosis for life is favorable in the absence of malignant transformation of the endometrium. The prognosis for reproductive function depends on how early treatment was started and what causes the pathology is based on. Thus, infertility treatment is most effective in the absence of virile and metabolic syndrome and severe hypothalamic-pituitary disorders.

Primary and secondary prevention of polycystic ovary syndrome consists of combating obesity, timely detection and correction of hypothalamic-pituitary, adrenal, and ovarian dysfunction. Women suffering from PCOS are at high risk of developing uterine cancer, and therefore are subject to clinical observation, including control studies (ultrasound, hysteroscopy, and, if necessary, diagnostic and treatment endometrial curettage).

is a disease that develops in women when the production of the male sex hormone is too intense. Due to such active production of androgen, the eggs remain in follicles. In turn, the follicles turn into cysts.

Modern statistics indicate that polycystic ovary syndrome most often manifests itself in girls who have entered into puberty . However, the disease can develop in women of any age. At a later age - during menstrual pause - the so-called secondary polycystic ovary syndrome , as a consequence of chronic female diseases. The disease must be properly treated, as it can threaten a woman’s health. In addition, the formation of multiple cysts on the ovaries significantly reduces a woman’s ability to conceive and bear a child. But still, after competent and timely treatment of the disease and elimination of the problem, such a patient can carry and give birth to a healthy baby.

Causes of the disease

Polycystic ovaries – a consequence of hormonal imbalance in a woman’s body. Cysts form due to too high production levels androgens and decreased production. Some experts theorize that the cause of this failure is a disrupted hormonal interaction between and ovaries . There is also evidence that the manifestation of this disease is influenced by a hereditary factor. That is, higher chances of getting sick are observed in those women who have a family history of polycystic ovary syndrome. Therefore, if this disease is present in female relatives, the woman should be regularly examined by a doctor.

Symptoms of polycystic ovary syndrome

When a woman develops polycystic ovary syndrome under the influence of endocrine imbalance not only the structure, but also the function of the ovaries is disrupted. Cysts develop in the ovarian tissue, which look like small bubbles with fluid inside. Such cysts are modified eggs , which have matured, but ovulation has not occurred. As a result, the ovaries become enlarged, and tubercles appear on their surface. In this case, the menstrual cycle fails. And in some cases, menstruation may stop completely.

In most cases, polycystic ovary syndrome begins to develop in young women. Most often, polycystic ovaries appear in parallel with first menstruation , the beginning of sexual activity , strong and sudden weight gain , . For quite a long period, a woman may not know that she is developing this disease, since there are no visible symptoms of polycystic ovary syndrome. One of the main manifestations in this case is considered irregular periods . Menstruation may occur irregularly, rarely, and eventually stop completely. In this case, the woman is diagnosed due to the absence of ovulation, during which a mature egg is released. Infertility as a consequence chronic anovulation, is diagnosed with polycystic ovaries in about a third of women. In addition, patients may experience periodic dysfunctional uterine bleeding .

There are also a number of other symptoms of the disease, but not all women experience them. In this case we are talking about heavy body hair, intense hair loss on the scalp, breast reduction, the appearance of acne And blackheads. In addition, women who suffer from polycystic ovary syndrome often experience appearance of excess weight . There are even statistics that show that approximately 30-60% of women diagnosed with polycystic ovaries suffer from. If a woman is overweight, other symptoms of the disease may become more pronounced. In addition, when examined by a gynecologist, some women with polycystic ovary syndrome experience hypertrophied clitoris .

Diagnosis of the syndrome

Unfortunately, most women suffering from polycystic ovary syndrome turn to doctors only when it becomes completely obvious. Polycystic ovary syndrome is considered one of the most common causes of infertility in women. Therefore, modern doctors insist that women who have irregular menstrual cycle or no periods at all , they must undergo examination to exclude the development of polycystic ovaries. It is especially important to exclude the disease if a woman exhibits other signs of polycystic ovary syndrome.

During the diagnostic process, it is necessary to carry out internal examination. To determine the condition of the ovaries, a woman is prescribed an internal ultrasound scan. To do this, a special sensor is inserted into the vagina. The main criterion for making a diagnosis using this method is the presence of more than 8 follicular cysts, the diameter of which is less than 10 mm. Also, in case of illness, it is determined endometrial hyperplasia . Sometimes additional research is also required, for which the patient is prescribed claporoscopy . A puncture is made in the abdominal wall, through which the optical device is inserted into the abdominal cavity. Using this device, the doctor examines the ovaries. In addition, urine and blood tests are prescribed, since the results of such tests can determine the excess or deficiency of hormones.

To confirm or refute the diagnosis, an excess of estrogen , androgen , luteinizing hormone , as well as the disadvantage . The patient also undergoes a glucose sensitivity test to determine the activity of her own insulin. In addition, with polycystic ovary syndrome there is a high level cholesterol And triglycerides . Thus, the diagnosis polycystic ovary syndrome» is established if two of the three signs are present: anovulation (female infertility) , signs of polycystic ovary syndrome identified by ultrasound, hyperandrogenism , confirmed by laboratory tests.

Treatment of the disease

Proper treatment for polycystic ovary syndrome involves more than just medical procedures and medications. It is also very important to carry out procedures aimed at the overall health of a woman. If the doctor and patient provide the correct and timely approach to therapy, then the chance of curing the disease is quite high. If the level androgens the patient's blood level decreases, her menstrual cycle is restored and some external manifestations of the disease disappear.

For the treatment of polycystic ovaries, a variety of drugs are used, the prescription of which must take into account the nature of the hormonal disorder, as well as the presence of hypertension And diabetes mellitus . But in most cases, women with polycystic ovaries are advised to take combined oral contraceptives . If there is no effect from such drugs, the doctor decides to prescribe medications that restore the woman’s ability to reproduce. Such drugs stimulate the production process follicle-stimulating hormone , which determines the start of the ovulation process.

If insulin levels are elevated, it is advisable to take medications that make the process of glucose utilization more efficient. But to this day, some experts note that the effect of such drugs on the fetus is not fully understood. Doctors say that conservative methods are effective in about 50% of cases. If the size of the ovaries greatly increases and there are a large number of cysts in them, it is possible for the patient to undergo surgical operation . To restore fertility, most often performed endoscopic surgical interventions , as they make it possible to minimize the recovery period. Often, surgery to excise cysts is performed using a laser. In addition, for polycystic ovaries it is practiced wedge resection of the ovaries , ovarian decapsulation , demedullectomy , electropuncture and other methods. During such interventions, part of the ovary that produces androgens is destroyed or removed. As a result, normal communication between the ovaries and central structures is restored. Surgical treatment for polycystic ovary syndrome is quite effective compared to drug therapy. After surgery, restoration of the monthly cycle is observed in 95% of patients, and more 80% of infertility is eliminated.

Conducting health procedures is recommended for those women who have strong hair growth And overweight. In this case, it is very important to maintain an active lifestyle, get regular moderate physical activity, and also adhere to the diet prescribed for patients with diabetes. should be low in calories (no more 2000 kilocalories per day) If a woman suffers from severe obesity, then additional treatment methods are used to combat. Bringing body weight indicators back to normal very often makes it possible to normalize and menstrual function, get rid of excessive hair growth. But if hair growth is still a serious cosmetic defect, then the hair is removed using special creams, depilatory, wax and other methods that help eliminate unnecessary hair. All these methods allow you to get a temporary effect. With the help electrolysis You can get rid of excess hair forever. If there is no effect from the treatment methods described above, in some cases in vitro fertilization is practiced.

Doctors

Medicines

Pregnancy with illness

Women of childbearing age are often concerned about whether polycystic ovary syndrome and pregnancy are combined. In this case, it is important to take into account that the chances of conceiving a child increase sharply in a woman who has undergone adequate and complete treatment, since conception with polycystic ovary syndrome is only prevented by lack of ovulation . Therefore, in this case, it is very important to regularly take medications prescribed by the doctor.

Complications of the disease

Previously, treatment of polycystic ovary syndrome was practiced exclusively in women of reproductive age who had a desire to become pregnant. But today, treatment of the disease is considered mandatory for all women who have been diagnosed with polycystic ovary syndrome, since this disease can provoke a number of unpleasant complications. So, due to the general hormonal imbalance of the body, the content in the blood for a long period is too high. As a result, the patient's risk of developing endometrial cancer And breast cancer . In addition, due to the lack of menstruation, the endometrium thickens significantly, which also provokes the development of cancer pathology in young women.

Women with polycystic ovaries have high resistance to their own insulin . As a result, the amount of insulin produced by the pancreas increases. As a result, several types of complications are possible. In particular, the pancreas may lose its ability to produce insulin, which will lead to the development. Due to high insulin levels, androgen production may be activated. Also, due to too high insulin levels, the amount of " useful» cholesterol. The woman is growing blood pressure and the risk of developing cardiovascular diseases in the future increases. In addition, obesity is often a complication of the disease.

Diet, nutrition for polycystic ovary syndrome

List of sources

• Manukhin, I.B. Polycystic ovary syndrome / I.B. Manukhin, M.A. Gevorkyan, N.E. Kushlinsky.- M., 2004;
• Gynecology. National Leadership, ed. V.I. Kulakova, G.M. Savelyeva, I.B. Manukhina. 2009;
• Nazarenko T.A. Polycystic ovary syndrome: modern approaches to the diagnosis and treatment of infertility. M.: MED press-inform, 2005;
• Dedov, I.I. Polycystic ovary syndrome: A guide for doctors / I.I. Dedov, G. A. Melnichenko. - Moscow: Medical Information Agency LLC, 2007.

Just about fifteen years ago, the approach to the treatment of polycystic ovary syndrome was entirely conventional: the woman was “put on” high-dose hormonal contraceptives – Diane-35, beloved by all doctors. In most cases, such treatment did not solve the problem, but instead created a false state of improvement: the woman had regular artificially created ones, which for some reason was mistaken for the normal functioning of the ovaries, while their function was in fact suppressed, as was the connection with the hypothalamus. pituitary system. Until now, many doctors are keen on this treatment regimen, although it is not only outdated, but ineffective and even harmful.

Modern treatment methods are divided into three main groups:

• non-medicinal;
• medicinal;
• surgical.

A combination of different types of treatment is quite possible, but most often they start with more gentle methods, since they have the least negative impact on the woman’s body.

The choice of treatment method and medications depends on the age of the woman, her desire to have children in the future, the manifestations of signs of PCOS and other factors. If a woman is planning a pregnancy, then months of treatment with hormonal contraceptives that suppress ovulation would be a wrong choice.

The main principles of treatment for PCOS are:

• reduction or elimination of symptoms associated with increased androgen levels;
• resumption and regulation of menstrual cycles;
• resumption of fertility;
• improvement of metabolic processes associated with this disease.

If a woman is not planning a pregnancy and has adapted to menstrual irregularities, should we focus on the need to treat PCOS? The answer to this question is interconnected with the answer to the question of how aware a woman is of the health risks that grow due to hormonal and metabolic disorders occurring in her body. After all, PCOS is associated with a fourfold increase in the risk of developing diabetes mellitus (Type 2).

Also, women suffering from PCOS have a significantly increased risk of developing dyslipidemia (disorders of fat metabolism), non-alcoholic fatty liver disease, sleep apnea, cardiovascular diseases, and mood disorders. Therefore, in accordance with modern recommendations of a number of professional societies - both endocrinological and gynecological - it is advisable for women suffering from polycystic ovary syndrome to be screened regularly (every 3-5 years or more often - as indicated) for diabetes (best of all - glucose-tolerant test), determine the level of fats in the blood, measure blood pressure. Endocrinologists additionally recommend screening for depression and symptoms of sleep apnea.

The most important rule in the treatment of PCOS will be an individual approach, taking into account the wishes of women.

Weight loss is the first step in treatment

If you are overweight, the first step in treatment will be to adjust your diet and lose weight, regardless of whether the woman is planning a pregnancy or not. A weight loss of just 5% of the initial weight in obese women resumes ovulation and promotes conception in 30% of cases. Adipose tissue, especially in the abdomen and thighs, is a reservoir of male sex hormones, so getting rid of these reservoirs leads to a decrease in the level of androgens in the blood, as well as a decrease in insulin levels. However, weight loss should be gradual and moderate because sudden loss of body weight can aggravate menstrual disorders. With moderate weight loss, improvement is observed after 4-12 weeks.

There are a huge number of diets that women and men use to reduce body weight. Almost all diets can be divided into several main groups:

• reducing energy consumption (calories);
• reducing protein intake;
• reducing fat intake;
• reducing carbohydrate intake;
• combination diets;
• complex diets (additionally include other weight loss methods).

In the history of studying polycystic ovary syndrome, there is an insufficient number of publications devoted to the effect of different types of diets on the course of PCOS and the restoration of the regularity of menstrual cycles, as well as increasing the fertility of women. Of all the most popular diets, the effects of nutrition with limited energy (from 1000 to 1400 kcal/day) and protein have been studied. Diets that take into account the low glycemic index deserve attention. Combinations of diet and exercise, as well as additional metformin, are becoming popular in the treatment of PCOS.

Planning pregnancy - stimulating ovulation

For women who are planning a pregnancy but have problems conceiving, the first step would be to stimulate ovulation, which increases the chance of conception, rather than long-term use of hormonal contraceptives. Traditionally, many doctors stimulate ovulation with clostilbegide (Clomid, clomiphene). This drug, when dosed correctly, rarely leads to hyperstimulated ovarian syndrome. It also has antiandrogenic properties, so it has a positive effect in women with a slight increase in the level of male sex hormones.

If conception of a child does not occur within 4-6 cycles of ovulation stimulation, it is necessary to use other reproductive technologies.

But if a woman does not agree to ovulation stimulation, she may be offered to take the antidiabetic drug metformin. Metformin is also recommended for those women who have confirmed insulin resistance. Although a 2012 Cochrane review found metformin to be ineffective in improving fertility in women with PCOS, many doctors still recommend the antidiabetic drug to women planning a pregnancy.

Treatment of hirsutism in women in this category is recommended through mechanical or chemical hair removal (depilation). To treat acne, topical ointments with antibiotics, benzoyl peroxide, and others are used. Synthetic vitamin A preparations, although they can lead to developmental defects in the fetus, are completely safe in the form of local treatment, but are not recommended for women planning a pregnancy.

Pregnancy is not planned - consider the symptoms

The group of women who are not planning a pregnancy has much more choice in the treatment of PCOS. Since this is actually a lifelong diagnosis (before the onset of menopause in most women), it is necessary to start treatment with those drugs that will have the least number of side effects with long-term use. The choice of treatment method will also depend on its cost.

The primary approach to selecting a treatment method will be to take into account the signs that cause the woman the greatest discomfort. And since the combination of irregular menstrual cycles, hyperandrogenism and hirsutism is most common in women with PCOS, the first line of treatment will be hormonal contraceptives.

Which hormonal contraceptive should you prefer? There is not a single clinical study that would show the advantage of any drug in the treatment of PCOS, but preference is given to modern drugs with low doses of hormones.

Women must first understand that taking hormonal contraceptives for many months does not lead to regular cycles. Prescribing hormones has three purposes: (1) to create comfort for a woman who wants to have artificial regularity of her cycles, (2) to prevent endometrial hyperplasia (excessive growth) and subsequent irregular bleeding, (3) to prevent unwanted pregnancy.

After stopping hormonal medications, in most cases, women will experience the same symptoms as before treatment. However, if treatment is combined with weight loss, a transition to a healthy lifestyle with increased physical activity, and a balanced diet, then the positive results will last for a long period even without taking hormonal drugs.

Often, women in the treatment of PCOS are offered not complex oral contraceptives (COCs), but synthetic progesterones (progestins), including the Mirena intrauterine hormonal system. The goal of this treatment is to prevent endometrial hyperplasia.

Taking hormonal contraceptives also has a beneficial effect on reversing hirsutism in women with PCOS, and this is supported by a 2015 Cochrane review. In the past, spironolactone, cyproterone, flutamide and a number of other drugs have been used to lower androgen levels and reduce signs of hirsutism, the effectiveness of which is now disputed. Also, treatment of hirsutism requires patience from both women and doctors, because the first signs of treatment effectiveness appear no earlier than six months after taking the drugs. Sometimes there is also a negative effect of long-term use of hormonal contraceptives - baldness due to changes in hormonal levels.

In the treatment of acne, hormonal contraceptives are used, as well as various ointments, both in monotherapy and in combination with other drugs.

Antidiabetic drugs (metformin) may be recommended for women who do not want to use hormonal drugs. Although taking metformin improves cycle regularity in half of women taking the drug, it is important to understand that without lifestyle and dietary modifications this effect will not last long. At the same time, it is important to understand that any drug used to treat PCOS has a high level of side effects, which can lead to abnormalities in the functioning of other organs.

Since the 1930s, polycystic ovary syndrome has been treated only with wedge resection of the ovaries, suggesting that the thick ovarian capsule prevents the ovulating follicle from rupturing and releasing a mature egg into the abdominal cavity for subsequent conception. However, this operation more often ended in failure and further aggravation of the problem due to adhesions in the abdominal cavity (in 70% of cases). Therefore, most doctors refused this type of surgery.

After it was established that PCOS is a hormonal-metabolic disease, the main methods of treatment for women with PCOS became non-drug and medication. But in a number of patients who have a thick ovarian capsule, some doctors suggest laparoscopic dissection of the ovarian capsule. Other types of laparoscopic treatment include laser drilling holes (5 x 5 mm) in the wall of the ovaries or performing multiple ovarian biopsies (taking pieces of tissue). It is assumed that creating holes in the ovarian capsule creates better conditions for the release of ovulating eggs outside the ovary.

However, surgical treatment has a serious disadvantage. In addition to increasing the incidence of adhesions, the risk of developing ovarian failure and early menopause increases due to damage to the ovaries, as well as the surrounding vessels and nerves. In many countries, surgical treatment is not strictly recommended in cases where conservative treatment has not been carried out.

Thus, modern medicine has several optimal methods for treating PCOS, the effectiveness of which is not very high, but still allows most women to alleviate the course of this disease and reduce the number of complications.

(Read about the features of diagnosing PCOS.)