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Polycystic ovary disease : symptoms of the disease, causes of occurrence, diagnosis of the syndrome , treatment of polycystic ovarian enlargements .
Polycystic ovary disease : symptoms of the disease, causes of occurrence, diagnosis of the syndrome , treatment of polycystic ovarian enlargements .
Polycystic ovary syndrome (PCOS) may be a sclerocystic ovarian pathology, manifested by a thickening of the ovarian capsule, their enlargement and multiple small cysts (formed at the location of follicles that have stopped developing).
Polycystic ovaries can develop primarily, then this condition is named polycystic ovary disease ( Stein-Leventhal syndrome ). The disease develops during puberty, against the background of chronic tonsillitis, after infections, and is manifested by a rise within the rhythm and a rise within the production of the hormone - luliberin within the hypothalamus, which regulates the assembly of gonadotropic hormones of the pituitary , regulating, in turn, the hormonal function of the ovaries. As a results of the chronic absence of ovulation, additionally to scanty periods or their complete absence, primary infertility develops. thanks to the prolonged increased production of estrogen, functional uterine bleeding and endometrial hyperplasia occur (in 25% of patients). The ovaries are enlarged by 2-6times compared to the norm. Excessive hair growth within the shins, thighs, lower abdomen, forearms, obesity of 2-3 degrees is noted . With timely started therapy, the prognosis is favorable - it's possible to revive reproductive function.
Polycystic ovary syndrome develops secondarily in pubertal and post-pubertal sorts of adrenogenital syndrome (due to increased synthesis of androgens within the adrenal glands). Follicles undergo cystic atresia, ovulation stops, estrogen synthesis decreases, and predominantly male sex hormones - androgens - are produced. Clinically, there's a late onset of the cycle (over 14 years old), the next cycle becomes irregular, with scanty discharge. Primary infertility occurs (less often spontaneous abortions within the early stages) and excessive hair growth within the upper lip, cheeks ("bucks"), chin, forearms, legs, thighs, perineum, areola of the mammary glands. Oiliness of the skin increases, acne occurs. Up to 40% of patients suffer from obesity.
Another explanation for polycystic ovary syndrome is neuroendocrine syndrome (PCOS of central genesis). during this case, there's a transparent beginning, characterized by rapidly progressing obesity after childbirth, abortion, mental trauma, and severe infections. The syndrome develops thanks to a violation of the assembly of hormones within the hypothalamic-pituitary region (as in polycystic ovary disease). Obesity reaches 3-4 degrees,fatty deposits are localized mainly within the pectoral arch and lower abdomen. Stretch marks (from pale pink to purple in color) appear on the skin of the mammary glands, lower abdomen. Against the background of a rise in weight , regular menstruation comes at increasing intervals, become scarce, 25% of girls experience acyclic uterine bleeding. Secondary anovulatory infertility develops. there's a rise in vital sign , increased appetite, thirst, emotional disorders (irritability, tearfulness, aggressiveness with the progression of the disease, apathy, lethargy, increased drowsiness occur).
Complications: additionally to infertility arising altogether sorts of polycystic ovarian disease (difficulty or impossibility of conception and gestation), complications are often arterial hypertension, heart attacks and strokes (due to thromboembolism, atherosclerosis), obesity, the event of type 2 DM , the danger increases the event of endometrial carcinoma and carcinoma .
Diagnostics
Laboratory research. Determination of the extent of hormones within the blood, characterized by an increased ratio of LH to FSH (at least 2). The content of testosterone and androstenedione within the blood is usually increased. With adrenal genesis - an increased content of androgens. High concentration of estrone within the blood.
Ultrasound of the pelvic organs reveals enlarged ovaries with numerous small cysts.
CT of the brain to exclude a pituitary tumor within the central genesis of PCOS.
Treatments
To reduce the severity of symptoms of increased levels of androgens within the blood and restore ovulation and fertility, hormone therapy is prescribed .
In the absence of the effect of hormonal therapy for 6-8 cycles and accompanying polycystic endometrial hyperplasia, surgery is additionally used: wedge resection of the ovaries, laser vaporization and diathermocauterization of the ovaries (cysts are destroyed under the influence of a laser or high-frequency current, healthy tissue is preserved).
After these operations, the frequency of cycle recovery, ovulation occurs in additional than 80% of girls within a month. All operations are performed from laparoscopic approaches under the control of endovideosurgical complexes, which significantly reduces the trauma of treatment and reduces the danger of complications.