Advances in clinical treatment of polycystic ovary syndrome

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PCOS is the most common gynecological diseases of endocrine diseases, in pregnant women in the incidence rate is as high as 5-10%[1], is one

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PCOS is the most common gynecological diseases of endocrine diseases, in pregnant women in the incidence rate is as high as 5-10%[1], is one of the most important cause of anovulatory infertility, its etiology is complex, there are endocrine factors, insulin resistance, lipid metabolism. A variety of clinical manifestations, the main clinical manifestations of menstrual disorders, with secondary amenorrhea, minorities such as menorrhagia and dysfunctional uterine bleeding, infertility, hirsutism, acne, obesity, acanthosis nigricans, diabetes, coronary heart disease and increased risk of disease, increased [1] incidence of endometrial carcinoma. The current clinical treatment is diverse, but not foreign single western medicine therapy and traditional Chinese medicine therapy, combined therapy. The current clinical treatment is outlined, aimed at exploring the best way to guide clinical treatment.

1 single western medicine treatment

In addition to adjusting lifestyle, exercise and weight loss in PCOS patients to improve their symptoms, clinical medication is also important. A single western medicine treatment includes ovulation induction, symptomatic treatment of Kaohsiung hormone and hyperinsulinemia. Clomiphene (CC) as the first-line drug for ovulation induction, the application of CC 75%-90% for ovulation rate, the pregnancy rate was 30%-40%[2]. Medicine for the Kaohsiung hormones are progesterone, oral contraceptives (commonly used for Marvelon, acetic acid ring cake progesterone that CPA), gonadotropin-releasing hormone (GnRH) agonist, spironolactone, Marvelon in the treatment of PCOS clinical reports, Marvelon for short acting oral contraceptives, the high progesterone against androgen, but luteinizing hormone (LH), testosterone (T) decreased, thereby increasing ovarian cystic narrowing, hair thinning and reduce acne disappeared [3]; compound cyproterone acetate (Diane -35) CPA2mg containing ethinyl estradiol 35ug can adjust the endocrine, improve the clinical symptoms of PCOS patients and induced ovulation, endometrial hyperplasia induced by PCOS treatment and prevention, so as to prevent the effect of [4] on the long-term complications of uterine endometrial carcinoma. The treatment of hyperinsulinemia with insulin sensitizing agents, including metformin and thiazolidinediones two ketones, metformin improved PCOS with pseudoacanthosis nigricans (AN) of [5] patients with insulin resistance and hyperinsulinemia Kaohsiung hormones, can enhance the resistance of CC were sensitive to CC [6]; thiazolidines two ketones rosiglitazone are commonly used, PCOS patients treated with rosiglitazone and insulin resistance makes Kaohsiung hormones improved, most patients recover ovulation, ovulation rate increased [7]. Surgical treatment of PCOS is mainly laparoscopic to drug therapy is generally poor, laparoscopic electrocoagulation drilling, laparoscopic multiple biopsy, laparoscopic monopolar needle cautery, the treatment of patients with refractory PCOS and the ovulation rate and pregnancy rate [8, 9, 10]. In vitro fertilization and embryo transfer methods are not available for the treatment of ovulation induction.

2 single Chinese medicine treatment

The Chinese medicine has no corresponding disease, often attributed to PCOS's disease, amenorrhea, menstruation, infertility treatment scope, TCM treatment using traditional Chinese medicine artificial cycle therapy and traditional Chinese medicine dialectical therapy, the main treatment method, kidney tonifying the kidney and promoting blood circulation, removing blood stasis, tonifying the kidney and invigorating the kidney and resolving phlegm dampness and phlegm etc.. That's, Hao respectively the application of traditional Chinese medicine artificial cycle therapy in the treatment of PCOS can regulate the hypothalamic pituitary ovarian axis function, promote follicle growth and development, maturation and egg discharge, recovery of menstrual cycle [11, 12]; Yu with hyperinsulinism Kaohsiung hormone of invigorating the kidney and activating Tiangui recipe in the treatment of PCOS, the party has the dual function of regulating ovarian function and improve IR, the ovulation rate was 59.7%[13].

3 combination therapy

3.1 western medicine combined therapy

Western medicine combined therapy is nothing more than a combination of Western medicine or western medicine plus surgery. Clinical reports of metformin and Diane -35 combined treatment of PCOS can play a synergistic effect, reduce the level of androgen and insulin, increase the efficacy of Diane -35, can improve insulin resistance, reduce the weight of [14 and 15]; metformin combined with Marvelon in the treatment of PCOS in correcting Kaohsiung hormones and improve abnormal glucose tolerance [16]; metformin combined with CC for PCOS is safe, and can improve the ovulation rate of [17, CC 18, 19] PCOS; rosiglitazone combined with metformin can significantly reduce the body weight index and insulin resistance index, increase ovulation rate [20]; metformin, pioglitazone and CC combined with PCOS can effectively reduce the serum LH and T levels, improve the ovulation rate [21]; gonadotropin releasing hormone agonist (GnRH-a) for the treatment of PCOS -35 GADA can effectively inhibit LH, FT, lose weight, more than single -35. Effective [22]; combined treatment for ovulation induction with CC plus dexamethasone, CC double America, CC plus CC plus tamoxifen, chorionic gonadotrophin (HCG), urinary gonadotropin (HMC) plus HCG, CC plus HCG plus HMG can improve the ovulation rate in patients with PCOS [1]; Yuan's report of laparoscopic surgery with the CC, HCG, progesterone and ethinylestradiol PCOS ovulation rate was improved [23].

3.2 combination of Chinese and Western Medicine

In this regard, the most common is the treatment of CC combined with traditional Chinese medicine, Chinese medicine Shao Shiyong Bushen Huoxue plus CC for treating infertility caused by PCOS is better than single CC effect, the cycle ovulation rate was 87%, the total pregnancy rate was 65.6%[24]; Lai with Daotan decoction combined with CC seed treatment of PCOS pregnancy rate was 65.9%, ovulation rate of 85.2%[25]; PCOS Shiyong Hou western medicine in the treatment of sex hormone level monitoring results in the guidance, which not only have strong pertinence, and can shorten the course of treatment, improve the curative effect of [26]; Chen application to kidney medicine mainly stimulating acupuncture, CC, HCG Decoction Treatment of PCOS 38 cases of infertility caused by the pregnancy rate was 55%[27]; Zhang bushenqutan application blood stasis combined with CC in the treatment of CC resistant PCOS16 patients with ovulation rate was 67.9%, the pregnancy rate was 43.8%[28]; Li's laparoscopic operation combined with phlegm medicine is better than the single use of laparoscopic surgery in treatment of PCOS [29].

4 discussion

At present, many PCOS clinical treatment methods, but no single drug can improve the clinical symptoms of all, combination therapy is clinical research direction, and the traditional Chinese medicine treatment of the disease. The study showed that tonifying kidney, promoting blood circulation and resolving phlegm, and traditional Chinese medicine has certain advantages in the adjustment of reproductive function and endocrine metabolism, the combined treatment of Chinese and Western obviously better than any single treatment, combined treatment of Chinese and Western medicine alone can not only shorten the time of treatment of the disease, but also can reduce the side effects of Western medicine, CC, British -35 and metformin in the treatment of PCOS curative effect, clinical research in the future is how to use the above drugs combined with traditional Chinese medicine treatment of the disease, and to explore the mechanism of treatment of traditional Chinese medicine PCOS, Chinese medicine effective the development of favorable clinical use.

 

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