Polycystic is a hormonal pathology that occurs due to a violation of the hypothalamic regulation of the ovaries. The disease entails an imbalance of the menstrual cycle, obesity, excessive hairiness (hirsutism), can also cause infertility. Among the causes of female infertility, polycystic ovarian disease (PCOS) occupies a leading position.
In more detail about what kind of disease it is, what causes it, as well as what symptoms and treatment are most effective for a woman – we will look at this material later.
Polycystic ovary: what is it?
Polycystic ovary is a change in the anatomy and function of the ovaries against a background of impaired ovarian metabolism (steroidogenesis). The disease is associated with impaired estrogen synthesis and folliculogenesis and increased formation of androgens, which leads to the formation of multiple small cysts on the surface of the ovaries (the result of the inability of the egg to exit the follicle) and infertility.
The disease can be found under a different name – polycystic ovary syndrome – a more capacious definition, as it combines several symptoms that form this pathology.
Female ovaries perform two important functions, without which the normal functioning of the reproductive system is impossible:
- Endocrine function is responsible for the normal production of progesterone and estrogen, which, in turn, prepare the inner layer of the uterus to attach the ovum in the event of pregnancy.
- The degenerative function is responsible for the growth and development of follicles, from which the egg cell subsequently leaves.
The size of the ovary depends on the age and phase of the menstrual cycle. The right one is usually bigger and heavier than the left one. Ovaries of normal size during examination usually can only be palpated in thin women.
What happens during the illness?
- During the menstrual cycle, many follicles form in the healthy gonads.
- In the middle of a normal cycle, a mature follicle is ruptured, from which an egg cell (ovulation) enters the fallopian tube, while the other follicles dissolve.
- But ovulation does not occur with polycystic because the egg within the dominant follicle does not mature, and all follicles are filled with fluid, transforming into small cysts.
The disease is conventionally divided into two forms, depending on the primacy of the pathology:
- primary PCO, or true polycystic, with other names – “Polycystic ovary disease” (PCND) ”,“ Sclerocystic ovaries ”,“ Stein-Leventhal Syndrome ”;
- secondary polycystic, which is the result of violations of the original mechanism.
There are three types of polycystic:
- the phenomena of ovarian dysfunction prevail,
- The symptoms that indicate a violation of the normal ratio of androgens and estrogens in the blood come to the fore. This is accompanied by the appearance of hirsutism, acne, often – fullness, excessive sweating.
- Symptoms that indicate endocrine dysfunction at the diencephalic level are expressed.
Science learned about polycystic ovaries more than 100 years ago, but so far, due to the fact that this manifestation is characterized by multiple manifestations, its etiology and pathogenesis are not yet fully understood.
Studies show that polycystic ovaries suffer from 5 to 10% of all women of child-bearing age, regardless of race or nationality.
The following factors contribute to the development of the disease:
- genetic predisposition;
- constant stress;
- the presence of chronic infections;
- a large number of abortions (leading to hormonal disruptions);
- complicated pregnancy and childbirth;
- irregular sex life;
- endocrine pathology (diseases of the thyroid, adrenal glands, pancreas, and others);
- disturbed ecology;
- gynecological problems (both inflammatory and endocrine nature).
Polycystic ovaries occurs in adolescent girls as well as in adult women who have given birth. A strong stress, a serious infectious disease, an autoimmune process, an abrupt change in climate can be the impetus for the development of the disease.
Symptoms of polycystic ovary
The symptoms of polycystic is incredibly diverse, most of them are not specific, as they can be present for any dishormonal disorder. They may appear with the first menstruation or a few years after a period of normal menstruation.
The most common symptoms of polycystosis in women:
- Disturbances of a menstrual cycle – long delays and long periods.
- Increased greasiness of hair and skin, the appearance of acne, acne, seborrhea. When polycystic develops due to hypersecretion of androgens, are permanent, not amenable to symptomatic therapy.
- Significant weight gain. Fat deposits appear mainly in the waist area (like an apple). The development of obesity in polycystic ovaries is associated with impaired glucose tolerance and an excess of insulin in the blood.
- The emergence of dark spots on the skin (often in the neck), acne, wrinkles and skin folds, increasing the oily skin, male-pattern hair growth (hirsutism).
- Abdominal tenderness. Pain symptom may be permanent. This is explained by an increase in the ovaries and pressure on the pelvic organs.
- the constancy of the basal temperature – an increase in the basal temperature in women indicates ovulation has occurred – it is on this basis that the best days for conception are determined. Patients with polycystosis have a constant temperature, which indicates that the woman does not ovulate.
- Infertility. It is explained by chronic anovulation or rare ovulation (during the rupture of the follicle and the release of the egg, it cannot break through the very dense membrane of the ovary).
- Depression and dysphoria. Manifestations of these conditions are expressed in nervousness, irritability and aggressiveness. Lackiness, apathy, and drowsiness are also often noted.
Diseases that can mimic polycystic
- Pathological processes associated with hypothyroidism;
- Tumors of the ovaries and adrenal glands;
- Increased secretion of prolactin (pituitary hyperprolactinemia).
I would like to emphasize that in the above diseases, the symptoms are very similar to the signs of PCO, and therefore much attention should be paid to the diagnosis of the pathological process.
Polycystic ovarian disease is a very insidious disease that, in addition to infertility, entails a lot of undesirable consequences for a woman’s health.
- The most serious complication of the disease is the inability of a woman to become pregnant.
- If a woman does not respond properly to the symptoms of the disease and does not seek medical help during the first two years since the onset of the disease, then she will have an increased risk of cervical and breast cancer.
- Metabolic disorders, especially fats, lead to the development of vascular atherosclerosis, stroke, myocardial infarction, hepatic fatty liver and type 2 diabetes.
- Severe anemia due to massive uterine bleeding.
Polycystic is a disease with a favorable prognosis. Timely and high-quality treatment leads to the restoration of the ability of the representative of the weaker half of society to conceive and bear the fetus in 75-90% of cases.
It is not a secret for anyone that a timely diagnosis will help to start an effective treatment in time and help to avoid surgery. Diagnosis will help to establish the true causes that provoked the disease.
Polycystic ovaries are placed only on a combination of several signs (infertility, androgen and associated symptoms are considered to be the main ones).
The main methods for the diagnosis of polycystic:
- General examination, which includes an assessment of body type, the nature of hair growth, the condition of the skin and mucous membranes, palpation of the abdomen, etc.
- Gynecological vaginal-abdominal examination on the chair, allowing to identify the enlargement and compaction of the ovaries on both sides.
- Ultrasound transvaginal examination. The volume of the ovaries is increased and is 8 or more cubic cm. Directly under the capsule 10 or more atretic follicles are found. The stroma is thickened, hyperplastic and may be 25% of the volume of the ovary.
- Magnetic resonance imaging (MRI), which allows to exclude tumor lesions.
- Pelvic laparoscopy – examination of the abdominal organs with an endoscope inserted through the anterior abdominal wall. The indications for laparoscopy are suspected uterus or ovarian tumors, chronic pelvic pain, suspected tubal pregnancy, ovarian apoplexy, tumors, cyst rupture.
- The test for glucose tolerance (insulin resistance), elevated insulin levels and high blood sugar indicate a violation of carbohydrate metabolism.
It is also necessary to conduct a study of the hormonal status.
- Pathognomic sign of polycystic ovary is the increase in the ratio of luteinizing hormone to follicle-stimulating to 3: 1.
- The blood levels of testosterone are elevated, there is a decrease in progesterone in the second phase of the cycle, and in the urine an increase in 17C is determined.
Note: with hormonal disruptions, the basal temperature throughout the entire menstrual cycle remains unchanged. The coarsening of the voice, defeminization and hypertrophy of the clitoris in PCOS, as a rule, are not observed.
In the overwhelming majority of cases (85%), sterility in polycystic ovary is primary and may be its only symptom. The number of spontaneous pregnancies in polycystic does not exceed 3 – 5%, and the probability of their successful outcome is negligible.
Most experts say that getting pregnant with PCOS is quite possible. In clinical practice, there are many cases of successful childbirth by patients suffering from polycystic disease. However, for this throughout the pregnancy, they are recommended supportive drug therapy.
Attention! With pregnancy with such a diagnosis, the risk of fetal death, miscarriage and premature birth is great.
How to treat polycystic ovaries?
Treatment of polycystic ovarian process is quite long and complicated. The main thing is to be patient and follow tirelessly to the goal.
- normalization of the menstrual cycle;
- restoration of ovulation and further pregnancy;
- elimination of cosmetic problems;
- weight correction.
Given the fact that polycystic ovaries can act as a side effect of another type of disease (chronic adnexitis, diabetes, liver disease, etc.), treatment should be directed not only at eliminating the symptoms (actually polycystic ovaries), but also at eliminating the underlying disease which provoked the pathology under consideration.
The treatment consists of:
- Mandatory weight loss in the presence of obesity. In these patients, this is the first stage. To do this, the correction of nutrition and lifestyle. Weight loss can help treat hormonal changes and improve health outcomes, such as diabetes, high blood pressure, or high cholesterol.
- Oral contraceptives reduce blood androgen concentration. If you take drugs for 2-3 months, it is possible to restore the ability to ovulate. The method is effective only when polycystic due to hyperandrogenesis.
- In the presence of insulin resistance – a reduced ability of cells to respond to insulin, which helps absorb glucose, prescribe metformin drugs: Glucophage, Siofor.
- Stimulation of ovulation. Prescribe the minimum dose of hormones that run the ovaries and will provide an opportunity to get the pregnancy as naturally as possible.
- Non-hormonal treatments for polycystic ovary syndrome, for example, physiotherapy or nonsteroidal antiandrogens are usually used as adjuvants.
- Reception of ascorbic acid, vitamins of groups is necessary: E, B12, PP, B1, B9, B6.
The indication for surgical treatment of polycystic ovary is the lack of effect from conservative therapy. The method of operation is determined depending on the picture of the disease. In women with infertility, surgical treatment is analogous to hormonal stimulation of ovulation.
Methods of surgical intervention are aimed at achieving the following goals:
- remove affected parts;
- destroy some areas of the ovary;
- activate the synthesis of androgens in order to normalize the relationship between the ovaries and the central parts of the brain structure.
The main advantage of laparoscopy is that this procedure does not harm the patient. It comes to life after a couple of hours after surgery, and full recovery occurs in a few days.
But surgical methods are resorted to in extreme cases where the drug methods described above do not help. They can also prescribe laparoscopy to women over 30 years old who have pronounced violations of hirsutism and the menstrual cycle, as well as those who have developed endometrial hyperplastic processes.
In the case when the treatment of polycystic will be appointed in a timely manner, you can get rid of it at the earliest stages. If all medical recommendations are followed, the prognosis of the disease is favorable, and only when planning a pregnancy can certain difficulties arise.
Pregnancy after surgical treatment occurs within 6-9 months, but the more time has passed after the operation, the less chance of becoming pregnant.
Nutrition provides the body with substances to produce the energy needed for metabolic processes, to restore and synthesize new cells, to set aside spare substances (fat — in adipose tissue, glycogen — in the liver).
Doctors recommend patients with polycystosis about this schedule:
- a full first breakfast about 30–40 minutes after waking up;
- easy second breakfast;
- full lunch;
- multi-course dinner;
- light snack before bedtime.
With polycystic ovaries, it is necessary to eliminate once and for all from the diet, which includes a large amount of carbohydrates and cholesterol. This requirement is very categorical – the products listed below cannot be eaten even sometimes and even if you really want to.
- low-fat fish and meat;
- rye, barley, bakery products based on them;
- Bean products: chickpeas, lentils, soybeans, peas, beans;
- brown rice;
- dairy products: cottage cheese, yogurt, with a low percentage of fat;
- berries and fruits: apricot, pears, gooseberries, apples, currants, peaches, strawberries, cherries, raspberries, strawberries, quinces, nectarines, mulberries, orange, grapefruit, tangerines, plums;
- nuts: hazelnuts, peanuts, almonds, pine nuts, cashews;
- vegetables: color, Brussels sprouts, broccoli, peppers, onions, asparagus, zucchini, garlic, eggplant, corn, tomatoes, cucumbers, greens;
- chocolate: black (at least 85% cocoa);
- sugar free jam;
- fructose based ice cream.
- fruits: pineapple, watermelon, melon, persimmon and mango;
- vegetables: potatoes, turnips, pumpkin, beets, carrots, parsnips;
- bakery products, flour of all kinds, baking;
- alcoholic beverages;
- jam, honey, jam, candy;
- chocolate: white, milk;
- ice cream;
- bulgur, rice, semolina;
- mayonnaise, ketchup, various sauces;
- canned foods;
- · Strong tea, coffee;
- tobacco, nicotine;
- fast food;
- semi-finished products;
- fatty, fried and smoked food.
Rules diet with polycystic ovaries:
- Food caloric content is not more than 1800 – 2000 kilocalories per day.
- Fractional nutrition 5-6 times.
- Protein products combine with vegetables.
- Do not combine fruit intake with other products.
- Cooking methods – cooking, stewing, baking, steaming.
- Drinking mode up to 2 liters of water per day.
- Fasting days no more than 1 time in 7-10 days (kefir, curd, fruit).
- To reduce the consumption of salt and foods, where Na is found in large quantities (crackers, nuts, canned food).
- Limit carbohydrate intake after 6 pm.
Traditional methods of treatment
Before using folk remedies for polycystic ovary, be sure to consult with the gynecologist.
- Tampons with mummy. Mumie in the amount of 150 grams pour 3 dessert spoons of warm water. After the main component swells, mix the mixture. The tampon, formed from a bandage, is placed in the composition and inserted into the vagina before bedtime. The course of treatment is 10 days. By the procedures do not resort during menstruation.
- Stalk and leaves of young celandine wash, dry, chop. In equal parts, mix with vodka and insist in a dark place for 10 days. Drink the infusion of a teaspoon in a mixture of 50 ml of water thirty minutes before meals.
- Put in a glass of boiling water 5 g milk thistle. Allow to cool and filter. Drink 100 ml in the morning on an empty stomach and in the evening before bedtime.
- It will take 40 grams of dry oregano per 300 ml of boiling water. After an hour, filter, drink 20 ml three times a day.
- To reduce androgens, you can use mint. Mint tinctures, tea with mint can be drunk without restriction (within reason). To quickly achieve the desired effect, you need to brew mint with milk thistle and take one glass twice a day.
Polycystic prophylaxis includes:
- regular visits to the gynecologist – twice a year;
- weight control, regular exercise, diet;
- hormonal contraceptive use.
Now, you know what this disease is. But, despite serious pathological changes in the reproductive system, reasonable, correct and staged treatment of polycystic ovaries makes it possible to restore its normal hormonal functioning and to achieve a full-fledged pregnancy and childbirth.