Polycystosis of ovaries
- Reasons of the Polycystosis of ovaries
- Symptoms of the Polycystosis of ovaries
- Treatment of the Polycystosis of ovaries
The syndrome of polycystic ovaries is neuroendocrinal a syndrome, is characterized by bilateral increase in ovaries and existence in them of a large number cystous атретичних follicles and is followed by disturbances of a menstrual cycle preferential as an oligoopsomenorea or an amenorrhea, a hirsutism, infertility, obesity.
Reasons of the Polycystosis of ovaries:
At the heart of development of a syndrome - disturbance of a tsirkhoralny rhythm of allocation of LG-RG owing to what products of LG amplify and allocation of FSG is limited.
Under the influence of FSG in granular cells of ovaries are formed, the aromatases and enzymes transforming androgens to estrogen. At a syndrome of polycystic ovaries deficit of FSG and surplus of LG in this connection ovaries in the increased quantity produce androgens is observed.
There is a theory connecting development of a syndrome of polycystic ovaries with hereditary deficit 19 hydroxylases and 3 - beta dehydrogenases which turn testosterone and androstendion into oestradiol and estrone at the expense of what the producing ovaries of androgens amplifies.
It is necessary to emphasize what positive and negative feedback between hormones of ovaries and hormones of gipotalamo-pituitary system remains.
In ovaries synthesis of inhibin which slows down allocation of FSG increases. Owing to reduced allocation of FSG there is no ovulation and, as a result, a lyuteinovy phase of a cycle. Against the background of the low monotonous long nature of emission of estrogen, and also due to their extra gonadal synthesis in fatty tissue the endometria hyperplasia develops.
Disturbance of processes of a folliculogenesis and synthesis of estrogen in ovaries can be a consequence of a giperandrogeniya of adrenal genesis.
Dependences on pathogenetic origins distinguish gipotalamo-pituitary, ovarian and adrenal forms of a syndrome of polycystic ovaries. Such division can be considered conditional as the functions of ovaries specified the level of neurohumoral regulation are closely interconnected.
Symptoms of the Polycystosis of ovaries:
The clinical current of a syndrome is generally typical and is characterized by disturbance of a menstrual cycle in the form of an amenorrhea or an aligoopsomenorea, in some cases patients complain of bleedings. As a rule, obesity, a hirsutism, infertility, pregnancy not incubation are observed. During bimanual inspection of patients find bilateral increase in ovaries. In case of a combination of a syndrome of polycystic ovaries to other neuroendocrinal syndromes (adrenogenital, puerperal obesity, Itsenko's disease - Cushing) the clinical picture is shown by the corresponding symptoms.
Diagnosis of a disease is based on a characteristic clinical picture, results of a gynecologic research, studying of a functional condition of ovaries, and also exceptions of androgenprodutsiruyushchy tumors. It is necessary to include in a complex of inspection of such patients: ultrasonography, tests of functional diagnosis of ovaries, determination of level in blood serum of gonadotrophins, sexual steroids, adrenal hormones and thyroid glands. With the purpose to exclude adenoma of a hypophysis carry out a kraniografiya. For confirmation of a giperandrogeniya and establishment of a form of a syndrome determine content 17-KC and 17-OKC in daily urine and put tests with AKTG, dexamethasone, LG-RG.
The final diagnosis is established after carrying out a laparoscopy and a histologic research of tissue of ovaries.
Treatment of the Polycystosis of ovaries:
For treatment of a syndrome of polycystic ovaries widely use both surgical, and conservative methods. Treatment is directed to normalization of a menstrual cycle, fertility recovery, decrease in a hirsutism and a hyperplasia of an endometria. Conservative therapy includes non-drug and medicamentous methods.
Treat non-drug methods a dietotherapy which purpose is decrease in the general caloric content of food, and also physiotherapeutic procedures (an endonasal electrophoresis of B1 vitamin, ultra-violet radiation of blood, etc.) directed to normalization of hormonal interrelations. Except non-drug methods use medicamentous drugs, is subject to normalization carbohydrate and a lipometabolism (Metforminum of 1500 mg a day).
Drug treatment consists in purpose of preferential hormonal drugs. For stimulation of an ovulation use clomifene or klostilbegit 50 - 150 mg a day from the 5th to the 9th day of a menstrual cycle, and also the drugs containing "pure" FSG or in a combination with LG (менопур, хумегон, метродин, etc.).
To treatment and prevention of hyperplastic processes of an endometria apply synthetic progestins according to the standard scheme (6 - 8 cycles).
Successfully apply tsiproteron-acetate (Diane-35) according to the standard scheme to treatment of a hirsutism, верошпирон on 50 mg 2 times a day from the 4th to the 21st day of a menstrual cycle, metronidazole from the 5th day of a menstrual cycle for the scheme. Such courses are repeated three times with a break of 1 month. In the presence of a giperprolaktinemiya appoint бромкриптин, метерголин, Parlodelum in a dose of 1,25 - 5 mg a day according to the reduced scheme from the 5th to the 14th day or it is continuous within 2 - 3 months.
The patient with an adrenal form add glucocorticoids (Prednisolonum, dexamethasone) to a complex of treatment.
Operational methods of treatment of a syndrome of polycystic ovaries are considered effective today. Early surgical treatment considerably increases efficiency of therapy in respect of recovery of ovulatory menstrual cycles and approach of pregnancy. Mechanisms of action of operational treatment still it is still insufficiently studied, however it is proved that reduction of volume of tissue of ovaries promotes decrease in development of androgens and increase in products of FSG. Among operational methods preferential use a laparoscopic klinopodobny resection of ovaries, a demedulyation, decapsulation, a decortication, laser vaporization by the carbonic or argon laser.