Amenorrhea

Amenorrhea is common gynecologic symptoms of the disease. Refers to the cessation of friends at least six months. According to the causes, divided into two categories: The first category is that the physiological amenorrhea due to a physiological causes of women in a certain period of time and not menstrual cramps, for example, before the onset of pregnancy, and post-lactation period, such as postmenopausal. The other is the pathological amenorrhea is that, for some pathological reasons not women menstrual cramps. According to the age of onset can be divided into two categories of primary and secondary. The former refers to all women aged 18 years or mature Second Sex levy no more than 2 years of menstrual cramps, which refers to women who have had rules menstrual cramps, but because after a certain period of rational reasons to stop 6 months or more. This chapter describes only pathological amenorrhea.

[Etiology and Category:

Menstruation is endometrial cyclical changes in the cyclical bleeding. Normal menstrual cycle is hypothalamus - pituitary - ovarian axis all aspects of the endocrine function of the adjustment, if any one link will take place obstacles in menstrual disorders, and sometimes lead to amenorrhea. Both primary and secondary amenorrhea, and the causes of both its common also different. Control of the normal menstrual cycle has four main components, the failure of a link will appear amenorrhea:

A uterine amenorrhea amenorrhea due to the uterus, normal menstrual regulation, functional ovarian, endometrial not have normal ovarian response, it said uterus amenorrhea. Of the uterus caused amenorrhea common diseases are:

(1) endometrial injury or adhesion syndrome often occur in abortion, postpartum hemorrhage, or bleeding after curettage abortion, the number is due to excessive curettage, damage the uterus, causing Asherman, there amenorrhea.

(B) Endometritis the most common result of endometritis amenorrhea TB uterine mucositis, post-abortion or other serious postpartum endometritis may also occur amenorrhea.

(C) absent or hypoplastic uterus because of the renal hypoplasia or not the result of the development of uterine hypoplasia or not, often manifested as primary amenorrhea.

(D) after hysterectomy or uterine cavity after radiation therapy for uterine reproductive tract disease after resection or uterine cancer as a result of certain brachytherapy treatment of endometrial damage arising after amenorrhea.

Second, ovarian amenorrhea amenorrhea due to the ovary, ovarian sex hormone level is low, endometrial cyclical changes do not result in amenorrhea, common diseases are:

(1) Ovarian congenital hypoplasia or so, lack of ovarian development, or just a cord-like non-functional, multi-primary amenorrhea, common diseases are:

1, and the most common chromosomal abnormality ① with Turner syndrome mosaicism such as nuclear ② 45, XO/46, XY, 45, XO/46, XX, 45, XO/46, XXX, 45, XO/47 , such as XXX.

2, as simple chromosome normal ovarian hypoplasia.

(B) ovarian function premature senility early postmenopausal women in the 40-year-old postmenopausal women who had previously called ovarian function premature senility (premature ovarian failure). Patients demonstrated secondary amenorrhea, and the menopausal syndrome with symptoms such as facial flushing, RUF fever, sweating, mood fluctuations, internal and external genital mutilation and the Second Sex levy gradually shrinking and degradation.

(C) ovariectomized or organization due to the destruction of more than surgical resection of bilateral ovarian or bilateral ovarian by radiation therapy after ovarian tissue destruction resulting loss of function, performance for the primary or secondary amenorrhea. Severe inflammation can also destroy ovarian ovarian tissue caused amenorrhea.

(4) ovarian tumors have androgen ovarian tumors because of the excessive androgen suppression of the hypothalamus - pituitary - ovarian axis function caused amenorrhea. Estrogen secretion of granulosa cell tumor can sometimes cause temporary amenorrhea is the result of sustained secretion of tumor estrogen, and restraining ovulation, there endometrial hyperplasia caused amenorrhea.

Third, pituitary amenorrhea is the major pituitary lesion. Or organic diseases of the anterior pituitary dysfunction can affect gonadotropin secretion, thus affecting ovarian there amenorrhea, the major diseases:

(1) the anterior pituitary dysfunction

1, pituitary induced amenorrhea due to pituitary ischemia, inflammation, radiation and surgery, such as the destruction of the anterior pituitary function, the performance of some or all of loss of function caused amenorrhea. Sheehan syndrome is due to postpartum hemorrhage and shock caused by the organization before the pituitary avascular necrosis, pituitary dysfunction in amenorrhea, emaciated and looking pale, Boling, no milk, hair loss and other symptoms. Second Sex and the internal and external genital levy gradually shrinking. Patients may also be associated with low blood sugar, low blood pressure, low basic metabolism, such as loss of libido.

2, gonadal function of the pituitary promoting a low rare genetic disease can be manifested as a single primary pituitary gonadotropin, or the lack of a single growth hormone deficiency, demonstrated for the primary amenorrhea.

(2) of pituitary tumor anterior pituitary tumor is the most common brain tumor, many different types. By electron microscopy and by the clinical data and the secretion of hormones, can be divided into adenoma growth hormone, prolactin adenomas, adenomas thyroid stimulating hormone, gonadotropin adenoma mixed tumors, non-functional pituitary adenomas, etc.. According to the different nature of the tumor in different symptoms, but there are amenorrhea performance. The age of onset different, there are also different types of amenorrhea, before the onset of adolescence, primary amenorrhea frequently manifests itself in adolescence showed the incidence of secondary amenorrhea. Craniopharyngioma slow growth, and more on the sella turcica, any age could occur.

4. Hypothalamic amenorrhea under the most common types of amenorrhea, the hypothalamus pituitary dysfunction affected, thereby affecting ovarian caused amenorrhea. The etiology is complex, because of the central nervous organic diseases, mental factors, systemic disease, drugs and other secretory function disorder caused:

(1) mental, neurological factors

1, the environment changes, such as over-stretched mental trauma, fear, anxiety, as well as various external stimuli such as cold, and other central nervous system and can lead to the hypothalamus between dysfunction, and through hypothalamus - pituitary - ovarian axis, ovulation barriers affecting mature follicles caused amenorrhea.

2, the spirit of Anorexia Nervosa caused dysfunction of the hypothalamus of the disease. Patients with anorexia, seriously emaciated, amenorrhea, and other thyroid, adrenal, gonadal, pancreas, and other functions are lower.

(B) nutrient malnutrition due to consumption of certain disorders or diseases, such as gastrointestinal dysfunction, and severe tuberculosis, severe anemia, schistosomiasis, malaria, caused systemic malnutrition, which affects the hypothalamus of gonadotropin-releasing hormone and growth Synthesis and secretion of hormones to suppress gonadotropin, gonadal dysfunction caused by primary or secondary amenorrhea.

(C) drugs inhibit some women's syndrome needle injection of long-acting contraceptive lead after oral contraceptives or secondary amenorrhea, the original common in women after abortion menstrual disorders or premature use of contraceptives, is due to inhibition of the drug hypothalamus and pituitary the function is often reversible, general withdrawal 3 to 6 months can be natural recovery.

(D) In addition to patients with amenorrhea Yiru also sustained amenorrhea, milk secretion, in the genital atrophy. Hypothalamus Shengru-inhibitory factor or reduce dopamine can lead to abnormal lactation, and gonadotropin-releasing hormone secretion caused by lack of amenorrhea. Yiru result of many causes, such as oral contraceptives, long service reserpine, chlorpromazine, Mian Seoul etc. can cause amenorrhea Yiru syndrome.

(5) patients with polycystic ovary syndrome mainly amenorrhea, infertility, hirsutism, obesity, bilateral ovarian increasing LH / FSH ratio High, ovarian secretion of testosterone and Androstenedione volume increased, a corresponding reduction in estrogen that without ovulation, there amenorrhea.

(6) Other endocrine dysfunction adrenal gland, thyroid gland, pancreas dysfunction can be caused amenorrhea, a common disease hyperthyroidism and shortcomings, hyperthyroidism adrenal cortex, such as adrenal tumor.

[Diagnosis]

First of all to find the causes amenorrhea, or hypothalamus - pituitary - ovarian axis adjustment disorders in which a link, and then determine which is caused by a disease.

First, asked in detail about how patients with a history of menstrual history, age at menarche, menstrual cycle, menstrual, the level. Understanding of their growth and development history, family history, childhood health conditions, whether congenital defects or other diseases, taking off drugs, required married women to their reproductive history, post-natal complications. In addition to the situation prior to the onset asked, have any incentive to lead to amenorrhea spirit of factors such as environmental change, all kinds of diseases.

Second, physical examination should pay attention to body, whether it is normal for development, whether deformities, attention should be paid to their height, weight, limbs, trunk ratio, intelligence, nutrition and health. Gynaecological examinations should pay attention to the development of internal and external genitalia, whether defects, deformities, as well as distribution of The Second Sex levy such as hair, breast development, such as whether lactation.

Third, aided diagnosis methods

(1) uterine function of the inspection, is used mainly to understand the uterine endometrium and function, a common method:

1, the diagnosis of endometrial tissue curettage and too many inspections apply to married women, to understand whether the uterine smooth, and the depth and width of uterine, endometrial Guaqu sent to understand pathological examination of ovarian hormones endometrial reaction cyclical changes, except tuberculosis uterine mucositis possible, and the scraps of a Mycobacterium tuberculosis culture.

2, uterus, fallopian tube lipiodol angiography understanding of the uterine cavity shape, the size, whether deformities and tubal situation.

3, endoscopy laparoscopy direct peep uterus, fallopian tubes and ovaries, and a biopsy. Sometimes needed for the observation of Hysteroscopy and endometrial uterine cavity, sent from endometrial tissue pathological examination, observation of uterine cavity whether malformations.

4, drug testing

(1) Progesterone test two methods: ① progesterone intramuscular injection 20 mg daily for 3 to 5 days; ② Medroxyprogesterone 10 mg daily oral even served five days. After stopping 3-7 days to withdraw properties for the bloodshed positive results, suggesting that functional endometrial, has been a certain level of estrogen, progesterone response from stripping.

(2) test such as estrogen progesterone test was negative (note in patients with low levels of estrogen, progesterone no reaction to it), can be used for estrogen trial. That is, to serve patients Yixicifen 1 mg daily, for 20 days or intramuscularly estradiol benzoate Note 2 mg every other day, a total of 5 times. After the withdrawal from 2 to 7 days dismantling properties bloodshed, suggesting that the hormone has endometriosis and uterine smooth normal reaction.

(B) ovarian function checks

1, vaginal examination Watchlist exfoliated cells, in the bottom of the percentage of cells, cell surface to reflect the higher percentage of the higher levels of estrogen.

2, Crystal checks such as cervical mucus smear on the dentate gyrus crystallization see sheep, goats dentate crystallization of the more obvious, the more rough, suggesting that estrogen significantly. Such as the Pap smear, see rows of oval body, suggesting that the role of estrogen and progesterone on the basis of the impact has been.

3, such as the basal body temperature of the menstrual cycle than two weeks after the first two weeks of basal body temperature increased by 0.4 to 0.6 ℃, for duplex-type, suggesting that ovarian with ovulation and luteal formation total. Description normal ovarian function.

4, in the serum estrogen and progesterone content such as estrogen and progesterone levels low, suggesting that ovarian function is not normal or failure.

(C) pituitary function tests suggested that estrogen positive test in patients with low estrogen levels, but the lack of estrogen may be due to ovarian dysfunction, but also may be due to the lack of a result in gonadotropin secretion of ovarian steroid hormones not, it needs further examination pituitary function.

1, determination of serum LH and FSH to the PRL output in the menstrual cycle in normal serum FSH value of 0.66 to 2.50 μ g / L LH values ranged from 6 to 30 IU / L, ovulation peak value of about three times the value of the foundation. If FSH than 2.5 μ g / L tips ovarian failure, LH less than 6 IU / L said gonadotropin dysfunction. If FSH and LH are low, suggesting that the central pituitary dysfunction or higher.

In the normal menstrual cycle, 24-hour urinary FSH biometric mouse uterus usually less than 52.8 units, if the FSH level higher than the 52.8 units mouse uterus, suggesting that hyperthyroidism pituitary, ovary amenorrhea reasons. If FSH less than 6.6 units mouse uterus, suggesting that pituitary dysfunction, amenorrhea in the pituitary or their reasons for the above positions.

2, Sella radiography suspected pituitary tumor can be used for sella radiography. Greater tumor can affect bone sella turcica and saddle cavity size, X-ray can be identified. Such as smaller tumor still stratified radiography inspection or for more sella to fault radiography.

3, in patients with pituitary stimulation test when the LH and FSH levels are low, should be conducted to distinguish between pituitary stimulation test in the pituitary lesions, in the hypothalamus suppression. Pituitary stimulation test is LHRH100 μ g dissolved in 5 ml saline, intravenous, 30 seconds End Note. Injection before and after injection of 15,60,120 minutes borrow 2 ml blood. Serum LH levels (RIA). If injection of 30 to 60 minutes before the injection of LH increased to more than three times the pituitary function of good tips on LHRH response is good, in the hypothalamus causes amenorrhea or more parts. LH injection after the increased value does not increase or not, suggesting that may cause amenorrhea in the pituitary.

4, other tests such as the suspected endocrine dysfunction or other deformity, and so on, should be for the relevant biochemistry, pathology, pathophysiology check-such as nuclear and chromosomal banding analysis, pelvic inflatable contrast, the site of B-mode ultrasonography checks to support the diagnosis.

[Treatment]

One to correct systemic health of female genital mutilation is part of the overall, systemic health will affect genital mutilation, treatment of amenorrhea, it should be corrected in patients with systemic health.

Second, find causes for the organic diseases caused amenorrhea given appropriate treatment. Such as TB uterine mucositis that is, to anti-tuberculosis treatment. Asherman patients should be placed and expansion of intrauterine contraceptive ring, again to prevent adhesion. Pituitary or in the diagnosis of ovarian tumors are defined, according to the tumor location, size, nature determine treatment programmes, choose surgery, radiotherapy and chemotherapy other comprehensive measures.

Third, hormone replacement therapy on ovarian congenital dysplasia, or damage to or destruction of ovarian function that premature senility are available hormone replacement therapy. General application of artificial cycle hormone therapy. Application of sex hormones, a kind of cyclical menstrual bleeding dismantling properties, on the one hand with the correct physical and psychological state, on the other, to promote genital mutilation and Second Sex levy a certain level of development.

(A) low-dose estrogen treatment cycle of its role is to promote pituitary function, luteinizing hormone secretion, thereby increasing the secretion of ovarian hormones, and to promote ovulation.

(B) estrogen and progesterone sequential therapy whose role is to inhibit hypothalamus - pituitary axis, may resume after stopping menstruation and ovulation.

(C) estrogen and progesterone combined therapy whose role is to inhibit pituitary gonadotropin, after stopping occasionally to jump role due to menstruation and ovulation resumed. Use of oral contraceptives, a night service, since the service from the fifth day of menstruation, and even served 22 days to stop. The first five days of next menstrual started the second course, the sharing of 3 to 6 cycles.

(D) if inducing ovulation failure of ovarian function and fertility requirements of the patients, hormone or its analogues can be induced ovulation:

1, pituitary dysfunction in postmenopausal women using urine from the follicle stimulating hormone (hMG), to promote follicle growth, secretion of estrogen. And the merger of similar pituitary luteinizing hormone human chorionic gonadotropin (hCG), the mature follicles that can promote ovulation and luteal promote the formation and development.

2, in the low sexual function, ovary and pituitary a normal reaction, hypothalamus insufficiency or lack of co-ordination, which uses chlorine Di phenol-amine promote hypothalamus of gonadotropin-releasing hormone secretion, and to rectify its function of inducing ovulation.

3, hypothalamus insufficiency, which LHRH inadequate secretion, and can be pulsed injection of trace LHRH inducing ovulation.

4, Application for Bromocriptine treatment of patients with amenorrhea Yiru, whose role is to promote inhibition Lactagogue hormone prolactin to reduce, at the beginning, with small dose of 1.25 mg, 2 to 3 times a day, such as no obvious reaction that gradually increases volume, the largest daily dose should not exceed 10 mg.

Adolescent women amenorrhea how do?

If more than 18-year-old girl also did not come to menstruation, or unmarried young women had normal menstrual, it has been stopped by more than three months, The former is original in amenorrhea, which is following in amenorrhea. Some girls from the onset of menstruation second interval months, or 12, are not menstrual regularity, two relatively long periods of time interval, we can not count amenorrhea. This is because their genital mutilation has not yet mature, ovarian function is not perfect, it is a normal physiological phenomenon.

Cause amenorrhea for more common are the following:

(1) disease. Including consumption of diseases, such as severe tuberculosis, severe anemia, malnutrition, endemic endocrine diseases, such as “reproductive incompetence malnutrition obese patients”; chaos in some of the impact of endocrine, such as the adrenal gland, a customs gland, the pancreas , and other dysfunction. The impact of these reasons, may not menstruation. But these types of situations caused amenorrhea, as long as the diseases cured, is naturally menstrual cramps.

(2) under paragraph reproductive tract atresia. Such as the cervix, vagina, the hymen, labia minora and other places, some of the congenital atresia, or the day after tomorrow injury caused adhesion atresia, although menstruation, but blood can not drain. This situation called hidden or false amenorrhea. Under paragraph reproductive tract atresia, a doctor after treatment, it is fully cured.

(3) The Secretary does not sound genital mutilation or stunted. Some congenital absence of ovary, ovarian or bad to infertility, ovarian Qi or bad, can not produce estrogen and progesterone, endometrial not be the cyclical changes, it will not appear endometrial shedding, so there will be no menstrual cramps. Some congenital absence of uterus, or endometrial dysplasia, or endometrium injury, even if healthy ovarian function, estrogen and progesterone secretion of normal, nor to menstruation.

(4) TB uterine mucositis. This is due to tuberculosis invasive endometriosis, endometrial inflammation, and are subject to different degrees of damage, last seen scar tissue, and cause amenorrhea. Therefore, had tuberculosis uterine mucositis, it should be timely treatment can not be delayed.

(5) the hypothalamus or pituitary function is not normal. Secreting pituitary gonadotropin. Gonadotropin ovarian function with the adjustment and maintenance of the role of menstruation. If the pituitary dysfunction, it will affect gonadotropin secretion into the effects of ovarian function, normal ovarian function will not cause amenorrhea. In addition, the hypothalamus is not normal function will lead to amenorrhea. Hypothalamic dysfunction caused for many reasons, such as mental stimulation, sadness anxiety, fear unrest, tension exertion, as well as environmental changes, such as cold stimulation.

If it is found that amenorrhea, it should be timely to go to the hospital to identify the causes and symptomatic treatment, the general will be satisfied with the results. Not shy away from the problem. Otherwise, the longer amenorrhea, uterine contraction will be more powerful therapeutic effect it worse. Adolescent women amenorrhea can cure the problem, depending on the reasons for the amenorrhea. For example, adolescent secondary amenorrhea, the majority of hydrocarbons by environmental change, emotional volatility and changes in body weight, remove these causes, menstruation can gradually resume. Amenorrhea illness caused by a few, such as polycystic ovary syndrome, thyroid dysfunction, tuberculosis Jundeng After treatment, menstrual can resume. But some amenorrhea can not be cured, such as birth no uterus, uterine endometrium has been too small or damaged due to disease causes such as amenorrhea, is not curable. No matter what the situation amenorrhea, should check. Even for the amenorrhea can not be cured, but also will check the identification of the recent impact.

Generally speaking, women amenorrhea can not be cured, can be the future of marriage, fertility is not in finding the time to the other side to make it clear that in the full understanding and trust on the basis of marriage, even if no children, also is happy .

How to prevent pre-SARS

Menstrual adolescent girls to a lack of experience, clearly has to be omen menstrual cramps, but do not know their own, so that in the coming period, caught unprepared, or that the illness itself.

Menstrual cramps before the emergence of some discomfort phenomenon, you will be told to menstruation. As many young girls in a few days before menstrual cramps will be the development of emotional fluctuations, irritability, insomnia, headaches and swelling, and other card-shaped, menstrual cramps, these symptoms will gradually reduce to or disappeared. Medicine such phenomenon is known as Premenstrual tension syndrome. So this girl is high on premenstrual tension syndrome, with all estrogen / progesterone increase of the ratio of the body or too much estrogen relative excessive, resulting in a Shuinazhuliu face edema, headache and other symptoms. In addition, the peacetime emotional tension, impatience, depression-prone people in the pre-tension syndrome. This menstrual discomfort usually not before the tide began to 7-14 days, 2-3 days ago in via increased performance for mental tension, nervousness, irritability irritability or depression, malaise, fatigue, insomnia, headache, thinking not concentrated, such as memory decline. Some people can also hand, foot and facial swelling, abdominal Zhuichan, such as pain and breast pain. These psychiatric symptoms and Shuinazhuliu symptoms, menstrual cramps disappeared or reduced significantly after. How to prevent the occurrence of pre-tension syndrome? First to lift the spirit of the tensions and ideological burden, frankly treatment of menstrual cramps, try to comfort, relax.

In daily life to avoid unnecessary to stimulate the spirit of diet Shaoyan, a law of life, take part in more cultural and sports activities, so that symptoms can be reduced significantly or even disappear. For more serious symptoms can be under the guidance of a doctor, taking the Palestinian properly benzene or sedative drugs, such as progesterone and androgen such as therapy.

Premenstrual Stress how control?

In a pre-menstrual irritability, irritability, insomnia and other symptoms, and then disappeared in the menstrual cycle, called Premenstrual tension levy. Such symptoms more common in women over 35 years of age, or with infertility, menstrual disorder patients. Only a few patients severe symptoms, the impact of work and life. 　　

Premenstrual tension patients, usually in the pre-menstrual cramps 7 ~ ~ symptoms began 14 days, the former 2 ~ 3 days increased after symptoms via reduced significantly or completely disappeared. Common symptoms of mental tension, nervousness, irritability irritability or depression, general weakness, fatigue, insomnia, headache, ideology is not concentration. Some patients in hand, feet, face swelling. Edema and abdominal and visceral abdominal Zhangmen a sense of gastrointestinal mucosal edema diarrhoea or soft it, pelvic edema Zhuichan or pain in the lower abdomen, breast edema and pain. When edema obviously increased the weight of many. 　　

Premenstrual Tension caused by the reasons for the levy is not very clear, may be feeling tense, unhappy with the spirit of factors or liver disease and retention of water and salt in the body. 　　

Laoyijiege attention before menstruation, to avoid undue tension on the spirit, eat less salt, and reduce the symptoms can be prevented. If there edema symptoms can be 10 days before or menstrual symptoms after oral urine thiadiazole dihydrochloride grams daily 25 ~ 50 mg, or daily oral Triamterene neopterin 100 ~ 200 mg, until menstrual cramps. Attention to the service even after 5 diuretics should be combined with potassium chloride. Sedative drugs can be served, such as the Rumi 0.03 grams each, three times per day or 10 mg per Limianning daily 2 ~ 3 times per night serving 0.2 ~ 0.4 g Mian Seoul-can oryzanol each ~ 10 ~ 20 mg three times a day, even for 1 ~ ~ 2, a function of the autonomic regulation; menstrual cramps beginning 10 days before oral lithium carbonate, 0.3 grams per day 3 , until only menstrual cramps, the excitement of the central nervous system change, and promote water salinization Xie, a certain therapeutic effect. Sex hormones and vitamin A in the starting 14 days before taking until menstrual cramps. 　　

“The pre-stress disorder”

Some women in the pre-recurring mental stress, depression, anxiety, irritability, mood indifferent, insomnia, breast pain and a series of expansion of physical and mental symptoms, thus affecting the normal daily life and study, work, and medicine to this situation called Premenstrual syndrome.

Premenstrual syndrome the most common in the 30 to 40-year-old women of childbearing age. Typical of Premenstrual syndrome in the previous week, the symptoms gradually worsened and menstrual cramps to 2-3 days before the worst menstrual cramps after suddenly disappear. Some patients symptoms persist for quite a long time until after the beginning of menstruation 3-4 genius completely disappear. Premenstrual syndrome from the women’s bodies are often multiple symptoms, with serious psychiatric symptoms, including anxiety majority, accounting for 70% to 100%. 60% of the Premenstrual syndrome patients have breast pain or weight gain, 45% to 50% of patients with hypoglycemia in shape and about 35% of patients had symptoms of depression, and with suicide awareness. Premenstrual syndrome cause is not yet very clear, and the general view is that endocrine, brain neurotransmitter, prostaglandin role and the lack of vitamin B6, and some other factors. Beijing Friendship Hospital director of obstetrics and gynecology physicians Lin Li suggested that vast numbers of patients, the clinical manifestations of Premenstrual Syndrome diversity, different gravity, targeting different patients need for the different treatment. After actively correct diagnosis and treatment by the vast majority of patients with symptoms of premenstrual syndrome may have markedly improved, thus enhancing the quality of life.

First is the spirit of comfort. Doctors will be under the patient’s symptoms characteristic of the design personality of the psychological and behavioral therapy designed to help patients with psychological adjustment of status.

In addition, under the guidance of doctors in the use of some prescription drugs, the patients successfully through this period. Depressive symptoms such as selection of antidepressant drugs - Prozac; obvious anxiety and irritability of the premenstrual syndrome patients to choose tranquilizers; bulging breast pain, headaches, dysmenorrhea, in the second half of back pain and general discomfort, pain symptoms Selection of prostaglandin inhibitor such.

Thirdly, the structure of a reasonable diet will help to relieve symptoms. It should be noted maintain adequate intake of vitamins and trace elements, such as vitamin B6, vitamin E intake of high carbohydrate low-protein diet can be improved by the spirit of premenstrual syndrome symptoms. Poor diet can increase the symptoms, therefore, the premenstrual syndrome patients should limit of salt, and avoid or reduce caffeine intake, etc..

Fourth, to the families of patients with cyclical attack understanding of the disease, the law and expected onset time, understanding and tolerance in the early misconduct, and to assist adjusted before the family activities, reduce environmental stimulation, so that patients and the control to reduce errors minimum.

The differential diagnosis of polycystic ovary syndrome

PCOS should pay attention to the cause amenorrhea, hirsutism and other diseases ovarian increase of identification:
A masculine ovarian tumor
Including support for a stromal cell tumors, tumor cell door, lipid cell tumor, and blastoma, traces of adrenal tumors, luteal tumors, and metastatic cancer teratoma. In addition to the above of blastoma, the other sustained tumor growth substantive unilateral tumor, androgen secretion was autonomy, masculine obvious symptoms, and accompanied ascites and metastasis.
Second, adrenal diseases
Including congenital adrenal hyperplasia, adenoma and carcinoma. After two major secreted Androstenedione and DHEA, also independent of secretion from ACTH to promote and dexamethasone suppression. And congenital adrenal hyperplasia, 21 hydroxylase deficiency, a typical genital - urogenital sinus malformation with Xingqi stunted.
Third, thyroid disease
Including hypothyroidism and hyperthyroidism. Hyperthyroidism, T3, T4, SHBG increased androgen metabolic clearance rate decreased by increased plasma testosterone masculine and menstrual disorders. A low, androgen into estrogen to increase by no ovulation.
Fourth, genetic hirsutism
A family history, only simple hirsutism without PCOS symptoms and signs. Normal fertility.
5, ovarian theca cell hyperplasia (ovarian hyperthecosis)
The gonadotropin secretion of normal ovarian not increased, but theca cells were nest (Island) hyperplasia, plasma androgen increased significantly, with serious masculine. Di chloro phenol in the treatment of non-sensitive.
6, insulin Jugang syndrome and melanoma acanthoma
As a fat Island receptor defects diseases (A / B), there will be similar to the PCOS symptoms and signs. Its significant feature is that hyperinsulinemia and neck, axilla melanoma acanthoma.
7. Hyperprolactinemia
Amenorrhea, Yiru, infertility, PRL and DHEAS increased masculine not obvious symptoms, ovarian normal.

Polycystic ovary syndrome insulin resistance

Polycystic ovary syndrome (PCOS) is a common female reproductive function disorders, mainly as ovarian androgen excess and without ovulation, the incidence rate for women of childbearing age 5% to 10% [1]. In addition, patients with PCOS also abnormal glucose metabolism is reflected mainly in insulin resistance (IR) and compensatory hyperinsulinemia, IGT also account for the incidence of women of reproductive age, 10% [1]. PCOS is on the IR on basic and clinical research for a progress review.
1, insulin and the role of IR
(1) the mechanism of the role of insulin
Human insulin is the most important metabolic hormones, is the only hypoglycemic hormone. The biological effects of insulin is regulated glucose metabolism and lipid metabolism, but also through the regulation of gene transcription and protein synthesis, and further affect the corresponding organ function, and its receptor by the distribution of the organ. Insulin receptor structure containing the two α and β subunit, connected by disulfide Chain Bridge. Α subunit in the cell, the β subunit containing extracellular part of the transmembrane and intracellular part. Of these, the β subunit of the cell membrane, including near, control and C-terminal region. Α subunit molecular combination with insulin, through its own variable configuration, allowing β subunit autophosphorylation of amino acid residues, and further phosphorylation of the enzyme reaction within the cell substrate, such as insulin receptor substrate, etc.. And insulin receptor binding, the transmembrane signal transmission. Insulin receptor autophosphorylation of the role is one of activated insulin receptor substrate-2 and P-3 ester (PI-3) kinase, through a series of glucose to glucose transport carrier protein-4 from cells in the storage pool and translocation to the cell membrane fusion, greatly speeded up glucose from the extracellular to intracellular membrane transport processes, for the completion of the biological function of the cells to provide energy, such as PI-3; insulin receptor itself phosphorus acidification bis is to enable the insulin receptor substrate 1 and mitogen activated protein (MAP) kinase phosphorylation, affect gene regulation and protein synthesis of various enzymes, insulin adjustment to achieve the cells with special functions, such as MAP channels. These two signaling pathways, and the tyrosine residues in the phosphorylation of its effects.
(2) IR glucose regulation compensatory and decompensated
IR means of in vivo physiological levels of insulin for organs, tissues and cells absorb and utilize glucose effectiveness of a decline in metabolism. The maintenance of normal blood glucose is the body regulating glucose metabolism in a state of equilibrium signs. IR to the development of the body from high blood sugar is the basic process: IR state, mainly muscle tissue such as the insulin-mediated glucose uptake efficiency decline, in order to avoid the resulting high blood glucose, pancreatic B cells formed compensatory high blood insulin disease, the long-term maintenance of normal blood glucose when IR continue to worsen, insulin secretion of pancreatic B cells of a decline in consumption, to a certain extent, because fat tissue IR lead to the release of free fatty acids into the blood significant increase in free fatty acids not only further aggravate insulin-mediated glucose uptake barriers, and more importantly, the increase in free fatty acids into the liver to stimulate the liver free fatty acid oxidation and sugar vary hygiene, cause liver glucose synthesis (HGP) and the release of increased levels of blood sugar because no compensatory hyperinsulinemia and maintain normal blood glucose Since then suddenly increased. IR state in the body maintain normal blood sugar compensatory process more lengthy, and free fatty acids increased the IR glucose discompensation process more quickly. IR state of high blood sugar once, on the one hand to absorb glucose impaired peripheral tissue glucose absolute increase in inflows, on the other hand lost relatively normal blood glucose levels, leading to overt diabetes. Hyperinsulinemia is under IR insulin regulation of glucose metabolism is still in the decompensated stage of the signs.
Second, the IR PCOS patients
(A) The clinical characteristics of IR
IR and hyperinsulinemia PCOS is abnormal glucose metabolism in patients with the basic characteristics of obesity in patients with hyperinsulinemia rate of about 75 per cent, instead of obese patients has reached more than 30%. PCOS patients with obesity accounting for 50% to 75% so that the PCOS patients IGT total incidence of 20% to 40% [1]. PCOS patients with the clinical characteristics of IR [2]: (1) obesity and obese patients do not their age and weight matching compared to the control group both IR and hyperinsulinemia, but obesity significantly increased IR. (2) in patients with different racial differences in the clinical manifestations, but it is common characteristics of IR. (3) reproductive dysfunction in patients with different degrees, IR varying degrees. Menstrual thin hair and no ovulation in patients with serious IR normal part of menstruation and ovulation patients; IR-obese patients in the non-obese patients, reproductive dysfunction also focus on non-obese patients. (4) adolescent patients often for the first performance of IR and hyperinsulinemia, and after the performance of androgen excess and without ovulation, and other reproductive dysfunction, IR and reproductive dysfunction in time there are priorities. Over the past 20 years, numerous studies confirm that the IR PCOS middle-level IR, insulin-mediated glucose uptake decreased the effectiveness of 35% to 40% [3].
(B) the occurrence of IR
PCOS patients IR mechanism is very complicated and may involve insulin regulation of glucose synthesis, transport, use, storage and metabolic degradation, the process of multiple organs, such as the pancreas, liver, muscle and fat, etc.. (1) B of insulin dysfunction. Mainly in fasting glucose tolerance and insulin concentrations after the insulin response was significantly higher than the corresponding concentration of the control group [4]. Insulin secretion of pancreatic B cells in vivo and hyperthyroidism neuropeptide substance offset to a certain extent [5]. Further study found that intravenous glucose load, the concentration of insulin response to peripheral tissue insulin sensitivity was significantly lower than the corresponding decline in the case of normal women, PCOS patients with impaired glucose tolerance after hyperinsulinemia did not reach the level of peripheral insulin resistance caused substituting compensation should have a high degree of the increase, the B cells to produce insulin response was slow [3]. PCOS patients with pancreatic B-cell dysfunction of this particularity and whether obesity and IGT irrelevant. (2) IR liver. HGP performance for the synthesis and insulin metabolism remove decline, and whether the obesity-related PCOS patients, the absence of such abnormalities in obese patients [4]. HGP body IR to accelerate the increase in state regulation of blood glucose discompensation, resulting in high blood glucose and type 2 diabetes [3]. Removal of the liver metabolism of insulin decreased obesity is increasing PCOS IR and hyperinsulinemia one mechanism [4]. (3) peripheral tissue IR. This is mainly to the muscle, fat, and other organizations within the insulin receptor phosphorylation of abnormal insulin signal transduction pathway to the defect. Phosphorus acid amide analysis found that about 50 percent of women with PCOS skin adipocyte insulin receptor on the basis of phosphorylation of increase, and the insulin receptor-mediated phosphorylation of further weakening. And the former receptor serine residues has been the increase in the number of phosphorylation, and the latter on the insulin receptor-mediated tyrosine residues can reduce the number of phosphorylation [3]. Experimental confirmed, serine phosphorylation of insulin receptor is an increase in the number of insulin signal transduction in the termination of information. About 30 per cent of the IR PCOS patients with insulin receptor phosphorylation of the foundation and the role of the insulin receptor-mediated phosphorylation of further are normal, these patients may be related to the subsequent IR signal transduction related defects [1]. In addition, the PCOS patients with glucose fatty membrane carrier protein-4 decline, which is a primary factor, or secondary to receptor signal transduction is not clear obstacles to [6]. Evidently, serine phosphorylation of insulin receptor tyrosine phosphorylation of increasing decline in PCOS peripheral tissue is the main features of IR. (4) the role of androgen. IR androgen major impact on the performance of insulin in the liver and peripheral tissue removal inhibit degradation, but also in the human androgen to use insulin-mediated glucose uptake by 1 / 3, drug and surgical treatment of PCOS of androgen excess, improve hyperinsulinemia and IR [7,8]. PCOS related to the IR and androgen excess has yet to clarify the relationship between, but is likely between the casual relationship. However, androgen-induced IR relatively minor [1,7].
Third, IR PCOS patients on the impact of reproductive dysfunction
(1) hyperinsulinemia cause of androgen excess
1. Direct role: that hyperinsulinemia through insulin receptor, a direct role in the ovarian follicle cells, and cause functional androgen excess. This may be follicular membrane polysaccharide inositol-mediated activity of cytochrome P450C17 increase progesterone accelerate cells into 17 α-hydroxy progesterone and 17 α-hydroxy progesterone further into Androstenedione testosterone and the process [9 ], cytochrome P450C17 increase in enzyme activity, phosphorylation of serine residues role in the [10]. Hyperinsulinemia on normal ovarian androgen synthesis of the above there is no similar role in ovarian This indicates that PCOS enzyme cytochrome P450C17 imbalance is inherent defects in women with PCOS.
2. Indirect role: that hyperinsulinemia increasing disharmony pituitary gonadotropin secretion indirectly involved in ovarian androgen excess formation. PCOS patients with pituitary dysfunction of the important characteristics, luteinizing hormone (LH) levels elevated pulse. As for the changes in pulse frequency no unanimity. Clinical gonadotropin-releasing hormone agonist (GnRH-a) down regulation of pituitary LH release, hyperinsulinemia still exist, but treatable ovarian androgen excess, indicating that LH PCOS patients with insulin for ovarian androgen-mediated excessive still play a decisive role.
3. Increased bioavailability: hyperinsulinemia inhibit liver synthesis sex hormone-binding globulin (SHBG), resulting in increased levels of free sex hormones, the body of sex hormones increased bioavailability. Currently, peripheral blood SHBG is a reflection of the level of human hyperinsulinemia and IR degree of biochemical markers [11].
4. Adrenal factors: About 50% of PCOS patients dehydroepiandrosterone sulfate (DHEA-S) concentration, suggesting that the adrenal gland with PCOS related to androgen excess. PCOS patients with elevated DHEA-S mechanism are: (1) adjusted its adrenal androgen synthesis cytochrome P450C17 activity, as the enzyme in ovarian tissue, in the role of hyperinsulinemia under increased [10] (2) GnRH-a PCOS treatment of ovarian androgen excess, and DHEA-S were also down, from the men and women change surgery for patients with androgen treatment, increased levels of DHEA-S; Instead, the men changed woman for surgery Patients receiving estrogen treatment, levels of DHEA-S dropped. This suggested that ovarian androgen excess could induce adrenal androgen excess, or ovarian - adrenal interaction [12]. In short, PCOS of androgen excess insulin is the main role in ovarian LH synergies within the theca cell results.
(B) hyperinsulinemia and the relationship between follicle development obstacles
Obstacles to the development of ovarian follicles within and without ovulation is reproductive dysfunction in PCOS patients Another feature. Normal ovarian follicle development experience within the collection, selection, and the advantage of a series of physiological processes, such as ovulation. PCOS patients with follicular development performance is the basic obstacle to raising the number of follicles more choice and advantages of follicular disrupted follicular development stagnation and without ovulation occurred. Current evidence suggests that follicular development obstacles and hyperinsulinemia in the follicular granulosa cell function in the. Frank Research Group and other relevant reference Lucker ovulation in mammals model, and in accordance with human follicular development of the regulation, analog PCOS follicular development obstacles mathematical model, reached the following conclusions: (1) anovulatory women with PCOS is not the mechanism of ovarian or pituitary itself, but mainly with the corresponding single ovarian follicles on the high sensitivity of the gonadotropin. (2) the development of abnormal follicles fate of the former may, in its non-sinus gonadotropin sensitive stage already doomed. (3) high sensitivity gonadotropin follicles may be too much to granulosa cells of estradiol (E2) [13]. For follicular phase pituitary follicle stimulating hormone (FSH) secretion in the E2 strictly negative feedback regulation, and LH is not the case [3]. E2 excessive decline in the level of FSH, not induced by the normal follicular development, abnormal follicle also interfere with the normal follicular development, the advantage of choice blocked follicles. PCOS patients with ovarian tissue in vitro studies suggest that: (1) a single granule cell E2 synthesis is greater than the corresponding normal cells, which no FSH-induced ovulation in patients with granulosa cell E2 synthesis in normal cells is 6 ~ 10 times (2) particle The cells were cultured insulin, the hormone-induced LH synthesis reaction of the greatly increased (3) by insulin in vitro follicular granulosa cells were treated LH response time was quite obvious in advance, which is normal for the corresponding follicular phase, the PCOS Follicular is “ageing follicle” [14]. Therefore, PCOS raise too many follicles and high insulin sinus preantral follicles increased sensitivity of FSH; granulosa cell E2 and FSH synthesis excessive negative feedback regulation by the decline in the normal follicular choices and advantages of a barrier was too early follicular LH sensitivity plus high levels of LH start follicular granulosa cell proliferation in the end, sex hormone synthesis increased, follicle growth and stagnation that occurred without ovulation [11, 13]. In addition, the following clinical signs tips hyperinsulinemia and ovarian cystic changes in the formation of more than [15]: (1) adolescent women IR and hyperinsulinemia formed, it was polycystic ovarian change is a common ultrasonographic signs; (2) Insulin can be coordinated human chorionic gonadotropin induced ovulation and no animal model of polycystic ovary (3) ovarian follicles was more of the women also have changed hyperinsulinemia, and ovarian volume and increased positive related. Polycystic ovarian change is the high insulin caused PCOS obstacles to the development of ovarian follicles in a morphologic features. In short, the follicle PCOS is the main obstacle to the development of insulin synergistic role in granulosa cells FSH results. From the functional point of view, hyperinsulinemia PCOS on the reproductive dysfunction from the role of gonadotropin-[3].
4, IR PCOS patients on the impact of metabolic abnormalities
PCOS patients with metabolic disorders have the following main aspects: (1) hyperinsulinemia and IGT [5]. Patients with low glucose tolerance by the general fertility rate was four times the women, obesity increased in patients with abnormal glucose metabolism. PCOS patients with hyperinsulinemia IR is the body under the state regulation of blood glucose decompensated stage, and that stage to reduce obesity, PCOS patients with diabetes incidence increased by seven times the normal population, the incidence early hours of the past 30 years [1]. (2) dyslipidemia [16]. Mainly in the peripheral blood triglycerides and low-density lipoprotein cholesterol levels rise, high-density lipoprotein level decreased. In addition, apolipoprotein A-1 and lipoprotein (a) also abnormal. Obesity to dyslipidemia become more obvious. (3) abnormal cardiovascular system [3]. The following points: ① elevated systolic blood pressure, were seen mainly in obese patients with hyperinsulinemia level was positively correlated; ② artery wall plaque formation, and hyperinsulinemia directly related to blood plasminogen activator ③ inhibitory factor-1 concentration, which is coronary heart disease (CHD) in an independent risk factor (4) aortic blood flow velocity drop zone. PCOS patients over the cardiovascular system changes with the normal postmenopausal women similar to the cardiovascular system changes. From the cycle perspective, the PCOS patients of childbearing age had advanced aging. Normal postmenopausal women’s cardiovascular system changes and the lack of estrogen. Long-term follow-up study found that PCOS patients with diabetes and the incidence of hypertension increased, but did not increase the incidence of CHD, which too many women with PCOS and the protective effect of estrogen-related [17]. Reaven [18] and the recent IR related metabolic disorders such as metabolic syndrome, diabetes, hypertension and CHD IR’s long-term complications such as metabolic complications. IR state, the performance of the PCOS patients with metabolic disorders, insulin adjustment reflects the actual body glucose, protein and fat compensatory function from becoming discompensation process.
5, the treatment of women with PCOS IR
Over the past 20 years, insulin resistance and compensatory hyperinsulinemia has been gradually were considered PCOS patients with abnormal glucose metabolism and reproductive dysfunction pathological basis, not only for the treatment of patients with PCOS IR provide a theoretical basis, as well as the treatment of PCOS opened up a new area. PCOS is the short-term therapeutic purposes treatment of metabolic syndrome, and improve reproductive function is the purpose of long-term metabolic complications of treatment is to improve the means of IR, reduce compensatory hyperinsulinemia. Type 2 diabetes treatment to control blood glucose levels and delayed complications occur, there are various means of hypoglycemic agents and insulin added. There are similarities between the two treatment, but different purpose. Therefore, diabetes treatment is not suitable for the treatment of patients with PCOS IR.
1. Diet, exercise and weight loss. This is the treatment of PCOS patients IR basic measures. Patients weight down 7% to 15% can improve IR and IGT improved, and some recovery in patients with spontaneous menstruation, pregnancy and ovulation. Some diet can be difficult for patients to consider appetite inhibitor.
2. Inhibition of pancreatic insulin secretion. Diazoxide (diazoxide) and somatostatin analogues - octreotide passed on pancreatic B cells play α-adrenergic and somatostatin, direct inhibition of insulin release. Experimental research has shown that this can reduce PCOS patients with hyperinsulinemia, and reduced androgen levels. Because the two drugs can directly increase IGT, the dominant induced diabetes, the patients are not applicable to the day-to-day IR treatment [11].
3. Insulin performance enhancer. Including dimethyl double Chat (metformin), and troglitazone (trogli-tazone), respectively Shuanggualei (biguanides) and Thiazolidinediones (thiazolidinedione) hypoglycemic agents. Dimethyl dual role of the Chat: ① inhibiting intestinal absorption of glucose; ② lower HGP synthesis; ③ such as the increase in muscle tissue insulin sensitivity; ④ on insulin secretion of pancreatic B cells is not directly [19]. Troglitazone mechanism: ① direct increase in muscle and adipose tissue insulin sensitivity, reduce compensatory hyperinsulinemia; ② increased liver on insulin sensitivity, the HGP synthesis decreased [20]. Two completely different for the two types of agents, the former mainly to reduce HGP synthesis, the latter to improve peripheral insulin sensitivity-based organizations. Therefore, the pathogenesis, troglitazone than double Chat dimethyl seems to be more suitable for the treatment of patients with PCOS IR. Two performance enhancer insulin treatment PCOS patients have the following effects [19,20]: ① lower fasting glucose tolerance and insulin concentrations after the insulin reaction concentration; ② SHBG increased blood concentration of 0.4 to 2 times that of free testosterone decline ③ pituitary LH basis of concentration and GnRH-stimulated response to a decreased concentration; ④ ovarian 17 α-hydroxy progesterone concentration and the basis of GnRH-stimulated response to a decline in concentration; ⑤ about 40% to 50% of the patients resume menstrual cramps rules, a small number of spontaneous ovulation and pregnancy; ⑥ of IGT and dyslipidemia also reverse effect. Among them, two-dimethoxy were the daily dose of 1500 to 1700 mg, 2 to 6 months; troglitazone daily dose of 200 to 400 mg, 3 months.
4. Other hypoglycemic agents. Acarbose (acar-bose) for the α-glucosidase inhibitor, and by inhibiting the small intestine single-chain decomposition of starch to glucose, glucose effectively retard the absorption in the small intestine. PCOS patients can be tested, and 150 to 300 mg per day [17]. Hypoglycemic agents for sulfonylurea stimulate insulin secretion, increasing hyperinsulinemia, banned for PCOS patients [11]. Type 2 diabetes, hypertension and hyperlipidemia is a metabolic complications IR, the treatment of these diseases is different from the corresponding incidence of treatment is to avoid the use of induced or exacerbated IR and IGT drugs, such as β-adrenergic receptor resistance Lag agents, large doses of niacin and diuretics Tiaozhi medicine [11]. Once IR development of diabetic complications, the deal with the same simple type 2 diabetes.

Misunderstandings polycystic ovary syndrome

Occra Executive Chairman of the European Association of obstetrics and gynecology professor pointed out: For the girls of GW, once diagnosed with polycystic ovary syndrome, can take birth control pills to maintain normal levels of hormone in the body.

PCOS is common female endocrine disorders and abnormal glucose metabolism syndrome pathogenesis is not yet confirmed. Study found that the abnormal metabolism and insulin, women in the high male hormone, insulin and obesity in women is the high pathogenic reasons. PCOS start puberty, reproductive performance for the period Irregular Menstruation, infertility, obesity and more hair. To the elderly, there will be hypertension, diabetes, cardiovascular disease and even endometrial cancer. Europe and the United States for more than obese women, a higher incidence rate in Asia. PCOS presence of her daughter, genetic tendency, if not normal menstrual mother, daughter should be concerned about whether it is normal, and in the early days of hormone in the body to the hospital to check whether it is normal. If not normal, under the guidance of a doctor to increase contraceptive use in the estrogen. In China, there are many mothers feel Shisansi-year-old daughter to use contraceptives is an incredible thing, in fact need not worry that it will not bring about the physical hazards. In Europe, clinicians will be proposed early girls with PCOS until she has been taking the pill for birth marriage.

PCOS is not only more hair, abdominal obesity, his face has acne, and a quarter of the infertile women will happen after marriage, but insisted medication, 80 percent of the people will be pregnant. Because it will trigger high blood pressure, diabetes, cardiovascular disease and endometrial cancer, not only for the purpose of treatment to fertility, even if Shengguohaizi should be active after the treatment. In addition to drug treatment, through campaigns to reduce weight can reduce the occurrence of the disease.

Occra professor said that many women even clinician awareness of PCOS unclear, leading to lack of timely and effective treatment. Some women frequented beauty salons or dermatologist solution of GW, the face of the acne problem, and not to obstetrics and gynecology, endocrine examinations, it is very wrong.

Beware of young women polycystic ovary syndrome

Obese women with abnormal menstrual we should pay attention to, experts recently warned that, if you do not have feasting and drinking and indulge also unable to control obesity, menstrual and months to come or simply a amenorrhea, but also many small-acne, then you there may have been suffering from polycystic ovary syndrome.

Second Hospital of Guangzhou Zhongshan Hospital South Professor of Obstetrics and Gynaecology said Chen Geng Sheng, polycystic ovary syndrome and the occurrence of hormone imbalance in the metabolism, from the female puberty, the long-term existence of follicular development obstacles, follicular envelope thickening, resulting not from the follicle, accumulation Hormone induced metabolic disorders, such as infertility caused adverse consequences.

Often long attention should be paid to small acne

According to Professor Chen Geng Sheng, polycystic ovary syndrome is common in adolescence and the reproductive age women, menstruation is the law, period of 3 to 6 months or a year from the minority of excessive menstrual bleeding or irregular. Polycystic ovary syndrome patients often small-acne, mainly in the face, breasts around, such as lower abdomen. In addition, the androgen stimulation, Ye Mao, pubic hair, limbs, hair growth, more than the gross rate of 17% to 18%, while the incidence of acne while 60 per cent. What upset the beautiful girl is suffering from the disease, Because of the occurrence of obesity and polycystic ovary syndrome existence of the occurrence and development of the role of mutual promotion.

Professor Chen Geng Sheng said that although women with polycystic ovary syndrome often love with the young girls, but had no fear of this disease. Pay attention to diet, lower body weight, physical exercise, proper diet control are necessary, symptomatic of drug use can often relieve symptoms. If the Health and children, then in laparoscopic surgery to remove or under, or punctured by small follicle estrogen levels can be changed to promote ovulation and smooth pregnancy.

Vigilance polycystic ovary syndrome

Q: I am 20 years old this year, the last two years to every 2-4 months to once menstruation, the number of diagnosed as polycystic ovary syndrome. I would like to know what harm polycystic ovary syndrome, the need for surgery?

Answer: Polycystic ovary syndrome is the most common gynecological diseases of the endocrine, it is the main clinical manifestations of menstrual scarce or amenorrhea. In addition, patients with polycystic ovarian syndrome also often obesity, hirsutism and acne, and other clinical manifestations.

Shanghai first maternal and infant health LI Ru Chi Hospital physicians said that women with polycystic ovary syndrome most notable characteristic is no ovulation. In the absence of ovulation, so only ovarian secretion of estrogen and androgen, without secretion of progesterone. Estrogen stimulates uterine endometrial hyperplasia. And progesterone secretion in the endometrial response. If the endometrium by the long-term role of estrogen without progestin role will be in endometrial hyperplasia and endometrial cancer. In addition, because of ovulation in polycystic ovary syndrome patients can not, so they are not able to natural pregnancy, women with polycystic ovary syndrome is the most common infertility patients.

Kaohsiung hormone hyperlipidemia polycystic ovary syndrome is another important feature. Polycystic ovary syndrome ovarian androgen secretion of a large number of so that they appear excessive androgen performance, including a long beard, pubic hair too much, too much, such as acne. These women may adversely affect the appearance.

In recent years, also found that many women with polycystic ovary syndrome patients hyperinsulinemia, hyperinsulinemia patients prone to diabetes and cardio-cerebral vascular diseases, diabetes and polycystic ovary syndrome is cardio-cerebral-vascular disease risk factors.

Polycystic ovary syndrome is the hypothalamus - pituitary - ovarian axis dysfunction caused by organic diseases do not belong. Therefore, under normal circumstances does not require surgery.