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Polycystic Ovarian Syndrome, Symptoms and Treatment

Date: Jul 21,2018   Read: 
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The polycystic ovarian syndrome is a hormonal disorder common among women of reproductive age affecting approximately 5-10% of this population. PCOS is usually diagnosed in women who present with oligomenorrhea (menstrual intervals >35 days), hyperandrogenism (elevated testosterone or hirsutism/acne) and obesity, after excluding other hormonal disorders. However, most of the women with PCOS do not exhibit all of these features and there is a considerable controversy about the definition and required criteria for the diagnosis. The new criteria include two of the following three signs: ovulation dysfunction; excessive hair growth and/acne; and polycystic appearing ovaries on ultrasound. The exciting news recently involves understanding the contribution of insulin resistance to the etiology and treatment of PCOS as well as the recent addition of ultrasound as a diagnostic tool.
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The clinical presentation and medical consequences of PCOS includes:
Infertility; abnormal uterine bleeding with the risk of endometrial hyperplasia  (a precancerous change to the uterine lining); hyperandrogenism; obesity; insulin resistance with the risk of impaired glucose tolerance and diabetes. Insulin resistance is a key finding in the metabolic syndrome along with elevated cholesterol, triglycerides, blood pressure, and waist circumference.

Polycystic ovary syndrome is primarily a clinical diagnosis, and laboratory findings should only be used to support the clinical testing and rule out other serious disorders. Evaluation should include measurement of thyroid stimulating hormone (TSH), prolactin, and in some cases, morning 17-alphahydroxyprogesterone to rule out late-onset adrenal hyperplasia. Patients regardless of age, with a greater than 3-month menstrual interval and/or an endometrial thickness of >=7mm on ultrasound should undergo an endometrial biopsy to assess the risk of hyperplasia. Insulin resistance can best be evaluated by the 2-hour glucose tolerance test (GTT).
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Management of Polycystic Ovarian Syndrome
Weight reduction, diet, and exercise are recommended for all women with PCOS. Some studies have also shown a 5-10% loss in body weight may result in a return of ovulatory cycles and a higher spontaneous pregnancy rate. Monthly progestin therapy can therapy can be used to prevent abnormal endometrial proliferation by inducing withdrawal bleeding. Insulin resistance has been implicated in the reproductive consequences of PCOS, namely infertility, miscarriage, and gestational diabetes. Multiple studies have supported the use of metformin to ameliorate these problems.

In patients desiring pregnancy, ovulation induction is often required usually with clomiphene citrate. Approximately 80% of women with PCOS ovulate in response to clomiphene, but only 40% of them become pregnant. Ovarian surgery has been an effective therapy for patients resistant to clomiphene citrate .laparoscopy with bilateral ovarian diathermy involves drilling holes in the ovary utilizing electrocautery or laser providing an approximate 84% ovulation induction rate and 58% pregnancy rate with the maintenance of ovulation demonstrated for up to 20 years in the majority of patients.
 
To ensure every patient can get enough time to communicate with doctors, Elizabeth hospital use of an appointment system. For appointment, please kindly contact 400-8869-268/, 18933981688 (English hotline)
Dr. Wang Xingxing
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Dr. Wang Xingxing  has more than thirty-five years experiences in Obstetrics and gynecology. Expect Gynecological tumors, gynecological endocrinology, infertility she is good at various vaginal surgery and pelvic floor repair surgery, skilled to complete radical operation of gynecological malignant tumors, laparoscopy, hysteroscopy, gynecologic benign diseases, tumor, pelvic endometriosis, tubal repair and plastic, anastomosis and other minimally invasive surgery, in perinatal care, recurrent abortion, high-risk pregnancy management, There are abundant clinical experiences in the treatment of obstetrical diseases such as pregnancy complications and complications.

 

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