Tens of millions of young women in China are trapped in the same circle - Polycystic ovary syndrome

Polycystic ovary syndrome

The "2022 China Reproductive Health Research Report for Women of Childbearing Age" shows that 50.8% of women have irregular menstrual cycles, dysmenorrhea, and abnormally increased menstrual flow, and only 29.9% of women do not have any gynecological symptoms. In other words, half of the girls have been tortured by menstruation. Menstruation is undoubtedly the most entangled thing for girls. They are afraid of it coming, and even more afraid of it not coming. If it comes one day late, it will make people suspicious. If you run away from home directly, it will make girls completely collapse. Because this is probably the most common endocrine disease among contemporary women-polycystic ovary syndrome (PCOS).

Polycystic ovary syndrome is not caused by obesity

Obesity is more of a result of PCOS than a cause, but obesity can make the condition worse. Under normal circumstances, a woman will have a follicle mature and be released from the ovary every month. However, PCOS patients often cannot ovulate normally. The follicles that are not released in the ovaries look like strings of pearls under ultrasound images - this is the origin of the name of the disease.

30% to 70% of PCOS patients are obese, and 70% have dyslipidemia, a vicious cycle in which obesity and dyslipidemia promote each other. In 2006, Peking Union Medical College Hospital surveyed 196 polycystic patients who visited the weight loss clinic. Among them, the incidence of obesity in polycystic patients of childbearing age was higher than 50%, and the incidence of obesity in adolescent PCOS was even higher. An analysis of a paper published in the Annals of Palliative Medicine in 2021 found that the prevalence of polycystic ovary syndrome in Chinese women of childbearing age has reached about 10.1%. Moreover, the risk of polycystic is higher for adolescent girls and girls in their twenties.

Abdominal obesity (central obesity) is another important feature of some PCOS patients. Up to 80% of PCOS patients may suffer from abdominal obesity. Even PCOS patients with normal BMI still have a 50% chance of suffering from abdominal obesity.

Obesity and abdominal obesity, in turn, increase the risk of hyperandrogenism, glucose and lipid metabolism, cardiovascular disease and reproductive dysfunction. In addition, about 50% to 70% of PCOS patients have insulin resistance, which is also related to hyperandrogenism and ovulation disorders.

The biggest feature of polycystic ovary syndrome is that the symptoms are not single

The more common clinical manifestations of PCOS include irregular menstruation, hyperandrogen-related manifestations (hirsutism, acne, androgenic alopecia, etc.), ovulatory dysfunction and infertility, etc., which may be accompanied by metabolic abnormalities such as obesity, insulin resistance, hyperinsulinemia, and glucose and lipid metabolism disorders.

According to the "Chinese Diagnosis and Treatment Guidelines for Polycystic Ovary Syndrome" published by the "Chinese Journal of Obstetrics and Gynecology" in 2018, women's oligomenorrhea, amenorrhea or irregular uterine bleeding are necessary conditions for the diagnosis of this disease. In addition, polycystic ovary syndrome also has clinical symptoms such as insulin resistance and excessive androgen. Insulin resistance is an imbalance in insulin secretion, which can lead to abdominal obesity and a more and more prominent belly. If it is not taken seriously and there is no intervention treatment, it is very likely to deteriorate into diabetes.

Among them, high androgen levels not only lead to the more familiar hirsutism, acne and other diseases, but also cause obesity together with insulin resistance and lipid metabolism disorders, especially abdominal obesity. Moreover, this type of obesity is the real "even drinking cold water will make you gain weight" type of obesity. Many women, especially adolescent girls, initially went to the weight loss clinic because of uncontrollable weight gain, and it turned out that they had polycystic ovary syndrome.

Seek medical treatment as soon as possible and standard treatment is important

Lifestyle intervention is the first choice of basic treatment for PCOS patients, especially for those with overweight or obesity. Lifestyle intervention should be performed before and/or during drug treatment. Lifestyle intervention includes diet control, exercise and behavioral intervention. Lifestyle intervention can effectively improve the health of overweight or obese PCOS patients.

1. Control your diet

Dietary control includes adhering to a low-calorie diet, adjusting the main nutrients, and replacing diets. Monitoring calorie intake and choosing healthy foods are important components of dietary control. Long-term calorie restriction, choosing a low-sugar, high-fiber diet, and replacing saturated fatty acids with unsaturated fatty acids. Change bad eating habits, reduce mental stress, quit smoking, drink less alcohol, and drink less coffee. Doctors, society, and families should encourage and support patients so that they can persist in the long term without weight rebound.

2. Exercise

Exercise can effectively reduce body weight and prevent weight gain. Regular and moderate energy-consuming physical exercise (30 min/d, at least 5 times a week) and reducing sedentary behavior are the most effective ways to lose weight. Individualized plans should be formulated based on personal wishes and taking into account personal physical limitations.

3. Behavioral intervention

Lifestyle intervention should include behavioral intervention to strengthen compliance with low-calorie diet plans and increase exercise measures. Behavioral intervention includes adjustments to obesity cognition and behavior. Under the guidance and supervision of a team of clinicians, psychologists, nurses, nutritionists, etc., patients can gradually change their lifestyle habits (lack of exercise, alcohol intake, smoking, etc.) and psychological states (such as stress, frustration, and depression, etc.) that are prone to cause diseases. Behavioral intervention can make traditional diet control or exercise measures more effective.

More importantly, the treatment of PCOS is not just lifestyle intervention, standardized clinical treatment is also very important. Because the condition is complicated, it may require joint treatment from multiple departments. According to the different physiological stages and treatment requirements of the patient, the gynecologist may give different treatment plans in the direction of adjusting the menstrual cycle, promoting fertility, etc.

For patients who do not respond well to lifestyle interventions, they may need to work with an endocrinologist to correct insulin resistance, lower blood sugar, and regulate blood lipids. For patients with acne due to hyperandrogenism, it is best to work with a dermatologist for standardized treatment.