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Polycystic Ovaries: An Overview of Information
Last reviewed: 18.10.2021
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Stein-Leventhal syndrome (syndrome of ovarian hyperandrogenia of non-tumorous genesis, polycystic ovaries) is a disease that is isolated in an independent nosological form by SK Lesniy in 1928 and in 1935 by Stein and Leventhal. In the world literature it is known as Stein-Leventhal syndrome, and according to the WHO classification is designated as polycystic ovary syndrome (PCOS). In our country, most authors call this disease the syndrome of sclerocystic ovaries (CJN). From our point of view, the pathogenetically most justified term is the term proposed by SK Lesniy in 1968 - hyperandrogenic dysfunction of the ovaries or the syndrome of ovarian hyperandrogenia of the neoplastic genesis.
The incidence of polycystic ovary syndrome (Stein-Levental syndrome) is 1.4-3% of all gynecological diseases. Polycystic ovaries are affected by young women, often from a puberty period.
[Causes of polycystic ovary syndrome
The cause and pathogenesis of the polycystic ovary syndrome is unknown. Early knowledge of the leading role in the pathogenesis of sclerosis of the gallbladder that hampers ovulation is rejected, since it has been shown that its severity is an androgen dependent symptom.
One of the main pathogenetic links of the polycystic ovary syndrome, which largely determines the clinical picture of the disease, is the hyperandrogenia of ovarian genesis, coupled with a disruption of the gonadotropic function. Early studies of the level of androgens, or more precisely of their metabolites in the form of total and fractional 17-ketosteroids (17-CS), showed their significant variation in the syndrome of polycystic ovaries, from normal to moderately elevated. Direct determination of androgens in the blood (testosterone - T, androstenedione - A) by radioimmunological method revealed their constant and reliable increase.
The causes and pathogenesis of polycystic ovaries
Symptoms of polycystic ovary
According to the published data, the frequency of various symptoms occurring in the syndrome of polycystic ovaries is marked by considerable variability, and often they are also opposite. As E. Vikhlyaeva notes, the very definition of the syndrome assumes the inclusion of various pathogenesis states in it.
For example, more often observed oposomenoreia or amenorrhea does not exclude the appearance of menometrorrhagia reflecting the hyperplastic state of the endometrium as a result of relative hyperestrogenism in these patients. Hyperplasia and polyposis of the endometrium with a significant frequency are found in patients with amenorrhea or opsonomenia. Many authors note an increased incidence of endometrial cancer in the syndrome of polycystic ovaries.
Anomaly is a typical symptom of gonadotropic regulation of ovarian function and steroidogenesis in them. However, in some patients, ovulatory cycles are observed periodically, mainly with a deficiency in the function of the yellow body. This ovulatory hypoxemia occurs in the initial stage of the disease and gradually progresses. In violation of ovulation, apparently observed infertility. It can be both primary and secondary.
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Diagnosis of polycystic ovary
In the presence of a classic symptom complex, the clinical diagnosis is not difficult and is based on a combination of such symptoms as opsono- or amenorrhea, primary or secondary infertility, bilateral enlargement of the ovaries, hirsutism, obesity in almost half of the patients. The results of the study (TFD) confirm the anovulatory nature of menstrual dysfunction; in colpositis, in a number of cases, an androgenic type of smear can be detected.
Objectively, an increase in the size of the ovaries can be determined with pneumopylicography, which takes into account the Borghi index (normally the sagittal size of the ovaries is less than the sagittal size of the uterus, with polycystic ovary syndrome - greater than or equal to 1). With ultrasound determine the size of the ovaries, their volume (the norm is 8.8 cm 3 ) and the echostructure, which allows to reveal cystic degeneration of the follicles.
A wide application is also found for laparoscopy, allowing, in addition to visual assessment of the ovaries and their sizes, to make a biopsy and confirm the diagnosis? Morphologically.
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Treatment of polycystic ovary syndrome
Its main goal is to restore full ovulation and reduce the degree of hyperandrogenism. Achieving it leads to the elimination of dependent clinical manifestations of the syndrome: infertility, menstrual disorders, hirsutism. This is achieved by various therapeutic agents, as well as by surgery - wedge resection of the ovaries.
Of the conservative agents, the most widely used synthetic estrogen-gestagenic preparations (SEGP) such as bisekurin, non-ovolone, ovidon, rigevidona, etc. EGGP is prescribed to inhibit the gonadotropic function of the pituitary gland to reduce elevated levels of LH. As a result, the stimulation of ovarian androgens decreases, and the binding capacity of the TESG is increased due to the estrogen component of the EGP. As a result, the androgenic inhibition of the cyclic centers of the hypothalamus decreases, and hirsutism is weakened.
Treatment of polycystic ovaries
However, it should be noted that in rare cases, due to the progestogen component of SEHP, which is a derivative of Cig-steroids, there may be an increase in hirsutism.