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treatment of polycystic ovary syndrome, how to do polycystic ovary syndrome, and medication for polycystic ovary syndrome

treatment of polycystic ovary syndrome, how to do polycystic ovary syndrome, and medication for polycystic ovary syndrome

Knowledge of diagnosis and treatment of polycystic ovary syndrome

Visiting department: gynecological treatment cost: about (2000-5000 yuan) in the top three hospitals in the city. Cure rate: treatment cycle: treatment method: drug treatmentGeneral treatment of polycystic ovary syndrome

Western medicine treatment:

Obesity and insulin resistance:

Increasing exercise can reduce body weight, correct endocrine and metabolic disorders aggravated by obesity, relieve insulin resistance and hyperinsulinemia, reduce IGF-1 and IGfBP-1, and increase SHBG to reduce free androgen level. Weight loss can restore ovulation in some obese PCOS patients, and prevent the occurrence of type 2 diabetes and cardiovascular diseases. Metformin 1.5 ~ 2.5 g/d can be used for patients with or without diabetes, which can effectively reduce body weight, improve insulin sensitivity, reduce insulin level, reduce hair and even resume menstruation (25%) and ovulation. Because obesity and insulin resistance are the main causes of PCOS, drugs that can reduce body weight and increase insulin sensitivity can treat this syndrome. In recent years, there have been many reports on the treatment of insulin sensitizing agents. Thiazolidone is a kind of oral insulin sensitizer, which is mainly used to treat diabetes. For example, Troglitazone can obviously alleviate hyperinsulinemia and hyperandrogenism in PCOS patients, and help to induce ovulation. Ciotta et al. reported that insulin sensitizer can obviously reduce blood LH and androgen levels, inhibit insulin secretion, increase SHBG concentration, and can be treated for a long time. Insulin sensitizer may be more suitable for PCOS patients with hyperinsulinemia.

2. Drug-induced ovulation

(1) Clomiphene citrate:

It is the first choice drug for PCOS, with ovulation rate of 60% ~ 80% and pregnancy rate of 30% ~ 50%. Clomiphene citrate competes with endogenous estrogen at hypothalamic-pituitary level for receptor, inhibits estrogen negative feedback, increases the pulse frequency of GnRH secretion, and thus regulates the secretion ratio of LH to FSH. Clomiphene citrate also directly promotes ovarian synthesis and secretion of estrogen. From the 5th day of natural menstrual cycle or withdrawal of drug-treated uterine bleeding, 50mg was taken orally every day for 5 consecutive times as a course of treatment, and ovulation was usually carried out within 3 ~ 10 days (average 7 days), and most of them were pregnant within 3 ~ 4 courses of treatment. If there is still no ovulation after 3 treatment cycles, the dose can be increased to 100 ~ 150mg per day, and the initial dose (25mg/d) can be reduced for those with lighter body weight. After taking this medicine, the ovary was enlarged due to excessive stimulation (13.6%), the blood vessels were dilated, and there were fever sensation (10.4%), abdominal discomfort (5.5%), blurred vision (1.5%) or side effects such as rash and mild alopecia.

During the treatment period, it is necessary to record the basal body temperature of menstrual cycle, monitor ovulation, or measure serum progesterone and estradiol to confirm whether ovulation exists or not, so as to guide the adjustment of dose in the next course of treatment. If there is still no ovulation or pregnancy after 6 ~ 12 months of clomiphene citrate treatment, clomiphene citrate plus HCG or glucocorticoid, bromocriptine or HMG, FSH, GnRH and other treatments can be given.

(2) Clomiphene citrate combined with choriotropin (HCG):

On the 7th day after stopping clomiphene citrate, choriotropin (HCG) was injected intramuscularly at 2000 ~ 5000U.

(3) Glucocorticoid combined with clomiphene citrate:

The effect of adrenocortical hormone is based on its ability to inhibit excessive androgen secretion from ovary or adrenal gland. Dexamethasone or prednisone is usually used. The dosage of prednisone was 7.5 ~ 10mg per day, and the effective rate was 35.7% within 2 months. The ovarian function of amenorrhea and anovulation patients was restored to some extent. When ovulation induced by clomiphene citrate is ineffective, dexamethasone 0.5 mg and 2.0 mg every night can be taken at the same time in the treatment cycle for 10 days, so as to improve the response of clomiphene citrate or pituitary gonadotropin treatment and increase the ovulation rate and pregnancy rate.

(4) Urotropin (HMG):

Urotropin (HMG) is purified from the urine of menopausal women, which contains FSH and LH in a ratio of 1: 1. Each ampoule contains 75U of FSH and 75U of LH. Urotropin (HMG) is regarded as an alternative ovulation-inducing drug for the treatment of anovulatory infertility. Because of its many side effects, it has a great risk of inducing ovarian hyperstimulation syndrome (OHSS). Generally, HMG1 ampoules are injected intramuscularly every day. After 3 ~ 4 days, if the serum estradiol level gradually increases, continue to take the medicine. If the estradiol level does not increase, it can be increased by 0.5 ~ 1 ampoule. After 3 days, adjust the dosage according to the situation. When the urine estrogen level reaches 50 ~ 100 g/24h, or the serum estradiol is 500 ~ 1000pg/ml, or the ovarian enlargement is obvious, the drug should be stopped. The therapeutic dose of choriotropin (HCG) should vary from person to person and treatment cycle, and strict follicular maturation monitoring measures should be provided to prevent ovarian hyperstimulation syndrome (OHSS). (5) Gonadotropin releasing hormone (GnRH): GnRH can promote pituitary FSHAnd LH release, but long-term application makes GnRH receptor of pituitary cells insensitive, resulting in a decrease in gonadotropins, thus reducing the synthesis of ovarian sex hormones. Its effect is reversible, and it starts to excite FSH and LH in pituitary gland and sex hormones in ovary, and then drops to normal level after 14 days, and reaches castration level after 28 days.

Clinically, GnRH-A 150 μ g can be injected subcutaneously once a day, starting from follicular phase or luteal phase (21st day) of the previous cycle. After sex hormones reach castration level, ovulation is induced with choriotropin (HCG) at the same dose as before. In this way, follicular luteinization caused by premature LH peak in menstrual cycle can be avoided. However, due to the high value and large dosage of GnRH-A, its clinical application is limited.

(6) FSH:

There are two kinds of FSH: purified and recombinant human FSH (rhFSH). FSH is an ideal therapeutic agent for polycystic ovary, but it is expensive. And may cause OHSS. During the application, ovarian changes must be closely monitored. The dosage of 75U is safer. FSH can also be combined with GnRH-A to improve ovulation success rate.

(7) Bromocriptine:

It is suitable for ICOS patients with high PRL. The initial dose is 1.25 mg, twice a day, which can be gradually increased to 2.5 mg, 2 ~ 3 times a day, and taken after meals.

3. Bilateral wedge ovariectomy:

It is suitable for patients with elevated blood testosterone, enlarged bilateral ovaries and normal DHEA and PRL (suggesting that the main cause is ovary). Removing part of ovary and excessive androgen produced by ovary can correct the regulation disorder of hypothalamus-pituitary-ovary axis, but the excised site and the amount of tissue are related to the curative effect, and the effective rate is different. The pregnancy rate is 50% ~ 60%. Postoperative recurrence rate is high, such as pelvic adhesion, which is not conducive to pregnancy. Laparoscopic ovarian cauterization or resection can also achieve certain results.

4. Treatment of hirsutism:

It can be cut off regularly or coated with "alopecia agent", and should not be pulled out to prevent excessive growth of hair follicles. It can also be used for electrical erosion treatment or androgen inhibition drug treatment.

(1) Oral contraceptives:

Estradiol and progesterone complex tablets are ideal, which can inhibit LH secretion, reduce blood testosterone, androstenedione and DHEAS, and increase the concentration of sex hormone binding globulin.

(2) Progesterone:

It has weak anti-androgen and mild inhibition of gonadotropin secretion, and can reduce testosterone and 17-ketosteroid levels. Medroxyprogesterone (medroxyprogesterone) is more commonly used. Generally, it is taken orally at 6 ~ 8mg/d. In addition, cyproterone acetate (Cyproterone acetate; CPA) belongs to highly effective progesterone and has strong anti-androgen effect. Often taken with ethinyl estrone.

(3) GnRH-A:

It is used on the first 1 ~ 5 days of menstrual cycle, and now there are many preparations such as percutaneous inhalation, subcutaneous and intramuscular injection. At the same time, taking ethinyl estrone can avoid the adverse reactions caused by estrogen.

(4) Dexamethasone:

It is suitable for adrenal hyperandrogenism, 0.25 ~ 0.5 mg/d. Take it orally every night.

(5) Spironolactone (spironolactone):

It can also interfere with ovarian androgen synthesis by inhibiting testosterone from binding to receptors in hair follicles. 50mg orally every day. It can reduce the hair growth and thin the hair of patients. Hyperandrogenism with anovulatory menstrual disorder patients can take 20mg orally every day from the 5th to 21st day of menstruation, which can make some patients recover their menstrual cycle and ovulation.

5. Artificial menstrual cycle:

For patients without hirsutism and without fertility requirements, progesterone can be given artificial cycle treatment to avoid excessive hyperplasia and canceration of endometrium.

Surgical treatment:

Including ovarian wedge resection and laparoscopic microsurgery.

Ovarian wedgeresection (OWR):

The exact mechanism of OWR in the treatment of PCOS is still unclear. Two groups reported that serum To, Adione, E1 and E2 decreased significantly 3 ~ 4 days after OWR, and then LH decreased but FSH did not change. At 2 weeks after OWR, LH/FSH ratio returned to normal and follicular development and ovulation occurred one after another. OWR ovulation rate was 80%, pregnancy rate was 50%, postoperative adhesion rate was 41% (Buttram 1975). The new microsurgical technique and the new adhesive barriermethod were used. It can effectively prevent postoperative adhesion.

2. Laparoscopic ovarian treatment:

Is a new technology. That is to say, laparoscopic multiple punch biopsy (MPBR), ovarian cauterization (VCA), laser multiple ovarianvaporization (LVV) and laser wedge resection (LW) were performed.

Treatment of polycystic ovary syndrome based on syndrome differentiation

Traditional Chinese medicine therapy:

1. Phlegm-dampness stops inside

The main syndromes are obesity, burnout and laziness, chest tightness and shortness of breath, epigastric fullness and apathy, excessive hair, constipation, amenorrhea and infertility.Leucorrhea, or see abdominal mass, according to the pain, fat tongue, tooth marks, or dark purple tongue, thick and greasy tongue coating, smooth or slippery pulse.

The treatment method is to eliminate dampness and phlegm, replenish qi and strengthen spleen.

2. Liver stagnation turns fire

The main syndrome is strong and fat, red face, acne, irritability, headache, dizziness, chest and hypochondrium pain, insomnia, dreaminess, dry mouth and bitter taste, amenorrhea, dry stool, red tongue and yellow fur, and wiry pulse.

The treatment method is to clear the liver and purge fire, accompanied by regulating qi

3. Phlegm and blood stasis

The main syndrome is obesity, dark complexion, thick hair, stuffy chest, fatigue, laziness, dizziness, excessive leucorrhea, amenorrhea and infertility, or excessive menstruation, early menstruation, less abdominal pain, fat tongue, dark purple tongue or ecchymosis, thick greasy fur and heavy and thin pulse.

Treatment methods: Dryness-dampness-resolving phlegm pill and Shaofu Zhuyu Decoction.

4. Kidney Yang Deficiency Syndrome

The main syndrome is soreness and pain in waist and knees, chills and cold limbs, especially in both lower limbs, laziness and fatigue, dark complexion, little menstruation or amenorrhea infertility, cold libido, clear and thin things, frequent urination, thin stool, pale and fat tongue, white and greasy fur and heavy and thin pulse.

Treatment method warms and tonifies kidney yang

5. Kidney Yin Deficiency Syndrome

The main syndromes are soreness and weakness of waist and knees, dizziness and tinnitus, insomnia and dreaminess, hot hands and feet, dry throat and red zygomatic, little menstruation or amenorrhea, or early menstruation, endless dripping, short and red urine, dry stool, red tongue with little fluid, little or light fur, and thin pulse.

The treatment method nourishes kidney yin.

6. Spleen and kidney yang deficiency

The main syndrome is obesity, white complexion, head dislocation and fatigue, laziness, chills and cold limbs, cold pain in waist, abdomen or lower limbs, short and red urine, loose stool, amenorrhea and infertility, pale tongue and white fur, and heavy and thin pulse.

The treatment method is to strengthen spleen and warm kidney.

7. Deficiency of both qi and blood

The main syndrome is sallow complexion, emaciated body, dizziness, lack of breath and lazy speech, fatigue and spontaneous sweating, palpitation and insomnia, amenorrhea or metrorrhagia, anorexia and loose stool, pale tongue with tooth marks on the edge, and thin pulse.

The treatment method is to strengthen spleen and qi, nourish blood and produce blood

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