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Endocrinology

Syndrome of polycystic ovaries

The syndrome of polycystic ovaries (SPKYa) also known as a polycystosis of ovaries, or the Matte syndrome – Leventalya, integrates a number of endocrine and metabolic symptoms, main of which – the increased production of male sex hormones (androgens) ovaries of the woman and the subsequent long disturbances of an ovulation.

Epidemiology.

The disease arises approximately at 5-10% of all women of fertile age, and is one of the leading reasons of infertility. In structure of infertility of endocrine genesis makes 70%.

Etiology.

The syndrome of polycystic ovaries was for the first time described in 1935, but still exact reasons of its development are not known. In recent years the theory of an insulinorezistentnost which at patients with SPKYa is observed several times more often than at other women comes out on top. At this state sensitivity of peripheral fabrics to pancreas hormone decreases that involves increase of its secretory activity – a giperinsulinemiya. And at the same time, tissues of ovaries keep normal sensitivity to insulin therefore in response to increase of level of this hormone in blood, ovaries begin to produce bigger amount of male sex hormones that leads to gradual development of all further disturbances. The Insulinorezistentnost can have the hereditary nature or arise because of unhealthy way of life: the defective, grown poor by nutrients food, an overeating, a little mobile way of life, stresses, bad ecology.

Symptoms.

Increase in weight or inability to grow thin. Many women with SPKYa have normally distributed fatty deposits or obesity as "Yabloko" when fat concentrates in a stomach. Obesity of different degrees or dominance of fatty tissue at a normal index of body weight is observed at 60% of patients. At the remained 40% at the normal body weight or even leanness disturbances of an insulin exchange also come to light.
Absent or irregular monthly (an amenorrhea or an oligomenorrhea) almost always confirm lack of an ovulation. Reduction of quantity of annual menstrual cycles can be SPKYa sign. At approach of periods of bleeding proceed more plentifully and is longer, than usually. 10-15% of women have acyclic bleedings against an endometria hyperplasia. In certain cases recurrence remains, but allocations differ in scarcity and short duration.
Infertility. At a syndrome of polycystic ovaries there is no maturing of follicles therefore the woman is not capable to become pregnant independently.
Excess growth of hair (hirsutism). High level of men's hormones causes growth of hair in zones, atypical for women: face, extremities, breast, back, crotch. Weight of manifestations can be various: from insignificant, in the form of a small down over a lip, to serious at which daily shaving is required.
Thinning of hair or baldness on man's type.
Fat seborrhea and acne. The superactivity of sebaceous glands and acne rash resistant to usual treatment is very often observed. Typical localization of eels: back, breast, shoulders, face. Some women note at themselves increase in quantity of dandruff.
Oothecomas. The hormonal imbalance leads to forming of multiple cysts of a follicular origin. The polycystosis is defined as 12 and more unripe follicles on one ovary.
Chronic fatigue. The common symptom directly connected with resistance to insulin. Also at women with SPKYa in many cases it is observed at the accompanying depression of function of a thyroid gland.
Other problems of skin. In axillary hollows, in the area of a bra, pleated necks, in inguinal area form skin sites with reinforced or granular structure and darkening. This state called an acanthosis is caused by excess of men's hormones.
Differences of mood. Very often at SPKYa there is a problem of lability of mood and the chronic depressions which are not giving in to usual treatment.
High level of cholesterol (lipidemia) and high blood pressure (hypertension). The raised LPNP cholesterol, or "bad" cholesterol acts as the factor increasing probability of heart attacks and a stroke. Women with a syndrome of polycystic ovaries, even in the second and third decade of life, have to pay special attention to the level of cholesterol and a blood pressure to prevent development of a serious cardiovascular illness.
Apnoea during a dream. Women with SPKYa have high risk of development of an apnoea (temporary cessation of breathing) during a dream. Approximately at a half of women with a syndrome of polycystic ovaries it can be connected with increase in an index of body weight. Other possible reason – impact of testosterone on blood vessels.
All complex of symptoms practically never meets, their combination individually in each case.

Diagnosis.

At statement of the diagnosis, first of all, it is necessary to exclude other diseases with giperandrogeniy and similar symptomatology: the idioaptichesky hirsutism, a giperprolaktinemichesky hypogonadism, a total hypercorticoidism, primary hypothyroidism virilizing tumors, nonclassical option of inborn dysfunction of bark of adrenal glands. Obligatory inspection is for this purpose appointed to a number of hormones: cortisol, 17 hydroxyprogesterone, prolactin, thyritropic hormone.
Statement of the diagnosis of SPKYa is admissible in the presence of all three symptoms (a classical current) of this disease: a giperandrogeniya, cystous changes of ovaries according to ultrasonography, disturbances of a menstrual cycle, or one their three (a nonclassical current) their combinations:
1) A combination of morphological features of a polycystosis to a giperandrogeniya, against a regular menstrual cycle with the absent ovulation;
2) A combination of morphological features of a polycystosis to disturbances of a menstrual cycle, in the absence of external signs of a giperandrogeniya;
3) A combination of a dysfunctional menstrual cycle to manifestations of a giperandrogeniya, but without ovarian polycystosis.
Giperandrogeniya signs (pathological pilosis, baldness on man's type, an acne) usually come to light at clinical examination of the patient and do not need laboratory verification on the level of androgens in blood or urine. At infertility and disturbances of a menstrual cycle ultrasonography of bodies of a small pelvis shall be carried out, it is desirable intravaginalno. Polycystic ovaries are diagnosed if 12 and more follicles of 2-9 mm in size on one ovary or bilateral increase in volumes of an ovary - more than 10 cm3 are defined, in combination with anovulatory cycles. Ultrasonography inspection is appointed synchronously with research to hormones for 3-5 day of a menstrual cycle.
The Insulinorezistentnost is established after carrying out blood tests on glucose and insulin on an empty stomach and in two hours after glucosic loading.

Treatment.

Tactics of treatment is chosen depending on a complex of symptoms and a specific life situation of the patient. When long recovery therapy (rather young age of the patient) is possible, basic conservative tactics of maintaining is chosen. Its components:

  1. Change of way of life. Fight against smoking, combination of optimum exercise stresses to a dietotherapy. A diet - the first stage of treatment at patients from SPKYa at the accompanying obesity. Decrease in the general caloric content of food at the expense of digestible carbohydrates and fats, restriction of liquid, salty and spicy food is recommended. Exercise stresses are important not only for normalization of an index of body weight, but also for increase of sensitivity of muscular tissue to insulin.
  2. Anti-androgenic drugs. To Diana-35, Jeanine, Yarin, Androkur, Veroshpiron, etc.
  3. Anti-diabetic drugs (Metforminum, troglitazon) are appointed at clinical laboratory signs of an insulinorezistentnost.

If the infertility situation in specific marriage reached social sharpness and urgency, the program of rehabilitation calculated on several years is not submitted real. In this case, after an exception of man's and pipe factors of infertility, purpose of anitiestrogenny inductors of an ovulation (clomifene citrate) according to the scheme in combination with Metforminum is actual. In the absence of results within half a year resort to other methods of treatment: therapy by gonadotrophins, resection of ovaries, EKO.
The resection of ovaries can be made laparoscopic or by laser cauterization. This method is not always effective and is complicated by commissural process in a small basin therefore at treatment of a syndrome of polycystic ovaries the priority is given to conservative methods.

 
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