Polycystic ovary syndromePathophysiology and diagnosis and treatment of polycystic ovary syndromePolycystic ovary syndrome (polycystic ovari
Polycystic ovary syndrome
Pathophysiology and diagnosis and treatment of polycystic ovary syndrome
Polycystic ovary syndrome (polycystic ovarian, PCOS) in the proportion of women with menstrual disorders, from the clinical point of view, more and more high (syndrome). Adolescent women with menstrual disorders, menopausal women with menstrual disorders, women of childbearing age can see PCOS cases. Many patients with infertility and menstrual disorders were chief complaints.
In clinical work, due to the diagnosis and treatment of this disease, so the pathophysiology of the disease and the diagnosis and treatment methods, hoping to improve the patient's awareness of the disease.
Insulin resistance and hyperinsulinemia:
GnRH sustained high secretion - LH high amplitude high frequency secretion - "LH/FSH" 2 or above.
The ovarian pathology: multiple bilateral ovarian follicular development, "Huang Suhua, is not broken and membrane thickening -" stimulus "due to endometrial hyperplasia, estrone, cystic adenoma or irregular hyperplasia, even the occurrence of endometrial carcinoma.
Follicular development, maturation and ovulation is a complex process. Local ovarian autocrine and paracrine regulatory factors such as steroid hormone and its receptor synthesis, various cytokines (TNF, IL-1, INF, alpha gamma), growth factor and its receptors (IGFs, EGF, VEGF, TGF P), inhibin, activin (INF) (ACT), and prolactin (ECM) and dissolved matrix the enzyme (MMPs) and plasminogen activator (tPA/PAI), inflammatory chemotaxis, prostaglandin (PG) with gonadal hormone and its receptor, together constitute the influence of complex network ovulation, any link is abnormal, may cause abnormal follicular development and ovulation failure.
Follicular development disorder and anovulation is a key feature of PCOS patients of reproductive dysfunction in patients with PCOS, follicular developmental disorders of the basic performance is raised too much the number of follicle, follicle selection and dominance is blocked, follicular development stagnation, lead to anovulation. The ovarian surface smooth, white thick, white film see many different levels of follicles and atretic follicles, occasionally white. Ovarian tunica albuginea obvious collagen and collagen formation of cellulose than normal collagen fiber broadband, the thick, was lamellar wrapped around the ovary, the final ovulation. The pathological outcome and endocrine disorders, insulin resistance and hyperinsulinemia Kaohsiung hormones, and may be affected by these factors under the control of local cytokines in the ovary and ovarian granulosa cells and theca cell function abnormal.
PCOS pituitary gonadotropin secretion is abnormal, the performance of LH is relatively high, FSH is relatively low or normal, the proportion of the two increase, secondary cause ovarian and adrenal synthesis of excessive androgen. Hyperinsulinemia and insulin resistance is associated with a significant performance of many obese and non obese PCOS women, insulin resistance may play a role in the pathogenesis of PCOS and early center, this phenomenon is particularly prominent in adolescent patients with hyperandrogenism in girls; insulin enhances ovarian and adrenal steroid hormones through its receptor (in particular) and increase androgen synthesis; pituitary LH release; insulin enhanced inhibition of liver SHBG synthesis (SHBG), circulating SHBG concentration decreased, free testosterone concentration, enlarge hormone level, and significantly decreased the serum levels of SHBG is almost various causes a marked insulin resistance; Hyperinsulinemia induced granulosa cells induced by abnormal formation of dominant follicle impairment without ovulation. Kaohsiung hormones can make ovarian stromal hyperplasia by membrane thickening in the ovary, and accelerate follicular atresia in the liver, inhibit the synthesis of SHBG, the testosterone and androst-4-ene-3,17-dione in two increased in the peripheral Xiangshuang hydrogen testosterone and estrone transformation, as a result of female acne and hirsutism, on the other hand, no periodic stimulation through further feedback estrone. Gonadal hormone secretion disorder, LH/FSH imbalance. PCOS obesity and insulin resistance and hyperinsulinemia Kaohsiung hormones have a certain relationship, but the exact relationship remains to be elucidated or has interactive. But research shows that obesity can be PCOS above SHBG to amplify androgen effect; strengthen adipose tissue aromatization to estrone process, further induce gonadal hormone disorder and endometrial hyperplasia, or endometrial cancer; obesity leads to high triglycerides and very low density lipoprotein cholesterol, increased lipid metabolism and atherosclerosis part; patient weight loss can improve ovulation. Thus, PCOS were mutually tied together, form a vicious spiral, resulting in a series of clinical manifestations and complications of PCOS, also led to the treatment of difficult and complicated.
2 ovarian pathological changes
Ovary and uterus also showed typical pathological changes, the bilateral ovarian cystic enlargement, the capsular thickening, cystic follicles visible from several layers of granulosa or theca cells covered under the microscope, the bubble of corpus luteum and the stroma luteinized; the endometrial because estrogen level and duration of the different, but for cystic hyperplasia, adenoma or hyperplasia, even with endometrial cancer.
3 clinical manifestations
The menstrual disorders: oligomenorrhea, menstruation or amenorrhea, few have shown for menorrhagia.
The hirsutism and obesity: often occur concomitantly, the distribution of hair like a male tendency, such as lip, peripapillary, ventral midline, hair around the anus and limbs increased, shaggy black hair.
A: because of menstrual disorders and infertility due to anovulation. Occasionally ovulation or luteal insufficiency, if pregnant, easy abortion.
The increase of bilateral symmetry: ovarian cystic increase 2~4 times, or 1/3~1/4 for polycystic uterine volume. 20%~30% does not increase.
The gynecological examination: vulva long hair and thick cloth, and perianal, lower abdomen and abdominal midline.
Endometrial cancer: PCOS is associated with 19~25% in patients younger than 40 years of age with endometrial cancer, and 14%PCOS progresses to endometrial cancer within a period of 14 years.
30~40% with hyperprolactinemia.
Merger absolute (complete) insulin resistance syndrome and hyperinsulinemia. Besides the PCOS symptoms and signs, but also a feature of the existing melanoacanthoma (acanthosis ni-gricans), which is in the back of the neck, armpit skin black and brown pigmentation (A and B) is caused by the defect of insulin receptor.
The ovulation treatment: early pregnancy is the key to the treatment of this disease, but in some cases, the clinical symptoms of PCOS appear postpartum still again. There are many ways to promote ovulation, can be simple to complex, gradually in-depth, and pay attention to ovarian hyperstimulation syndrome and other side effects.
The traditional Chinese medicine on the treatment of menstruation: Chinese medicine treatment of this disease effect is positive, but must have patience, regulate the methodology of treatment doctors may be different, but the rules of menstruation, ovulation, pregnancy period and so on is the purpose of treatment and results.
The treatment of traditional Chinese and Western medicine: this treatment method is often used, is also a very effective way to improve the curative effect. Chinese medicine to cure menstruation, restore ovulation, reduce insulin and androgen levels, endocrine and metabolic recovery so far; western medicine mainly uses ovulation, improve insulin resistance, reduce prolactin or androgen levels, improve ovulation success rate, reduce complications. Combination of traditional Chinese and Western medicine treatment of this disease is the best method.
The surgical treatment: normal regulation objective is to restore the endocrine rhythm, to restore ovulation for the purpose. However, it is necessary to pay attention to the problem of ovarian fibrosis after operation.
The treatment method of patient and correct, is to cure the disease.
We are in basic research, clinical research and clinical work, for PCOS and other diseases has accumulated more experience and, in some cases the condition is relatively shallow, method of combination of traditional Chinese and Western medicine, promoting ovulation or regulating endocrine therapy, curative effect, relatively simple. In some cases the stubborn, prolonged does not heal, not good, to the ovulation treatment response in this case, Chinese medicine is conditioning for a longer period of time, and then with ovulation treatment, ovarian or resting during a long period of time, and then give the ovulation treatment, the effect is more obvious; Chinese medicine treatment is very important, because the traditional Chinese medicine based on syndrome differentiation is to strengthen the spleen and stomach or kidney essence, nourishing qi, or Shuganjieyu or regulating qi, dampness and water, with blood stasis, removing phlegm and dredging collaterals, nourishing yin and Yang, or medicine, palliative restore endocrine function, the final PCOS for the cure, plays a very important role.
Combination of traditional Chinese and Western medicine, in the treatment of PCOS has a unique significance, can not be ignored, can not be replaced.
Polycystic ovary syndrome (PCOS) is a complex disease. There are many differences among individuals. Regulate and improve the ovarian endocrine function and is the core of governance. Good attitude, positive cooperation, detailed communication, when the pathophysiology of the state or the TCM syndrome more accurate, more in-depth, then the effect will be better. A lot of diseases, tend to interact with each other, such as prostaglandin system, endocrine and metabolism, inflammation coagulation network, inflammation and insulin resistance and decreased inflammation and fibrosis or ovarian sensitivity to aromatase system, even between the digestive function of physical aspects or various symptoms, there will be some link, the link, the West medicine known as pathophysiological condition, TCM syndrome of traditional Chinese medicine and Western medicine, coherent, accurate grasp of the condition, the deeper the better, especially mutual contact molecules or factor of the network, can create wonderful correlation with syndrome of traditional Chinese medicine chain. According to the vertical and horizontal aspects, prudent development program, so clear, orderly, treatment will be more standardized, closer to science and reduce blindness. No matter how deep the doctor, compared with the complexity of the disease, is still far from enough. Therefore, the treatment is always a slow process.