Polycystic ovary syndrome is an endocrine disease in which the ovary is enlarged and contains many small cysts filled with liquid, the level of androgen is increased and ovulation is not possible. The most significant feature is anovulation, which can cause infertility in severe cases. How to treat this disease most effectively?
1,Improve insulin resistance: increase exercise to reduce weight, correct endocrine and metabolic disorders exacerbated by obesity, and reduce insulin resistance and hyperinsulinemia. Insulin sensitizers are commonly used in obese or insulin resistant patients. By reducing the level of insulin, we can correct the state of hyperandrogen, improve ovarian ovulation function and improve the effect of ovulation induction therapy.
2,Induced ovulation: Patients with fertility requirements shall be treated with ovulation induction. Clomiphene is the first choice for the treatment of polycystic ovary syndrome, and can also be combined with chorionic gonadotropin. When ovulation induced by clomiphene is ineffective, dexamethasone can be taken simultaneously in the treatment cycle to improve the response of clomiphene or pituitary to gonadotropin treatment and improve the ovulation rate and pregnancy rate.
In addition, it is also necessary to regulate the menstrual cycle, and it is also very important to regularly and reasonably use drugs against androgens.
1.Adjust menstrual cycle:
① Oral contraceptives: estrogen and progesterone compound tablets dominated by estrogen are ideal, which can inhibit LH secretion, reduce blood testosterone, androstenedione and DHEAS, and increase the concentration of sex hormone binding globulin. Oral short acting contraceptives are commonly used. They are taken periodically. The course of treatment is generally 3-6 months and can be reused. It can effectively inhibit hair growth and treat acne.
② The second half cycle of progesterone therapy can regulate menstruation and protect endometrium. It also inhibited LH hypersecretion. It can also achieve the effect of restoring ovulation.
2.Reduce blood androgen level:
① Glucocorticosteroid: it is applicable to polycystic ovary syndrome. Too many androgens are from adrenal gland or mixed source of adrenal gland and ovary. The commonly used drug is dexamethasone, which is suitable for hyperandrogenemia from adrenal gland. The dose should not exceed 0.5mg per day to avoid excessive inhibition of pituitary adrenal axis function.
② Cyproterone: 17 α- Hydroxyprogesterone derivatives have strong anti androgen effect, can inhibit the secretion of pituitary gonadotropin and reduce the level of testosterone in the body. Oral contraceptives composed of ethinylestradiol are effective in reducing hyperandrogenemia and treating hyperandrogen signs.
③ Spironolactone: can reduce the patient’s hair growth and make the hair thinner. Menstrual disorders with hyperandrogenemia and anovulation can take 20mg orally every day on the 5th ~ 21st day of menstruation, which can restore the menstrual cycle and ovulation of some patients.
In addition to drug treatment, surgical treatment can also be selected.
Surgical treatment of polycystic ovary syndrome:
1,Laparoscopic ovarian therapy
Laparoscopic multi-point ovarian biopsy, ovarian electrocautery, laser multi-point ovarian vaporization and laser wedge cutting are effective in patients with elevated LH and favorable testosterone. The ovulation promotion mechanism of this method is to destroy the ovarian stroma producing androgens, simply regulate the pituitary ovarian axis, reduce the levels of serum LH and testosterone, increase the chance of pregnancy, and may reduce the risk of abortion. 90% ovulation rate and 70% pregnancy rate can be obtained. However, the possible problems of this method are ineffective treatment, pelvic adhesion and low ovarian function.
One third of the bilateral ovaries were wedge-shaped, which could reduce the androgen level and reduce the symptoms of hirsutism. The ovulation rate was 80% and the pregnancy rate was 50%. New microsurgical technique and new adhesion shielding method were applied. It can effectively prevent postoperative adhesion.