Right ovarian polycystic manifestations

Polycystic ovaries can occur on one side or on both sides at the same time. The most significant features of right-sided polycystic ovary are amenorrhea, hirsutism, obesity and infertility, especially the last one, which I believe no woman wants to experience. Therefore, we must be aware of the manifestations of right ovarian polycystic disease and provide timely treatment when abnormalities are found to avoid serious consequences.

1. Menstrual disorders

PCOS causes anovulation or infrequent ovulation in patients, and about 70% of them have menstrual disorders. The main clinical manifestations are amenorrhea, oligomenorrhea and dysfunctional uterine bleeding, accounting for 70% to 80% of women with abnormal menstruation, 30% of secondary amenorrhea, and 85% of anovulatory dysfunctional uterine bleeding. Due to the ovulation dysfunction and lack of cyclical progesterone secretion in PCOS patients, the endometrium is under simple high estrogen stimulation for a long time. The continuous proliferation of the endometrium is prone to simple endometrial hyperplasia, abnormal hyperplasia, and even atypical endometrial hyperplasia and endometrial cancer.

2. Clinical manifestations related to hyperandrogenism

(1) The amount and distribution of hirsutism varies with gender and race. Hirsutism is one of the important manifestations of increased androgen levels. There are many methods for evaluating hirsutism clinically. Among them, the method recommended by the World Health Organization is the Ferriman-Gallway hair scoring standard. In my country, hirsutism is not serious in most PCOS patients. The results of a large-scale community epidemiological survey show that hirsutism can be diagnosed if the mFG score is >5 points. Excessive sexual hair is mainly distributed on the upper lip, lower abdomen and inner thighs.

(2) Hyperandrogenic acne PCOS patients are mostly adult female acne with rough skin and enlarged pores. Unlike adolescent acne, they are characterized by severe symptoms, long duration, stubbornness, and poor response to treatment.

(3) Female pattern hair loss (FPA): PCOS women begin to lose their hair around the age of 20. It mainly occurs on the top of the head, extending forward to the front of the head (but not invading the hairline) and backward to the back of the head (but not invading the back of the head). The hair on the top of the head becomes diffusely sparse and falls out. It neither invades the hairline nor causes baldness.

(4) Seborrhea PCOS produces excessive androgens, resulting in hyperandrogenism, which increases sebum secretion, causing excessive oil on the patient's head and face, enlarged pores, slightly red and greasy skin on both sides of the nasolabial groove, dandruff and itchy scalp, and increased oil secretion on the chest and back.

(5) The main manifestation of masculinization is the male-pattern pubic hair distribution. Generally, there are no obvious masculinization manifestations, such as clitoral hypertrophy, breast atrophy, deep voice and other abnormal development of external genitalia. In PCOS patients with typical masculinization manifestations, attention should be paid to distinguishing congenital adrenal hyperplasia, adrenal tumors, and tumors that secrete androgens.

3. Polycystic ovary (PCO)

Although a lot of research has been done on the ultrasound diagnostic criteria for PCO, there are still many different opinions. In addition, racial differences make it even more difficult to unify the diagnostic criteria. The 2003 Rotterdam PCO ultrasound standard was ≥12 follicles in one or both ovaries, with a diameter of 2 to 9 mm, and/or an ovarian volume (length × width × thickness/2) >10 ml. At the same time, it may show increased medullary echo.

4. Others

(1) Obesity Obesity accounts for 30% to 60% of PCOS patients, and its incidence varies depending on race and dietary habits. In the United States, 50% of women with PCOS are overweight or obese, while reports of obese PCOS in other countries are relatively rare. The obesity of PCOS is manifested as central obesity (also known as abdominal obesity), and even non-obese PCOS patients show an increased proportion of perivascular or omental fat distribution.

(2) Infertility: Due to ovulatory dysfunction, the pregnancy rate of PCOS patients is reduced and the miscarriage rate is increased. However, it is not clear whether the miscarriage rate of PCOS patients is increased or whether miscarriage is the result of being overweight.

(3) Obstructive sleep apnea is a common problem in PCOS patients and cannot be simply explained by obesity. Insulin resistance has a greater predictive effect on dyspnea during sleep than age, BMI or circulating testosterone levels.

(4) Depression: The incidence of depression in PCOS patients is increased and is associated with high body mass index and insulin resistance. The patients' quality of life and sexual satisfaction are significantly reduced.