Polycystic ovary syndrome is a disease that is well known, but also misunderstood by patients. I am often asked questions such as “Will I be okay? Will I be able to get pregnant?” But let’s start at the beginning. A disease with several names This condition is known as polycystic ovary disease, Stein-Leventhal syndrome, non-tumor ovarian hyperandrogenism, sclero-cystic ovary syndrome. The main one is always the increased production of androgens mainly by the ovaries; disturbed ovulatory process, the maturation of the follicles does not reach the release of an egg; endocrine infertility is present. This also determines the role of the disease in a woman’s reproductive functions. Its frequency is about 3% of all gynecological patients, for sterile women this percentage is close to 32%. Pathogenesis of the disease It comes down to a defect in the biosynthesis of steroid hormones — the formation of androgens increases in the ovaries, the synthesis of estrogens decreases. There is an altered activity of the enzyme systems in the ovary — of 3-beta-old dehydrogenase or of the enzymes for the aromatization of androgens into estrogens. This leads to an accumulation of androgens — androstenedione, oxyprogesterone and testosterone, which, with their virilizing properties, determine the clinical signs of the disease. The increased androgen level, in addition to a disorder in the maturation of the follicles, also gives a change in the feedback of the ovaries with the hypothalamic-pituitary system. About 1/3 of the patients also have an increased level of prolactin, which further disrupts the neurohormonal regulation of the menstrual cycle. Signs of polycystosis The clinical picture is represented by menstrual disorders, sterility, hair loss, weight gain and neuro-vegetative complaints. In about 95% of the patients, there are various disturbances in the menstrual function – oligomenorrhea and hypomenorrhea, secondary amenorrhea of ​​varying duration (sometimes up to one or two menstruations per year). There are also patients with regular menstruation, but always with a disorder of the ovulatory process such as anovulation or less often – such as lutein deficiency. About 1/3 of patients have irregular uterine bleeding of anovulatory nature. This is the so-called metrorrhagic form of polycystic ovarian disease. The disease almost always proceeds with sterility. Therefore, the questions and concerns of my patients are completely justified. Most often, infertility is primary and, less often, secondary. Sterility is caused by the lack of ovulation, and in a small number of patients, by lutein deficiency. The leading clinical signs of the disease should be considered the disorder of the menstrual cycle and the presence of anovulation. In about 60-80% of patients, hirsutism is observed on the limbs, face and body. Gradually, increased hair growth acquires a masculine appearance – growth of sideburns, appearance of hair on the upper lip, diamond-shaped pubic hair, etc.The intensity of hair virilism is different — it depends on the receptivity of the hair follicle to the increased level of androgens and on the nature of the applied cosmetics. In 30%, excessive body mass is also found, with marked feminization of body proportions. The increased androgenic level and the known anabolic effect of androgens should also be considered as factors of obesity. Excess body mass suggests hyperfunction of the adrenal cortex — the symptoms of the disease worsen. Nerve-vegetative complaints are also found in some of the patients – red dermographism, headache, irritability, emotional lability, etc. How is the disease diagnosed? The differential diagnosis is made first of all with Itsenko-Cushing syndrome and an androgen-producing tumor of the adrenal cortex or ovary. This requires determining the level of 17-ketosteroids as a metabolic origin of androgens. Then, at the physician’s discretion, their chromatographic fractions are examined. It is known that the ovary produces androgens in the form of androstenedione and etiochonalonone, and the adrenal glands produce dehydroepiandrosterone. According to the growth of individual fractions, the origin of androgens can be judged. The functional tests of stimulation of the adrenal cortex with ASTH and of suppression with cortisone preparations are also used for the differential diagnosis. NEWS_MORE_BOX In adrenal genesis of the disease, stimulation gives a significant increase in 17-ketosteroids, and suppression – a sharp decrease. Ultrasound examination of the adrenal glands and ovaries, scintigraphy of the adrenal glands by radioisotope, radiography of the adrenal glands by means of retropneumoperntoneum are also applied. The necessary tests are also carried out to clarify the hormonal activity of the ovaries – basal thermometry, vaginal hormonal cytodiagnosis, endometrial biopsy, determination of the level of gonadotropic hormones, prolactin and sex steroids. The level of 17-ketosteroids is usually mildly elevated or normal. The size of the ovaries is determined. with a gynecological examination, and in case of difficulties, by ultrasound or laparoscopy. Pneumogynecography (introduction of the abdominal cavity — to create contrast, and radiography) can also be used. Polycystic disease treatment – two main methods In the treatment there are two main methods – operative and conservative. If surgical treatment fails, medical treatment of menstrual disorders and induction of ovulation can be applied, and if conservative behavior fails, a wedge-shaped resection of the ovaries can be performed. The results of operative and conservative treatment are almost the same, and therefore the treatment approach must be refined individually. Operative treatment consists of a wedge-shaped resection of the ovaries. Through the operation, the menstrual function is normalized up to 90%, ovulation occurs in about 70% and up to 60% of the operated women become pregnant. So answer the patients’ questions,with which I started the article to be quite optimistic. It should be noted that the results are better if the operation is performed at a younger age, already with the diagnosis of polycystic ovarian disease, in order to “prevent” the sclerotic process. Conservative treatment – In recent years, the prevailing opinion is for conservative treatment of the disease. The reasons for this are the still unclear etiopathogenesis of the suffering, the fascination with surgical intervention without a precise diagnosis, the possibility of adhesive processes in the small pelvis and obstruction of the fallopian tubes. Medicinal treatment consists in regulating the menstrual cycle by means of progesterone, and in the case of a desire to become pregnant, stimulation of ovulation. The stimulation carried out depends on the hormonal changes; it is most often carried out with clomiphene citrate, and in the case of a reduced level of estrogens, a preparation with FSH is also added, in the case of an increased level of prolactin, bromocriptine is used, etc. treatment – to proceed to surgical treatment. The choice of the type of treatment also depends on the patient’s age — if she is sexually mature and wants to get pregnant, stimulation of ovulation is appropriate. With regard to hair virilism, the treatment results are weaker – in about 1/3 of the patients, regression of hair growth is observed, and in the rest it remains unchanged, which is why cosmetics must be applied for a long time. New possibilities New possibilities are revealed by the treatment with cyproterone-acetate, which is an anthandrogen in its action. In the pharmacological preparation, andandrogen is combined with contraceptive ingredients, which is why it is advisable to apply this treatment to women after childbirth (in order not to deepen and otherwise damaged ovulation). An important condition for achieving good results in both surgical and medical treatment is the patients’ normal body mass. Obesity compromises the therapeutic effect, as excess body mass causes more significant disturbances in the neurohormonal regulation of the menstrual cycle. I always recommend sports and diet to my patients, this is very important. Obesity is thought to alter the activity of the hypothalamic-pituitary system, lowering gonadotropic production and increasing prolactin production. At the same time, it also leads to hyperfunction of the adrenal cortex, and hypercorticism prevents the normal activity of the ovaries.the fascination with surgical intervention without a precise diagnosis, the possibility of adhesive processes in the small pelvis and blockage of the fallopian tubes. Medicinal treatment consists in regulating the menstrual cycle by means of progesterone, and in the case of a desire to become pregnant, stimulation of ovulation. The stimulation carried out depends on the hormonal changes; it is most often carried out with clomiphene citrate, and in the case of a reduced level of estrogens, a preparation with FSH is also added, in the case of an increased level of prolactin, bromocriptine is used, etc. treatment – to proceed to surgical treatment. The choice of the type of treatment also depends on the patient’s age — if she is sexually mature and wants to get pregnant, stimulation of ovulation is appropriate. With regard to hair virilism, the treatment results are weaker – in about 1/3 of the patients, regression of hair growth is observed, and in the rest it remains unchanged, which is why cosmetics must be applied for a long time. New possibilities New possibilities are revealed by the treatment with cyproterone-acetate, which is an anthandrogen in its action. In the pharmacological preparation, andandrogen is combined with contraceptive ingredients, which is why it is advisable to apply this treatment to women after childbirth (in order not to deepen and otherwise damaged ovulation). An important condition for achieving good results in both surgical and medical treatment is the patients’ normal body mass. Obesity compromises the therapeutic effect, as excess body mass causes more significant disturbances in the neurohormonal regulation of the menstrual cycle. I always recommend sports and diet to my patients, this is very important. Obesity is thought to alter the activity of the hypothalamic-pituitary system, lowering gonadotropic production and increasing prolactin production. At the same time, it also leads to hyperfunction of the adrenal cortex, and hypercorticism prevents the normal activity of the ovaries.the fascination with surgical intervention without a precise diagnosis, the possibility of adhesive processes in the small pelvis and blockage of the fallopian tubes. Medicinal treatment consists in regulating the menstrual cycle by means of progesterone, and in the case of a desire to become pregnant, stimulation of ovulation. The stimulation carried out depends on the hormonal changes; it is most often carried out with clomiphene citrate, and in the case of a reduced level of estrogens, a preparation with FSH is also added, in the case of an increased level of prolactin, bromocriptine is used, etc. treatment – to proceed to surgical treatment. The choice of the type of treatment also depends on the patient’s age — if she is sexually mature and wants to get pregnant, stimulation of ovulation is appropriate. With regard to hair virilism, the treatment results are weaker – in about 1/3 of the patients, regression of hair growth is observed, and in the rest it remains unchanged, which is why cosmetics must be applied for a long time. New possibilities New possibilities are revealed by the treatment with cyproterone-acetate, which is an anthandrogen in its action. In the pharmacological preparation, andandrogen is combined with contraceptive ingredients, which is why it is advisable to apply this treatment to women after childbirth (in order not to deepen and otherwise damaged ovulation). An important condition for achieving good results in both surgical and medical treatment is the patients’ normal body mass. Obesity compromises the therapeutic effect, as excess body mass causes more significant disturbances in the neurohormonal regulation of the menstrual cycle. I always recommend sports and diet to my patients, this is very important. Obesity is thought to alter the activity of the hypothalamic-pituitary system, lowering gonadotropic production and increasing prolactin production. At the same time, it also leads to hyperfunction of the adrenal cortex, and hypercorticism prevents the normal activity of the ovaries.and in the rest it remained unchanged, which is why the cosmetics must be applied for a long time. New possibilities New possibilities are revealed by the treatment with cyproterone-acetate, which is an anthandrogen in its action. In the pharmacological preparation, andandrogen is combined with contraceptive ingredients, which is why it is advisable to apply this treatment to women after childbirth (in order not to deepen and otherwise damaged ovulation). An important condition for achieving good results in both surgical and medical treatment is the patients’ normal body mass. Obesity compromises the therapeutic effect, as excess body mass causes more significant disturbances in the neurohormonal regulation of the menstrual cycle. I always recommend sports and diet to my patients, this is very important. Obesity is thought to alter the activity of the hypothalamic-pituitary system, lowering gonadotropic production and increasing prolactin production. At the same time, it also leads to hyperfunction of the adrenal cortex, and hypercorticism prevents the normal activity of the ovaries.and in the rest it remained unchanged, which is why the cosmetics must be applied for a long time. New possibilities New possibilities are revealed by the treatment with cyproterone-acetate, which is an anthandrogen in its action. In the pharmacological preparation, andandrogen is combined with contraceptive ingredients, which is why it is advisable to apply this treatment to women after childbirth (in order not to deepen and otherwise damaged ovulation). An important condition for achieving good results in both surgical and medical treatment is the patients’ normal body mass. Obesity compromises the therapeutic effect, as excess body mass causes more significant disturbances in the neurohormonal regulation of the menstrual cycle. I always recommend sports and diet to my patients, this is very important. Obesity is thought to alter the activity of the hypothalamic-pituitary system, lowering gonadotropic production and increasing prolactin production. At the same time, it also leads to hyperfunction of the adrenal cortex, and hypercorticism prevents the normal activity of the ovaries.