Patient's question:
What is the reason my wife got polycystic ovary syndrome?Doctor's answer:
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by enlarged ovaries containing numerous small fluid-filled cysts, elevated androgen levels, and an inability to ovulate. Its most significant feature is anovulation. PCOS is caused by dysfunction of the hypothalamic-pituitary-ovarian axis and is not a structural disease.Symptoms:
1. Menstrual disorders (click the link to view the medical care guide for this disease): Primarily amenorrhea, mostly secondary amenorrhea, often preceded by menstrual oligomenorrhea or hypomenorrhea. Occasionally, menstrual hypermenorrhea or polymenorrhea may occur.
2. Infertility: Due to menstrual disorders and anovulation, infertility is common. Menstrual disorders and infertility are often the primary reasons for seeking medical attention.
3. Hirsutism and obesity: Excessive androgen secretion may lead to hirsutism and obesity. Hair distribution tends to be masculine, with hirsutism often unnoticed by patients but detected during physical examination.
4. Bilateral ovarian enlargement: In some cases, gynecological examination may reveal that both ovaries are 1–3 times larger than normal and have a firm texture. In most patients, enlarged ovaries are detected through auxiliary examinations such as ultrasound and are not easily palpable during clinical examination.
Diagnosis of PCOS:
(1) Clinical manifestations:
- Occurs in women aged 22–31, accounting for 85%.
- Menstrual oligomenorrhea, hypomenorrhea, and secondary amenorrhea account for 60%.
- Anovulatory menstruation, hypermenorrhea, polymenorrhea, or dysfunctional uterine bleeding account for 20%.
- Hirsutism occurs in more than 70%, with significant distribution in the lips, arms, and legs. Hair growth may appear on the areola, lower abdomen, and midline, ranging from a few long hairs to multiple strands.
- Obesity occurs in about 30%, with some patients only experiencing weight gain without obvious obesity.
- Infertility occurs in about 75%, with primary infertility being more common.
- Gynecological examination reveals one or both ovaries in about 67% of cases.
(2) Ultrasound: Bilateral ovaries are larger than more than one-fourth of the normal uterus, with multiple cystic follicles inside.
(3) Hormone testing: Luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio ≥3 is diagnostically significant. Estriol levels are often higher than estradiol levels. Androgen levels are elevated, while progesterone levels are low. LH and estradiol do not show normal pre-ovulatory peaks. In about 30% of cases, prolactin is also elevated.
(4) Laparoscopic examination:
- Ovarian capsule thickening with a pearly appearance and uneven surface occurs in about 73%.
- Ovarian enlargement occurs in about 80%.
- Multiple follicles scattered under the ovarian capsule, causing slight protrusion of the surface, occurs in about 71%.
- Increased ovarian surface blood vessels occur in about 64%.
(5) Ovarian tissue biopsy: The capsule is about 2–5 times thicker than normal, with varying thickness. The cortex contains follicles of varying degrees of development, with diameters of 2–6 mm (rarely exceeding 10 mm). Follicular membrane cells show hyperplasia and luteinization, with or without occasional corpora lutea or albicantia.
Based on the above (1) and (2), PCOS can be considered for diagnosis. The more tests conducted, the higher the diagnostic accuracy.
Treatment of PCOS:
General treatment: Patients should actively exercise, reduce the intake of high-fat, high-sugar foods, and lose weight to lower androgen levels, which is beneficial for restoring ovulation.
Medication: Drugs can counteract androgen effects and promote ovulation. The primary medication is oral contraceptives, which can also regulate the menstrual cycle. Treatment is typically continued for 3–6 months, and medication is stopped after normal hormone levels are confirmed.
Laparoscopic surgery: If the above methods are ineffective, laparoscopic surgery may be considered. During the procedure, follicles are punctured to lower androgen levels, achieving therapeutic goals.
Most patients can restore ovulation and conceive after symptom control. However, some may experience recurrence, requiring regular follow-up. It should be noted that the longer PCOS persists, the harder it is to treat. Therefore, patients with related symptoms should seek medical attention promptly to avoid delaying diagnosis.