Polycystic ovary syndrome

Polycystic ovary syndrome is an important factor leading to female infertility. In addition to this harm, another obvious feature of polycystic ovary syndrome is that it will make patients gain weight. There are many methods for treating PCOS. Since the disease will make you fat, some people think that losing weight means the disease is cured. So, can polycystic ovary syndrome be cured by losing weight? Let’s take a closer look at it below.

After losing weight, the body's endocrine system may improve, but PCOS is generally difficult to cure completely. It requires long-term control of weight and diet and regular check-ups.

Drug treatments for PCOS:

1. Regulate the menstrual cycle: It is very important to use medications regularly and reasonably to counteract the effects of androgens and control the menstrual cycle.

① Oral contraceptives: It is a combined cyclical therapy of estrogen and progesterone. Progesterone can reduce the production of estrogen in the ovaries by negative feedback to prevent abnormally high secretion of pituitary LH. It can also directly act on the endometrium to prevent excessive endometrial proliferation and regulate the menstrual cycle. Estrogen can promote the production of sex hormone-binding globulin in the liver, leading to a decrease in free testosterone. Commonly used oral short-acting contraceptives are taken cyclically, with the course of treatment generally lasting 3-6 months and can be used repeatedly. It can effectively inhibit hair growth and treat acne.

② Progestin second half cycle therapy can regulate menstruation and protect the endometrium. It also has an inhibitory effect on excessive secretion of LH. It can also restore ovulation.

2. Reduce blood androgen levels:

① Glucocorticosteroids: Suitable for patients with polycystic ovary syndrome whose androgen excess is of adrenal origin or mixed adrenal and ovarian origin. The commonly used drug is dexamethasone, which is

②Cyproterone acetate: It is a derivative of 17α-hydroxyprogesterone, has a strong anti-androgenic effect, can inhibit the secretion of pituitary gonadotropin, and reduce the testosterone level in the body. It can be used together with ethinyl estradiol to form an oral contraceptive, which is effective in reducing hyperandrogenemia and treating signs of hyperandrogenism.

③ Spironolactone: It is a competitive inhibitor of aldosterone receptors. Its anti-androgen mechanism is to inhibit the synthesis of androgen by the ovaries and adrenal glands, enhance the decomposition of androgen, and compete for androgen receptors in hair follicles. The anti-androgen dose is 40-200 mg per day, and the treatment of hirsutism requires 6-9 months. When irregular menstruation occurs, it can be used in combination with oral contraceptives.

3. Improve insulin resistance: Insulin sensitizers are often used for patients with obesity or insulin resistance. Metformin can inhibit glucose synthesis in the liver and increase the sensitivity of peripheral tissues to insulin. By lowering insulin levels, the patient's high androgen state can be corrected, ovarian ovulation function can be improved, and the effect of ovulation induction treatment can be enhanced. The usual dose is 500 mg orally, 2-3 times a day.

4. Induce ovulation: For those who want to have children, ovulation induction treatment is carried out after basic treatment such as lifestyle adjustment, anti-androgen and improvement of insulin resistance. Clomiphene is the first-line ovulation-inducing drug. Patients who are resistant to clomiphene can be given second-line ovulation-inducing drugs, such as gonadotropin. Ovarian hyperstimulation syndrome is prone to occur when ovulation is induced, which requires close monitoring and enhanced preventive measures.

Surgical treatment of polycystic ovary syndrome

1. Laparoscopic ovarian drilling

It is more effective for those with elevated LH and testosterone. The ovulation-inducing mechanism of this method is to destroy the ovarian stroma that produces androgens, simply regulate the pituitary-ovarian axis, reduce serum LH and testosterone levels, increase the chance of pregnancy, and possibly reduce the risk of miscarriage. Electroacupuncture or laser perforation is used for polycystic ovaries under laparoscopy. Four perforations are preferably made on each ovary, and attention should be paid to the perforation depth and avoiding the ovarian hilum. This can achieve an ovulation rate of 90% and a pregnancy rate of 70%. However, possible problems with this method include ineffective treatment, pelvic adhesions, and ovarian dysfunction.

2. Ovarian wedge resection

Wedge removal of 1/3 of each ovary can reduce androgen levels, alleviate hirsutism symptoms, and increase pregnancy rates. The incidence of postoperative periovarian adhesion is high and it is no longer commonly used in clinical practice.