Polikistoz of ovaries
Polikistoz of ovaries (Xing. – the syndrome of polycystous ovaries or SPKYa) represents bilateral good-quality growth in or outside of ovaries of multiple cystous educations owing to a complex of endocrine frustration (dysfunction of ovaries, thyroid and a pancreas, bark of adrenal glands, a hypophysis and a hypothalamus). Primary ovaries can be congenital or arise at teenage age at a stage of formation of menstrual function. At mature age development of SPKYa can be caused by chronic endocrine pathology or inflammatory diseases of female reproductive system.
Polikistoz of ovaries
Polikistoz of ovaries – education and growth on the surface of ovaries of multiple small cysts owing to hormonal violations in the woman's organism. Can proceed asymptomatically, it is sometimes shown by violation of menstrual function (), growth of hair on a body on men's type, obesity, acne rash. Leads to not incubation of pregnancy and infertility.
Primary ovaries can be congenital or arise at teenage age at a stage of formation of menstrual function. At mature age development of SPKYa can be caused by chronic endocrine pathology or inflammatory diseases of female reproductive system – secondary ovaries. Incidence polikistozy ovaries makes from 5 to 10% of women in a reproductive phase. Constitutes the greatest danger of SPKYa as the reason of female infertility in 25% of clinical cases.
A number of the violations arising in an organism at a polikistoza of ovaries allow the woman to suspect its development.
- Irregularity of a menstrual cycle. Violation of an ovulation (is more often as an anovulyation – its total absence) leads to the change of a menstrual cycle which is shown in long delays (more than a month) or total absence of periods (amenory). Often such manifestations occur already at the very beginning of formation of menstrual function at girls in the teenage period. In certain cases at a polikistoza of ovaries long delays of monthly can alternate with the uterine bleedings caused by an endometrium giperplaziya (excessive growth of a mucous uterus).
- The increased greasiness of hair and skin, appearance of eels, spots, seborrheas. At a polikistoza of ovaries develop owing to hyper secretion of androgens, have constant character, do not give in to symptomatic therapy.
- Obesity. It is shown by sharp increase in weight by 10-15 kg. Fatty deposits can be distributed on universal type (evenly on all body) or on men's type of obesity (to be postponed mainly in a waist and a stomach). Violations of lipidic and carbohydrate exchanges can lead 2 types to development of diabetes.
- The increased growth of hair on a body - a girsutizm. At SPKYa hair begin to grow on men's type on a stomach, in a crotch, the internal surfaces of hips, shins. On a face "short moustaches" over an upper lip usually appear.
- Nagging pains in the lower departments of a stomach. Pains have the chronic moderately expressed character, can irradiate in a waist or pelvic area.
- Constancy of basal (rectal) temperature during all menstrual cycle. In the second phase of a menstrual cycle the characteristic jump of basal temperature coinciding on time with process of an ovulation is normal observed. Lack of a temperature maximum testifies to an anovulyatorny cycle.
- Infertility. At SPKYa primary infertility, i.e. absence in the anamnesis of the fact of approach of pregnancy at regular maintaining sex life without contraception use is observed.
Development of a polikistoz of ovaries is the cornerstone, first of all, the polyendocrine violations which are shown disorder of functions:
- hypophysis and hypothalamus (violation of regulation of activity of adrenal glands and ovaries);
- cortical layer of adrenal glands (the increased secretion of androgens);
- ovaries (irregularity or lack of an ovulation, the increased secretion of estrogen);
- pancreas (the increased production of insulin at tolerance of fabrics to it).
Violation of hormonal regulation leads to suspension of development and maturing of follicles, increase in the sizes and consolidation of the capsule of ovaries under which of immature follicles multiple cystous growths begin to be formed. It involves frustration of an ovulation, menstrual function and infertility. Against the background of obesity (and it occurs at women with SPKYa in 40% of cases), these processes proceed is even more expressed. Infectious diseases, stresses and even change of climate can provoke hormonal violations.
Polikistoz of ovaries who is followed by hormonal violations and lack of an ovulation is one of the most frequent reasons of female infertility. The long current of a polikistoz of ovaries without the corresponding treatment considerably increases chances of development of malignant tumors of a body and neck of a uterus, and also, according to some data, a breast cancer. This risk factor is higher at a combination of a polikistoz of ovaries to obesity and diabetes. Besides, violation of lipidic and fatty exchange is led to development of atherosclerosis of vessels, a myocardial infarction, a stroke. Identification of SPKYa at an early stage of development considerably facilitates treatment and reduces risk of development of terrible consequences.
Diagnosis of a syndrome of polycystous ovaries is possible with at least two of below-mentioned criteria:
- the dysfunction of ovaries which is shown in violation of a menstrual cycle, lack of an ovulation (anovulyation) and infertility;
- giperandrogeniye at women – the excessive development in a female body of androgens (male sex hormones) which is shown the raised osvoloseniye (girsutizm), acne rashes (acne) strengthened by greasiness of skin and seborrhea;
- ekhoskopichesky or laparoscopic picture of increase and cystous change of ovaries.
For confirmation of these criteria at diagnostics of SPKYa a number of objective, laboratory and tool methods is used:
- The general survey including assessment like a constitution, character of pilosis, a condition of integuments and mucous, a stomach palpation etc.
- Gynecologic vaginal and abdominal survey on a chair, the increase allowing to reveal and consolidation of ovaries on both sides.
- Ultrasonography of bodies of a small pelvis at which bilateral increase in ovaries in sizes up to 4 cm in width and 5-6 cm in length, their dense capsule, existence multiple (from 8 and more) small follicular cysts on the periphery is noted. At a dopplerometriya increase in a blood-groove in vessels of ovaries is fixed.
- Determination of content in blood of level of hormones of a hypophysis, ovaries, adrenal glands: Prolactinum, follikulostimuliruyushchy hormone (FSG), lyuteiniziruyushchy hormone (LH), progesterone, estradiol, 17-gidoroskiprogesteron, testosterone, androstendion, cortisol, DEA-S (degidroepiandrosterona-sulfate).
- The magnetic and resonant tomographic research (MRT) allowing to exclude tumoral damages of ovaries.
- Research of level of lipids and lipidic fractions for definition of violations of lipidic exchange.
- Determination of content of insulin and glucose in blood, TTG (the test of tolerance to glucose) for the purpose of identification of violations of carbohydrate exchange.
- The laparoscopy confirming bilateral cystous changes of ovaries.
Treatment of SPKYa
Treatment of a polikistoz of ovaries is directed to restoration or normalization of an ovulation, menstrual and reproductive functions and is performed by conservative and operational methods. Conservative treatment of SPKYa is carried out by means of hormonal medicines: anti-estrogen, the combined oral contraceptives having anti-androgenic effect (restoration of a menstrual cycle, elimination of a giperandrogeniya), the gonadotrophins (stimulating an ovulation).
The women suffering polikistozy ovaries against the background of obesity have to combine physical activity with a certain diet and a diet:
- restriction of caloric content of food to 1200 - 1800 kcal a day with 5-6 single food;
- use of low-calorie food (fruit, vegetables);
- increase in protein content in a diet (fishes, seafood, meat, cottage cheese);
- restriction of carbohydrate food (pastries, sugar, jam, honey, sweet drinks);
- exception of animal fats and their replacement by vegetable. Daily consumption of fats no more than 80 g;
- exception of spices, spices, sauces, smoked and marinated products;
- complete elimination of alcohol;
- fasting days 2-3 times a week (apple, kefiric, cottage cheese, vegetable).
In the absence of result from the carried-out conservative therapy or development of a giperplaziya of endometrium carry out surgical treatment. As a rule, the modern operational gynecology uses less traumatic laparoscopic operations in treatment of a polikistoz of ovaries. At a polikistoza of ovaries the wedge-shaped resection, i.e. partial removal or a kauterization (cauterization) of the struck tissue of ovaries is carried out. It leads to reduction of development of androgens and normalization of an ovulation. Pregnancy is caused by surgery at 65% of patients. Unfortunately, the effect of operation lasts from 1 to 3 years, and then again there comes the recurrence of a polikistoz of ovaries.
For approach of pregnancy the first half a year after operation are considered as the optimum period. At this time the hormones stimulating maturing of an ovum are appointed. Carrying out repeated operations is possible, but they bring smaller effect. The women operated concerning SPKYa have to be under constant dispensary observation of the gynecologist.
Forecast and prevention
Completely it is impossible to cure SPKYa therefore the purpose of treatment is creation of favorable opportunities for pregnancy approach. When planning pregnancy women with the diagnosis " ovaries" need to receive medical treatment for restoration and stimulation of an ovulation. With age ovaries progresses therefore it is necessary to resolve an issue with pregnancy as soon as possible.
As well as in case of prevention of other gynecologic diseases, regular planned consultations of the gynecologist are necessary for prevention of SPKYa. Polikistoz of ovaries revealed in an early phase of development allows to begin correction of violations in time and to avoid terrible consequences, including infertility. Prevention of abortions, the inflammatory and other diseases leading to dysfunction of ovaries is of great importance. Mothers of teenage girls have to be interested in "female" health of the daughters and at the first signs of a polikistoz of ovaries immediately to take away them to the competent expert.