Polycystic Ovaries - Information Overview

Stein-Leventhal syndrome (ovarian hyperandrogenism syndrome of non-tumor genesis, polycystic ovaries) is a disease that was identified as an independent nosological form by S.K. Lesnoy in 1928 and in 1935 by Stein and Leventhal. In world literature it is known as Stein-Leventhal syndrome, and according to the WHO classification it is designated as polycystic ovary syndrome (PCOS). In our country, most authors call this disease sclerocystic ovary syndrome (SCOS). From our point of view, the most pathogenetically justified term is the one proposed by S.K. Lesnoy in 1968 - hyperandrogenic ovarian dysfunction or ovarian hyperandrogenism syndrome of non-tumor genesis.

The incidence of polycystic ovary disease (Stein-Leventhal syndrome) is 1.4-3% of all gynecological diseases. Polycystic ovary disease affects young women, often from puberty.

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Causes of Polycystic Ovary Syndrome

The cause and pathogenesis of polycystic ovary syndrome are unknown. The early idea of the leading role of tunica albuginea sclerosis in the pathogenesis, which impedes ovulation, has been rejected, since its severity has been shown to be an androgen-dependent symptom.

One of the main pathogenetic links of polycystic ovary syndrome, which largely determines the clinical picture of the disease, is hyperandrogenism of ovarian genesis, associated with a violation of the gonadotropic function. Early studies of the level of androgens, or more precisely their metabolites in the form of total and fractional 17-ketosteroids (17-KS), showed their significant spread in polycystic ovary syndrome, from normal values to moderately elevated. Direct determination of androgens in the blood (testosterone - T, androstenedione - A) by the radioimmunological method revealed their constant and reliable increase.

Causes and pathogenesis of polycystic ovaries

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Symptoms of Polycystic Ovary Syndrome

According to the literature, the frequency of various symptoms encountered in polycystic ovary syndrome is characterized by significant variability, and they are often opposite. As E. M. Vikhlyaeva notes, the very definition of the syndrome assumes the inclusion of conditions with different pathogenesis.

For example, more frequently observed opsomenorrhea or amenorrhea does not exclude the occurrence of menometrorrhagia in these same patients, reflecting the hyperplastic state of the endometrium as a result of relative hyperestrogenism. Hyperplasia and polyposis of the endometrium are also found with significant frequency in patients with amenorrhea or opsomenorrhea. Many authors note an increased incidence of endometrial cancer in polycystic ovary syndrome.

A typical symptom of gonadotropic regulation of ovarian function and steroidogenesis in them is anovulation. However, some patients periodically have ovulatory cycles, mainly with corpus luteum insufficiency. Such ovulatory opsomenorrhea with hypoluteinism occurs at the initial stage of the disease and gradually progresses. With ovulation disorder, infertility is obviously observed. It can be both primary and secondary.

Symptoms of Polycystic Ovary Syndrome

Diagnosis of polycystic ovary syndrome

In the presence of a classic symptom complex, clinical diagnosis is not difficult and is based on a combination of symptoms such as opso- or amenorrhea, primary or secondary infertility, bilateral enlargement of the ovaries, hirsutism, and obesity in almost half of the patients. The results of the study (TFD) confirm the anovulatory nature of the menstrual dysfunction; in some cases, colpocytology can reveal an androgenic type of smear.

Objectively, an increase in the size of the ovaries can be determined by pneumopelvigraphy, which takes into account the Borghi index (normally, the sagittal size of the ovaries is less than the sagittal size of the uterus, in polycystic ovary syndrome - greater than or equal to 1). Ultrasound determines the size of the ovaries, their volume (normal - 8.8 cm ³ ) and echostructure, which allows identifying cystic degeneration of the follicles.

Laparoscopy is also widely used, allowing, in addition to visual assessment of the ovaries and their size, to perform a biopsy and confirm the diagnosis morphologically.

Diagnosis of polycystic ovaries

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Treatment of polycystic ovary syndrome

Its main goal is to restore full ovulation and reduce the degree of hyperandrogenism. Achieving it leads to the elimination of dependent clinical manifestations of the syndrome: infertility, menstrual irregularities, hirsutism. This is achieved by various therapeutic means, as well as surgical - wedge resection of the ovaries.

Among conservative means, the most widely used are synthetic estrogen-gestagen preparations (SEGP) such as bisecurin, non-ovlon, ovidon, rigevidon, etc. SEGP is prescribed to inhibit the gonadotropic function of the pituitary gland to reduce the elevated level of LH. As a result, stimulation of ovarian androgens decreases, and the binding capacity of TESG increases due to the estrogenic component of SEGP. As a result, androgenic inhibition of the cyclic centers of the hypothalamus decreases, and hirsutism is weakened.

Treatment of polycystic ovaries

However, it should be noted that in rare cases, due to the gestagenic component of SEGP, which is a derivative of Cig-steroids, an increase in hirsutism may be observed.