How is PCOS treated?

Polycystic ovary syndrome is a common endocrine disease in women, and the specific cause of the disease has not been clarified so far. It not only affects the patient's fertility, but also has an impact on the patient's long-term health, requiring long-term health management. The main manifestations of this disease are abnormal menstruation. B-ultrasound examination can reveal polycystic changes in the ovaries and clinical manifestations of hyperandrogenism. Whether it is for adolescents or women of childbearing age, physical changes should not be ignored. If severe acne recurs on the face and back, or coarse hair appears in multiple parts around the upper lip, lower jaw, and areola, and menstrual abnormalities (2 years after menarche) such as irregular menstruation, amenorrhea, or sparse menstruation, you should be vigilant and go to the hospital for examination and treatment as soon as possible. At present, many people know little about the "treatment of polycystic ovary syndrome". The following is a brief introduction and popularization, hoping to provide a reference for more people to learn and understand relevant knowledge.

Polycystic ovary syndrome is not a single disease, but a syndrome with multiple clinical manifestations. Different patients have different clinical symptoms. In the actual treatment process, doctors will provide individualized treatment based on the patient's age and treatment needs.

1. Improve your lifestyle

Diet and physical exercise are two key components of a healthy lifestyle.

① Aerobic exercise for weight loss. For patients with polycystic ovary syndrome, weight loss can reduce androgen levels, which plays an important role in improving symptoms such as hirsutism and acne, and can also effectively improve ovulation function. When the weight is reduced by 10 kg, the insulin level can be reduced by 40%, the testosterone level can be reduced by 3.5%, and there is a possibility of restoring ovulation. Based on this, patients cannot ignore aerobic exercise for weight loss as a non-drug therapy, such as aerobic exercise through running, jogging, skating, swimming, cycling, Tai Chi, rhythmic gymnastics, etc., to ensure that each exercise time is more than 1 hour, and insist on 3-5 times a week.

②Diet therapy. This method is beneficial for patients to lose weight, improve insulin resistance, and organize the various adverse consequences of reproductive and metabolic abnormalities caused by the long-term development of polycystic ovary syndrome. Patients should maintain a light diet, avoid eating fatty and greasy foods, and avoid spicy and irritating foods to prevent aggravation of the condition. It is recommended to consume all food groups in the daily diet plan, focusing on whole grains, fresh fruits and vegetables, beans, lentils, lean protein, eggs, poultry, fish, nuts, healthy fats, seeds, vegetable oils and olive oil, and limit processed foods, trans fats, and refined carbohydrates. This dietary behavior will provide all the nutrients needed, increase immune defense, improve metabolic pathways, and help improve the overall health of individuals. High-protein and low-carbohydrate diets, as well as moderate fat diets, can better reduce body weight and improve reproductive metabolic function.

③ Avoid staying up late. Based on the current clinical research results, we can see that many women with PCOS in adolescence and childbearing age often stay up late at night due to various reasons, resulting in insufficient sleep time, lack of regularity, and difficulty in ensuring quality. This will not only affect the body's weight loss, but also cause menstrual disorders and hinder recovery. Even if some people make up for sleep during the day, it cannot replace sleep at night. It is recommended to go to bed before 10 pm.

2. Drug treatment (all drugs must be taken under the guidance of a physician)

① Treat insulin resistance. Obesity and insulin resistance are important pathogenic factors of PCOS. If the patient has insulinemia, with or without diabetes, the doctor may recommend oral metformin according to the situation. While enhancing insulin sensitivity, it also helps to reduce weight for some patients. It can also reduce hair loss and even restore menstruation (25%) and ovulation.

② Anti-androgen drug treatment. Some patients have symptoms of hirsutism and acne with masculinization signs. Short-acting oral contraceptives (COCs) can reduce free androgen levels by increasing the concentration of sex hormone binding proteins. If oral COCs for six months or longer fail to adequately improve hyperandrogenic symptoms, or if there are contraindications to COCs or poor tolerance, anti-androgen drug treatment may be considered. Spironolactone is the most commonly used drug, which can reduce the growth of new terminal hair. Hyperkalemia is a rare side effect of spironolactone, and regular monitoring of blood potassium is required.

③ Drug-induced ovulation. If patients with PCOS have fertility needs, they can use drugs to induce ovulation, such as letrozole, clomiphene and other drugs. If necessary, it needs to be used in combination with chorionic gonadotropin, but the specific medication needs to be treated individually by the doctor according to the patient. If the couple still has other infertility factors besides the infertility caused by the woman's PCOS ovulation disorder, they can also choose IVF to assist pregnancy.

④ Adjust the menstrual cycle. For patients with irregular menstruation, in order to prevent the possibility of excessive proliferation and cancer of the endometrium, oral COC alone or oral progesterone in the second half of the menstrual cycle can be considered to adjust the menstrual cycle. However, it should be taken under the guidance of a doctor, and relative and absolute contraindications and side effects must be considered.

⑤ Treatment by syndrome differentiation of traditional Chinese medicine. A deep analysis based on the theory of traditional Chinese medicine will reveal that PCOS is mainly related to the inadequacy of the kidney's congenital endowment, the acquired dysfunction of the spleen and stomach, and the stagnation of liver qi. In this regard, syndrome differentiation of traditional Chinese medicine treatment of PCOS, body acupuncture, abdominal acupuncture, moxibustion, auricular acupoint pressing, acupoint embedding, etc., combined with traditional Chinese medicine, can effectively improve symptoms and adjust the menstrual cycle, and better help patients control their weight.

3. Surgery

It is not used as a first-line treatment and is mainly suitable for patients who have failed to respond to drug treatment, have refractory excessive LH secretion, or require laparoscopy due to other diseases.

Polycystic ovary syndrome seriously affects women's health. Early identification and management are crucial to prevent and reduce long-term complications. Otherwise, it will increase the risk of metabolic syndrome, cardiovascular disease, type 2 diabetes, endometrial cancer and other diseases. Once the corresponding symptoms are found, they should go to the hospital for diagnosis and treatment in time. In addition, due to appearance and other reasons, some patients have psychological problems such as anxiety and depression, and mental health management should also be taken seriously.

Author: Shi Xiaoyu, Baoding First Central Hospital