Patient's question:
BR> I went to the hospital for a check-up last week, and the result was polycystic ovary syndrome. The doctor prescribed me Dian-35 and suggested I have a uterine curettage. I would like to ask if it is necessary to have a uterine curettage? (Note: the endometrial thickness is 6mm) Can this condition be regulated with traditional Chinese medicine? If the estrogen levels return to normal after stopping the medication, will it recur?First follow-up question: Thank you for your answer. Since I have already given birth, do I just need to take the medication prescribed by the doctor? I would also like to ask: Can polycystic ovary syndrome lead to the birth of twins? Because I have already given birth to a pair of twins.
Doctor's answer:
Hello! First of all, I wish you a speedy recovery! I will discuss the issue of "Polycystic Ovary Syndrome" with you. Patients with this condition exhibit menstrual disorders, amenorrhea, anovulation, hirsutism, obesity, infertility, and bilateral ovarian enlargement with cystic changes, which are collectively referred to as Polycystic Ovary Syndrome (PCOS). Patients may exhibit all of the above typical symptoms or only some of them. However, infertility caused by ovulatory dysfunction is the main clinical manifestation of PCOS. The exact etiology of PCOS is unclear, but it is currently believed that excessive androgen production by the ovaries is the result of a synergistic effect of multiple endocrine system dysfunctions in the body.1) The clinical manifestations of PCOS vary in severity and primarily occur in women of reproductive age (20–40 years). Typical patients with PCOS mainly exhibit the following aspects:
1. Infrequent menstruation or amenorrhea.
2. Infertility.
3. Obesity: Approximately half of the patients exhibit this symptom, with increased hair growth that is coarse and dark, and in some cases, a masculine hair distribution pattern. Some patients may also have acne.
4. Bilateral ovarian enlargement: The volume of the ovaries can be determined through laparoscopic visualization or ultrasound imaging.
5. Hormonal changes: Excessive androgens are a fundamental feature of PCOS. Additionally, PCOS may show significant elevations in hormones such as testosterone, free testosterone, androstenedione, LH, LH/FSH ratio, free estradiol, estrone, and fasting insulin.
2) General treatment
1. Weight reduction: Weight reduction is a fundamental principle for PCOS.
2. Cyproterone acetate plus ethinyl estradiol: This regimen is the first choice for women who do not wish to conceive.
3) Treatment of PCOS with infertility:
① Medication
㈠ Clomiphene: It is the first-line medication for ovulation induction in PCOS. Clomiphene treatment can induce ovulation in 75–90% of patients, but some patients may still fail to ovulate or conceive.
㈡ Gonadotropin-releasing hormone (GnRH): The advantage of this regimen is that it induces the development of a single dominant follicle and ovulation in most patients.
㈢ Human menopausal gonadotropin (HMG): For PCOS patients resistant to clomiphene, exogenous gonadotropin-induced ovulation is a commonly used treatment.
㈣ Pure follicle-stimulating hormone (r-FSH, brand name: Goal-F, Chinese name: Gonal-F): PCOS patients often have excessive endogenous LH secretion, so pure follicle-stimulating hormone is more effective than HMG for ovulation induction.
㈤ GnRH-a regimen
㈥ GnRH-a + GnRH regimen
② In vitro fertilization and embryo transfer (IVF-ET): For PCOS patients who remain infertile after six cycles of gonadotropin treatment, IVF-ET is an extremely effective treatment. The reason is that IVF-ET is not affected by tubal factors and does not require strict control of single follicular development. Therefore, the therapeutic effect is better than gonadotropin treatment.
③ Laparoscopic surgical treatment: Postoperative ovulation rates can reach 54–92%, and pregnancy rates can reach 35–69%. The advantages of this method include minimal trauma, rapid recovery, the ability to achieve multiple ovulatory cycles with a single surgery, and the absence of complications such as multiple pregnancies and ovarian hyperstimulation syndrome.
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