Update: October 2018
One of the causes of female infertility is polycystic
the ovaries, but fortunately, this pathology is not so common
Often, from 4 to 8% of cases among all women of childbearing
Of course, polycystic ovary is a serious disease, but it’s
does not mean that to fight him and try to get pregnant does not have
meaning. The earlier the therapy is started, the greater the chance if not
completely defeat the disease, then “moderate its ardor” and give birth
The concept of “polycystic ovary”
This term implies structural and functional
ovarian pathology that develops on the background of neuroexchange
failures. The disease is associated with impaired estrogen synthesis and
folliculogenesis and increased formation of androgens, which leads
to the formation on the surface of the ovaries multiple small cysts
(the result of the inability of the egg to exit the follicle) and
Synonyms of polycystic ovary syndrome is
Stein-Levental syndrome or scleropolycystic ovaries.
Why does it arise?
Scientists still have not come to a single decision on the reasons
polycystic. In the mechanism of the development of the disease are guilty violations in
the hypothalamus-pituitary-adrenal-ovarian system, and
wrong production of hormones in the pancreas and thyroid
Abnormal decline plays a big role
insulin sensitivity of adipose and muscular tissues, i.e.
their insulin resistance arises. Consequently, in the blood
an enormous amount of insulin circulates that spurs
ovarian stimulation and they begin to produce estrogens and
of course, androgens in enhanced mode. What leads to a violation
ovulation, and the second phase of the cycle becomes inadequate (lack of
Or perhaps another scenario. Ovarian tissue
becomes very insulin-sensitive, whereas muscle tissue and
the fat layer retain a normal ability to respond to
insulin. That is, there is a normal content in the blood.
insulin, but since the ovaries differ in elevated
insulin sensitivity, they are still strenuously and in large
quantities secreted by androgens and estrogens, which ends
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
Plastic containers may contribute to hormonal failure.
women and promote polycystic ovary
For all the time there is a plastic packaging question about
the safety of its use in the food industry rises
constantly. Harvard scientists have determined that with
use of drinks from plastic bottles in the body by 69%
increases the content of substances that affect sexual
Bisphenol A, used to make tetrapacks and
jars in their action resembles estrogen and can
promote the development of women polycystic ovaries, infertility and
cancer of the uterus. When consumed during the week of drinks from
plastic packaging in urine bisphenol A increases by 69
Some parents, without thinking, warm up the milk (milk
mixture) for children directly in plastic bottles that
promotes chemical penetration into the product. Frequent consumption
such drinks can disrupt the hormonal glands in children with
early childhood. Scientists fear that the harmful effects of bisphenol
may be one of the reasons for early puberty in adolescents
cause growth problems, birth defects of the future
generation, polycystic ovaries in girls, an increase in risk
heart disease and diabetes.
How does polycystic ovarian disease
The main clinical symptoms of polycystic ovary
- increase in ovarian size
- primary infertility (i.e. lack of pregnancies in
- violation of the menstrual cycle by the type of oligomenorrhea and
- weight gain
Disrupted menstrual cycle is noted from the age of menarche.
(first menstruation), which corresponds to an average of 12 – 13 years.
After the first periods come, the cycle is no different.
regularity, menstruation occurs once every 3 to 6 months, which
called oligomenorrhea and amenorrhea, or are scarce (see
causes of scanty menses) or abundant discharge. Besides,
menstrual painful (see painful menses: causes,
Against the background of a chronic lack of ovulation, infertility develops,
or ovulation does not occur monthly. In the blood are recorded
increased levels of androgens. High androgen content
promotes the development of hirsutism (excessive hair growth).
Core localization hair often falls on the legs, hind
the surface of the thighs, perineum and white line of the abdomen. On the face
hirsutism is expressed in the form of “antennae” above the lip.
Also indirect signs of polycystic ovary
obesity on the background of the female morphotype. The body weight of the patients can
exceed 10 – 15 kg of normal weight. And it is noted
even distribution of excess kilograms (adipose tissue).
The mammary glands are usually developed. Such signs of excess
the amount of androgens as alopecia (see the causes of hair loss in
women), seborrhea, multiple acne, and oily skin are not typical
for patients with this disease.
In case of polycystic ovary, the symptom of the disease can be considered
rough voice (androgen effect), skin pigmentation (from
light brown to dark brown) armpits, under
mammary glands, in the neck, the duration of symptoms,
resembling premenstrual syndrome (edema, instability
mood, pain in the lower abdomen and in the lumbar region,
breast engorgement and hypersensitivity).
Due to the ovaries of patients with enlarged
polycystic has a persistent pain syndrome that
localized in the lower abdomen, in the lower back and sacral area, that
associated with compression of the adjacent organs by the ovaries and increased
production of prostaglandins.
Some patients are diagnosed with cyclic uterine
bleeding. This phenomenon is due to the result of prolonged
monotonous effects of estrogen on the uterine lining in the background
reduced formation of progesterone. As a result, the endometrium is not
a secretory transformation occurs, it thickens and
Polycystic ovary increases the risk of developing depression and
anxiety in women
Women with this diagnosis are most at risk of developing
depression and other mental disorders. Conducted by Dr. Anuja
Dokras Research (Philadelphia, University Medical Center), in
which involved 206 patients with polycystic ovaries,
showed that 20% of them had anxiety disorders,
social phobias, panic attacks, obsessive-compulsive
disorder, low self-esteem, depressive states (in
only 4% of women with symptoms were identified in the control group.
That is, in patients with polycystic almost 7-fold increase
risk of common signs of anxiety. In another
The study found that depression occurs in 35% of women with
such a diagnosis (in the control group 11%). In one more
The study examined the dependence of age, mass index
body and anxiety – as a result, most women with
polycystic is obese or overweight, and in 13%
identified anxiety states.
The possibility of pregnancy with polycystic ovaries
«Мне постаatили поликистоз яичникоat, can I get pregnant?»
This is the question that most patients ask. Despite
all “horror stories”, this pathology is not a reason to put
cross on children. Indisputable, get pregnant with this
disease is difficult, but possible.
Of course, just like that, with ease, few people succeed, but
medicine is moving forward, and at the moment the treatment of polycystic
The ovaries increase the chances of the patient being pregnant. To start
it is necessary to restore the cycle of menstruation, while often
use combined oral contraceptives.
Then ovulation is stimulated with an anti-androgen agent.
clostilbegit, after which the optimal day is calculated for
conception, which is confirmed by ultrasound of the ovaries and
detection of dominant follicle. If fertilization has occurred,
then the first 3 months of pregnancy to a woman without fail
progesterone drugs are prescribed to support poorly
functioning yellow body, and, respectively, pregnancy.
Пример из практики: У меня достаточно долго
A woman with a confirmed diagnosis was observed (ultrasound and laboratory
analyzes) polycystic ovary. For the time being she is about
pregnancy did not think (or decided that everything would cost and
will get pregnant herself as soon as she wants). But on the threshold of the 30th anniversary
The question arose, and the patient asked the reception to request
assistance in conception. After a short course of birth control pills
(3 months, but she didn’t want to do any more) I appointed her
clostilbegit. The patient got pregnant in the first month. Took
(at least it was recommended to take) duphaston long,
month 2. But during the next gynecological examination
it turned out that pregnancy does not develop (frozen), the uterus is not
corresponds to the expected duration of pregnancy, and bother
(after the aiming “interrogation”) periodic spotting. Ultrasound
confirmed the diagnosis and the woman had to scrape. Then patient
disappeared from my field of vision, and appeared after 2 years with
final decision on laparoscopic intervention. Having passed
all necessary examinations, the woman went to the regional hospital,
where she underwent laparoscopic resection of the ovaries, and returning,
got pregnant after 4 months. Pregnancy proceeded more or less
normal, but at the end of the period she gave birth to a wonderful baby.
How to confirm the diagnosis?
In addition to the collection of complaints and external examination (physique, hair growth,
pigmentation, skin and hair condition – oiliness, palpation
thyroid, abdomen and mammary glands) is carried out
gynecological (bimanual examination). During palpation
inguinal areas are defined increased by 2 – 3 times, dense and
slightly painful ovaries. In the basal body temperature chart
there is no biphasic, which indicates the insufficiency of the second phase
menstrual cycle and anovulation (no ovulation).
Polycystic ovary syndrome has a clear picture of
- First, there are large ovaries (more than
9 cubic cm)
- Secondly, up to 8 – 10 and smaller cysts are visualized.
circle up to 8 mm.
Characterized by a dense stroma. During laparoscopy
ovaries look like enlarged masses up to 5-6 cm long and 4
cm wide, surrounded by a smooth pearl-whitish capsule.
The density of the capsule is determined by the absence of translucent
It is also necessary to conduct a study of hormonal
- Pathognomic sign of polycystic ovary is
the increase in the ratio of luteinizing hormone to
follicle-stimulating up to 3: 1.
- The blood levels of testosterone increased,
- there is a decrease in progesterone in the second phase of the cycle,
- and in the urine is determined by the increase in 17-COP.
Besides, необходимо определить содержание инсулина
(increased, decreased, or normal; different variants are likely)
and glucose (see blood glucose standard). There is also an increase
Fat levels (triglycerides, cholesterol and others). When
dysfunctional uterine bleeding is performed
medical and diagnostic curettage of the uterus, in the resulting scraping
определяется гиперплазия endometrium.
There are diseases in which the clinical picture is similar.
polycystic ovarian cancer: adrenogenital syndrome, Cushing’s disease,
reduced thyroid function, increased production
prolactin, androgen-producing tumors, etc. Therefore, when
final diagnosis of these diseases should be
excluded because their treatment is different.
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
goals The first step is to normalize weight in women with
Food and gymnastics
As you know, fatty tissue in large quantities produces
androgens and estrogens, which exacerbates the disease (excess
additional male and female sex hormones are created by
their formation, both in the ovaries and in body fat).
Often, with normalization of weight, menstrual function, and sometimes
ovulation restored independently. Selection of diets for
weight loss must be done with a dietitian.
Recommended restriction of fatty, spicy, spicy, salty foods,
avoiding alcohol and consuming large amounts of fluid.
Particular attention should be paid to sweet, that is, to exclude it
from your diet at all. Along with dieting
need to exercise (gymnastics,
swimming pool, jogging, yoga). Exercise should not
bring to weariness, and bring pleasure, in this regard
The most simple and effective set of exercises Bodyflex.
When insulin resistance
Also in treatment for polycystic ovaries (in case of detection
insulin resistance) include metformin, which potentiates
utilization of glucose in the body, thereby normalizing its level in
blood, weakens appetite, and, according to some, regulates
menstrual cycle. Dose and duration of the course (3 – 6 months)
are selected by a doctor.
After normalization of weight go to the next stage of therapy –
recovery cycle. For the regulation of the cycle in polycystic ovaries
prescribed treatment contraceptive (estrogen-progestin)
drugs with antiandrogenic effect (Diana-35, Yarin,
Janine (see good contraceptive pills), for a period of 6 or more
months. Also, to combat hirsutism, use other
antiandrogenic agents: veroshpiron,
However, you should know that taking combined oral
contraceptives in women with polycystic ovary syndrome 2 times
increases the risk of venous thromboembolism.
After restoring the cycle, proceed to the main point of treatment.
– stimulation of ovulation (in those patients who wish to
get pregnant). To do this, use the drug with pronounced
antiestrogenic properties – clostilbegit (clomiphene).
After discontinuation of the drug, FSH and LH are produced, the action
which stimulates the maturation of the dominant follicle and ovulation.
The drug is prescribed from the 5th to the 9th day of the cycle at a dosage of 0.05 g. at
сутки, сроком не более трех months. При отсутстatии эффекта дозу
уatеличиatают до 200 мг. Одним из побочных эффектоat клостилбегита
яatляется atероятность the formation of functional ovarian cysts
large sizes. If drug treatment for three
months turned out to be ineffective, the question of the operation is being resolved.
Surgical treatment of the disease is currently underway.
laparoscopically. 2 surgical options are used.
Interventions: wedge-shaped resection of the ovaries and electric
coagulation of the tassels in the ovaries. The second way is more
gentle, as it consists in applying notches on the ovarian capsule
and cauterization of multiple brushes. When wedge resection
the most modified areas of the ovaries are excised (and the capsule and
But it should be noted that female fertility is right
proportional to the statute of limitations of the operation, that is, the more
the time passed after surgical treatment, the less likely
get pregnant Maximum ability to conceive falls on
the first 3 months after surgery, and by the end of the year
significantly reduced (read more about planning and
preparing for pregnancy post-laparoscopy). However operational
treatment is indicated not only for patients with infertility, but also for
diagnosing persistent hyperplastic processes