PCOS is a nightmare that runs through a woman's life. The onset of puberty, infertility in childbearing age, menstrual disorders and endometrial diseases plague nearly 5%- 10% of women, and even endanger the health of pregnant mothers and fetuses. However, PCOS brings not only fertility problems, but also the high incidence of diseases such as hypertension, diabetes and tumor in menopausal women.
How are so many cysts formed?
The causes of PCOS are complex and diverse. Due to the influence of heredity, environmental factors and mental stress, some diseases (such as diabetes, cardiovascular diseases, etc. ) and insulin resistance, abnormal regulation function of hypothalamus-pituitary-ovary axis, excessive androgen production by ovary and adrenaline, inhibition of follicular maturation, leading to anovulatory menstruation (functional uterine bleeding, rare menstruation), infertility, obesity, hirsutism, acne and other symptoms.
Polycystic was also fat and thin!
Obesity is very common in PCOS patients. Studies have shown that nearly 50% of patients are obese, and it is reported as high as 70%. However, there are still a group of "innocent" skinny people (they look normal or thin), but unfortunately they have all become skinny and polycystic.
Literature reports compare obese patients with thin patients and find that both of them have insulin resistance and hyperinsulinemia, but the degree of insulin resistance in patients with thin polycystic ovary syndrome is relatively light. Both of them also have a significant increase in gonadotropin levels, which leads to excess androgen production, but the increase is more obvious in patients with polycystic ovary syndrome.
Therefore, patients cannot judge the degree of illness by being fat or thin. Thin and polycystic people must pay attention to it, and active treatment is the most important thing!
How to fight against thin polycystic ovary?
Adjust lifestyle and change bad habits;
Based on the current therapeutic evidence, the recommended diet structure is low in carbohydrate (47%), low in saturated fat (38%) and moderate increase in protein (15%).
Eat some fish and shrimp with high content of protein.
Replace saturated fatty acids with unsaturated fatty acids, and eat vegetable oil and olive oil. Eat less animal fat.
Eat fresh fruits: low-sugar fruits-kiwi, pitaya, pear, grapefruit, cherry, bayberry and so on. Eat about 200g a day; Sweet fruits-litchi, orange, mango, pineapple, banana, longan, etc. , should be controlled within 100g per day; High-sugar fruits-watermelon, sugarcane, candied fruit, etc. Should not be used more.
Eat fresh green vegetables, such as celery; Eat coarse grains and ensure that the daily dietary fiber is not less than 12g.
Appropriate vitamin D supplementation can effectively improve insulin resistance.
We must control ourselves and try to "quit" carbonated drinks, other sweet drinks, caffeine and so on. Edible scented tea can replace strong tea, so you must quit smoking and limit alcohol.
Exercise combined with healthy diet can control patients' body fat and block the vicious cycle of hyperandrogenism → hyperinsulinemia → androgen increase, which is beneficial to the recovery of ovulation rate and menstrual cycle.
Avoid sedentary, recommend walking, brisk walking, aerobics, swimming, mountain climbing, cycling and other aerobic exercises. , 5 days a week, lasting 12-24 weeks, 30-45 minutes each time.
At the same time, pay attention to daily life, the living environment is suitable, you can't be overworked, and pay attention to changing clothes with the weather to avoid being infected by bacteria and viruses.
Clinical drug therapy:
1, regulating menstrual cycle:
Periodic use of progesterone can be the first choice for PCOS patients in adolescence and perimenopausal period.
Short-acting compound oral contraceptive (COC): It can reduce the production of androgen (from ovary), regulate menstrual cycle and prevent endometrial hyperplasia; Reduce hair growth and treat acne. It can be used as the first choice for PCOS patients who have no fertility requirements in childbearing age.
The most commonly used tablets in clinic are Diane -35 tablets, Mafuron tablets and Yousiming tablets.
2. Reduce the level of kaohsiung hormone:
Oral contraceptives, spironolactone, glucocorticoids, etc. It is usually used to improve ovarian ovulation function by reducing androgen level in PCOS patients.
Glucocorticoid: Excessive androgen suitable for adrenal gland or adrenal gland mixed with ovary. Dexamethasone is commonly used.
Spironolactone: inhibits the synthesis of androgen in ovary and adrenal gland, and enhances the decomposition of androgen.
3. Improve insulin resistance:
Insulin sensitizer and metformin can inhibit the synthesis of glucose in liver and increase the sensitivity of peripheral tissues to insulin. By lowering the blood insulin level, the patient's hyperandrogenic state can be corrected and the ovulation induction effect can be improved.
4, ovulation induction:
Clomiphene citrate is a first-line drug that can induce ovulation. The ovulation rate after clomiphene citrate application is 60% ~ 85%, and the pregnancy rate after 6 ovulation cycles is 30%~50%.
It is suitable for PCOS patients with fertility requirements but persistent anovulation/rare ovulation.
5. Assisted reproductive technology
Patients who fail in ovulation induction therapy or are complicated with other infertility factors can choose appropriate ART, such as IVF.
Because PCOS has complex etiology and pathogenesis, diverse symptoms and poor efficacy of single drug, most of them are combined drugs at present:
Metformin combined with Diane -35 in the treatment of PCOS- can improve insulin resistance, correct hyperandrogenism, regulate endocrine environment and improve the sensitivity of ovulation induction drugs.
Metformin combined with clomiphene citrate in the treatment of PCOS- can improve sex hormones, significantly increase ovulation rate and pregnancy rate, significantly shorten the treatment time, improve islet function and clinical symptoms, and improve the therapeutic effect.
Psychotherapy:
With the increasing mental stress of women in today's society, as well as the combined effects of hormone disorder, body shape change, infertility fear and other factors, the quality of life of PCOS patients is reduced and the psychological burden is aggravated. At the same time, introversion and depression will lead to bad emotions and form a vicious circle. Therefore, it is suggested to combine drug therapy with psychotherapy, seek the help of doctors, adjust and eliminate psychological barriers, and obtain reasonable psychological support and intervention through consultation or participation in support groups.
Patients should learn to adjust themselves, learn to relax and relieve their nervousness: cultivate some hobbies, travel, go shopping, run, read books, listen to music, watch comedies, listen to cross talks, etc., quietly. At the same time, we must also ensure adequate sleep, otherwise it will easily lead to irritability and dissatisfaction due to lack of sleep.
Polycystic is not only difficult to get pregnant and irregular menstruation, but also brings harm like dominoes, and a series of chain reactions seriously affect health and quality of life. So, let's fight against thin and polycystic, pay attention to "keep your mouth shut, open your legs and stay up late less", and keep an optimistic and cheerful mood while managing your body; Actively and rationally use drugs to protect a happy life!