Polycystic Ovaries (PCOs)
Polycystic ovary syndrome is a complex endocrine and metabolic disorder common to women of childbearing age. It is characterized by chronic anovulation (dysfunction or loss of ovulation) and hyperandrogenism (overproduction of male hormones in women). , The main clinical manifestations are irregular menstrual cycle, infertility, hirsutism and/or acne, which is the most common female endocrine disease.
At present, there are two kinds of non-genetic theories and genetic theories for the etiology of PCOS.
1. PCOS non-genetic theory
Studies suggest that the hormone environment in the uterus during pregnancy affects the endocrine status of the individual after adulthood. Exposure to high concentrations of androgens during pregnancy, such as a history of maternal PCOS, and poor control of high androgen in the mother with congenital adrenal hyperplasia, is prone to ovulation after puberty obstacle.
2. PCOS genetics theory
This theory is mainly based on the fact that PCOS is in the familial grouping, familial ovulation dysfunction and polycystic ovarian changes suggest that the disease has a genetic basis. Hyperandrogenemia and/or hyperinsulinemia may be the genetic characteristics of the same disease in PCOS family members. The effect of insulin on promoting ovarian androgen production is also affected by genetic factors or genetic susceptibility. The prevalence of hyperinsulinemia in women and premature hair loss in men among family members with sparse ovulation, hyperandrogenemia and polycystic ovarian changes is increased. Cytogenetic research results show that PCOS may be X-linked recessive inheritance, autosomal dominant inheritance or polygenic inheritance. Through genome-wide scanning, the largest number of genetic genes related to PCOS were discovered, such as candidate genes for steroid hormone synthesis and related functions, androgen synthesis-related regulatory genes, insulin synthesis-related genes, carbohydrate metabolism and energy balance candidate genes, Candidate genes for gonadotropin function and regulation, adipose tissue-related genes, and chronic inflammation-related genes.
In short, the etiology of PCOS cannot confirm that the disease is caused by a certain gene locus or a certain gene mutation. Its pathogenesis may be related to the occurrence of certain genes under the action of specific environmental factors.
PCOS diagnosed according to the PCOS international diagnostic criteria (see the diagnosis section for details) can be subtyped to facilitate individualized treatment options:
Type 1: Classic PCOS, ultrasound ovarian polycystic changes and clinical manifestations of hyperandrogenism and/or hyperandrogenemia;
Type 2: Ultrasound ovarian polycystic changes and sparse ovulation or anovulation;
Type 3: NIH standard PCOS, clinical manifestations of hyperandrogenism and/or hyperandrogenemia and sparse ovulation or anovulation;
Type 4: It also has ultrasound ovarian polycystic changes, clinical manifestations of hyperandrogenism and/or hyperandrogenism and oligoovulation or anovulation. This type is also known as classic PCOS.
1. Menstrual disorders
PCOS causes anovulation or logorrhea in patients, and about 70% of them have menstrual disorders. The main clinical manifestations are amenorrhea, oligomenorrhea and dysfunctional uterine bleeding, accounting for 70% to 80% of women with abnormal menstruation and 30% of secondary amenorrhea %, accounting for 85% of anovulatory uterine bleeding. Due to ovulation dysfunction and lack of periodic progesterone secretion in PCOS patients, the endometrium is under the stimulation of pure high estrogen for a long time, and the continuous endometrial hyperplasia is prone to simple endometrial hyperplasia, abnormal hyperplasia, and even atypical endometrial hyperplasia And endometrial cancer.
2. High androgen-related clinical manifestations
(1) The number and distribution of hirsutism vary with gender and race. Hirsutism is one of the important manifestations of androgen increase. There are many methods for clinical evaluation of hirsutism. Among them, the evaluation method recommended by the World Health Organization is Ferriman- Gallway hair scoring standard. The phenomenon of hirsutism in PCOS patients in my country is not serious. The results of large-scale community population flow analysis show that mFG scores> 5 can be diagnosed as hirsutism. Excessive sex hair is mainly distributed on the upper lip, lower abdomen and inner thighs.
(2) High androgenic acne PCOS patients are mostly adult female acne, accompanied by rough skin and enlarged pores. Unlike adolescent acne, it has the characteristics of severe symptoms, long duration, stubbornness and difficulty in healing, and poor response to treatment.
(3) Female pattern hair loss (FPA) PCOS begins to lose hair around the age of 20. It mainly occurs on the top of the head, extending forward to the front of the head (but not invading the hairline), and extending back to the back of the head (but not invading the posterior occiput), but the hair on the top of the head is diffusely sparse and falling off. Neither infringes on the hairline nor does bald head occur.
(4) Seborrhea PCOS produces excessive androgens, and hyperandrogenemia occurs, which increases sebum secretion, resulting in excessive oil on the head and face, enlarged pores, slightly red and greasy skin on both sides of the nasolabial fold, and scaly scalp. The scalp is itchy, and the secretion of oil on the chest and back also increases.
(5) Manifestations of virilization are mainly manifested as male-type pubic hair distribution, and generally do not appear obvious manifestations of virilization, such as clitoral hypertrophy, breast atrophy, low voice and other abnormal development of external genitalia. In patients with PCOS, if there are typical virilization manifestations, attention should be paid to distinguishing congenital adrenal hyperplasia, adrenal tumors, and androgen-secreting tumors.
3. Polycystic ovarian changes (PCO)
Although a lot of research has been conducted on the ultrasound diagnostic criteria of PCO, there are still divergent opinions. Coupled with ethnic differences, it is more difficult to unify the diagnostic criteria. The PCO ultrasound standard in Rotterdam in 2003 is that there are more than 12 follicles in unilateral or bilateral ovaries, with a diameter of 2-9mm, and/or ovarian volume (length×width×thickness/2)>10ml. At the same time, it can be manifested as medullary echo enhancement.
(1) Obesity Obesity accounts for 30% to 60% of PCOS patients, and its incidence varies with race and eating habits. In the United States, 50% of women with PCOS are overweight or obese, while there are relatively fewer obese PCOS reports in other countries. The obesity of PCOS is manifested as central obesity (also known as abdominal obesity), and even non-obese PCOS patients also exhibit an increased proportion of perivascular or omental fat distribution.
(2) Infertility Due to ovulation dysfunction, the pregnancy rate of PCOS patients is reduced, and the miscarriage rate is increased, but it is not clear whether the miscarriage rate of PCOS patients is increased or whether the miscarriage is the result of overweight.
(3) Obstructive sleep apnea This problem is common in PCOS patients and cannot be explained by obesity alone. Insulin resistance is more predictive of dyspnea during sleep than age, BMI or circulating testosterone level.
(4) Depression The incidence of depression in PCOS patients increases, which is related to high body mass index and insulin resistance, and the quality of life and sexual satisfaction of patients decrease significantly.
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