Sclerokistoz ovary: what is it, the causes of the onset, symptoms, diagnosis, treatment, consequences

Approximately five percent of all cases of gynecological diseases doctors diagnosed with "sclerokystoz ovaries." What this is, not every woman imagines, so many people perceive such a diagnosis as a sentence of infertility. Indeed, about a third of those who have found this pathology, their children can not have. But the rest have high chances to recover and give birth to a healthy baby.

Osteoarthritis has another name - Stein-Leventhal Syndrome, because it was first described by two American gynecologists - Irving Stein and Michael Leventhal. This happened in 1935. Over the next eighty years, the pathogenesis of the disease has been thoroughly studied, the methods of its treatment and diagnostics have been developed, but until now scientists do not know all the reasons for its occurrence.

If you are given such a disappointing diagnosis and you really want to have children, do not despair. In this article, we will try to tell you the most important thing about the sclerokystosis of ovaries and about the methods that allow it to cope.

How healthy ovaries are arranged

To better understand how ovarian sclerosis and pregnancy are related, you need to know how these organs are arranged and how they work if they do not have pathology. Ovaries are female paired sex organs. They can be represented in the form of original bags filled with brain substance. The walls of the ovaries lining the layer of dense connective tissue, there is a layer of cortical substance on it. It has a complex structure and importance. It is in this layer that follicles are formed - specific structural elements in which eggs develop. Follicles, called primary, in the amount of about one to two million are laid in the body of each girl at the fetal stage. Throughout life, beginning with the period of maturity and ending with the period of menopause, they are gradually consumed, and new ones no longer form. Therefore, the hour comes when their stock ends.

This almost never occurs in women of childbearing age, so the inability of follicles can not be the cause of infertility. Another thing is that in their phased maturation, sometimes failures occur. So they are the culprits of the fact that the desired pregnancy does not occur. Moreover, incorrect development of follicles in one hundred percent of cases leads to gynecological diseases, without treatment of which women are at increased risk of thrombosis, thrombophlebitis, diabetes, infarction, malignant lesions in the mammary glands.

How does the ovarian cyst appear and what does it have to do with pregnancy

When girls become sexually mature, the process of ripening of primary follicles, which until now sleeps, is included in their bodies. This process always takes place cyclically. In each cycle, about 15 follicles "wake up". They, under the action of the hormone FSH, produced by the pituitary gland, start growing, increasing in diameter from 50 to 500 microns. During this period, they form a follicular fluid, and in the largest of them a cavity appears. This follicle becomes dominant, grows up to 20 millimeters, protrudes. Inside, the egg develops rapidly. The remaining follicles from the group of "awakened" one by one die and dissolve. If everything goes according to the rules, the endocrine system is included in the female body. As a result, estrogen hormones, progestins and androgens, which influence the further maturation of the dominant follicle, are produced. Under the influence of the luteinizing hormone (luteotropin, lyutropin, abbreviated LH), it bursts, the egg leaves it into the fallopian tube, and it turns into a yellow body and gradually resolves.

If a rupture does not occur, the unoccupied egg is reborn, and in place of the follicle appears the size of the ovarian cyst cherry. Those of the "awakened" follicles, which did not have time to die, also turn into cysts, only smaller in size. The cyst, formed from the follicle, sometimes grows to a considerable size (40-60 millimeters), but it may not manifest itself in any way. Only in some cases, patients complain of pain in the ovaries. After the woman normalizes the production of hormones, she slowly dissolves. If a woman's ovulation is restored, the follicular cyst presently present in the ovary does not interfere with the occurrence of pregnancy, but if this cyst grows to a size of 90 millimeters, it must be surgically removed.

Causes of the disease

Scientists know in detail how sclerokystosis of ovaries is formed. The reasons for this phenomenon have not yet been clearly established, there are only assumptions. Since hormones play the most important role in the normal development of the follicle and the release of the ovule from it, the main cause of ovarian sclerosis is hormonal disorders, and in particular, a malfunction in the mechanism of the synthesis of estrogens. The following causes of hormonal disorders are called:

• heredity;
• Anomalies in the structure of genes;
• Disorders in the pituitary-ovarian system;
• Mental trauma;
• Complications after abortion;
• Infectious and gynecological diseases;
• Complications after childbirth;
• Changes in the functions of the adrenal cortex.

Clinical symptoms

Unfortunately, it is possible only with the beginning of the maturity period to find a girl with sclerocystosis of the ovaries. Symptoms at this stage are blurred and mainly involve irregularities in the menstrual cycle. But this phenomenon can have many other causes, not related to ovarian disease, down to poor nutrition and nervous disorders. By the age of twenty, to a maximum of twenty-five years, girls have more definite symptoms of sclerocystosis of the ovaries. The main is still a violation of the cycle and the nature of menstruation (in 96 percent of patients). More often there are long delays of the monthly (about six months or more) or too small amounts of secretions (hypomenstrual syndrome). Much less often patients complain of the duration and the profuse of menstruation.

Other symptoms that allow suspected sclerocystosis of the ovaries are:

• Hirsutism (approximately 90 percent of the patients have hair around the area around the nipples, back, abdomen, chin and above the lip);
• Overweight (70 percent of patients);
• Baldness and pimples on the face (occurs in no more than 40 percent of cases);
• Some changes in the proportions of the body;
• Disorders in the work of the nervous system;
• Asthenic syndrome;
• Ovarian enlargement (detected by a gynecologist upon examination).

In addition, some women may have symptoms common to many diseases: pain in the lower abdomen, malaise, inexplicably fast fatigue.

Laboratory research

Based on external signs, ovarian sclerosis is only suspected, and the final diagnosis is made after additional examinations. These are:

• Blood test for testosterone (the total should be within 1.3 ng / ml, free in women under 41 years - within 3.18 ng / ml, and up to 59 years - no more than 2.6 ng / ml);
• An analysis of the susceptibility of glucose, the content of blood sugar and triglycerides;
• Colpositogram (the material is taken from the vagina, the analysis data show whether or not there is ovulation, as well as the correspondence of the colpositogram indices to the age of the patient and the phase of her menstrual cycle);
• Scraping endometrium (allows you to judge the violations of functions in the ovaries);
• Monitoring changes in basal temperature;
• Tests for certain thyroid hormones, pituitary gland, ovaries (LH, FSH, PGS, prolactin, cortisol, 17-hydroxyprogesterone);
• Determination of estrogen excretion.

Now the patients themselves can conduct a simple test, which allows them to suspect cystic ovarian formations. This will require a microscope (you can buy in pharmacies). In the morning, when you wake up and do not eat or drink anything, you need to put a drop of your saliva on the laboratory glass and allow it to dry out. During ovulation, the level of estrogen always rises, which, in turn, changes the composition of the saliva. If there is ovulation, the saliva sample in the microscope will be in the form of fern leaves, and if there is no ovulation, in the form of dots.

Hardware diagnostics

As a rule, for an accurate and definitive diagnosis, patients are prescribed in a complex of examinations with the help of medical equipment.

The most gentle and absolutely painless method is ultrasound diagnosis of ovarian sclerokistoza. The procedure is transabdominal (through the abdomen), transvaginal (the most highly informative method), transrectal (performed only in young girls and elderly women).

With the help of ultrasound determine the size of the ovaries, their shape, structure, the number of follicles in them, whose diameter is up to 8 mm, the presence or absence of the dominant follicle, the presence or absence of ovulation, the presence of cysts in the ovary.

Another type of examination is a gas pelvetogram showing deviations from the norm of the size of the ovaries and uterus.

One of the most difficult types of diagnosis is laparoscopy. It is carried out in a hospital under general anesthesia. The algorithm is as follows: the patient's surgeon makes a perforation of the peritoneal wall and injects the device that pumps carbon dioxide into the body in order to create a volume in the peritoneum and to better examine the organs. Further, a laparoscope is inserted into the patient's body, which shows the status of the ovaries on the screen. Laparoscopy is the most accurate method of diagnosis, but after it a woman needs a rehabilitation period.

Conservative methods of treatment of ovarian sclerocystosis

After the final diagnosis, the woman is prescribed medication in most cases. Its goal is to restore the normal menstrual cycle and resume ovulation. Than to treat a sclerokastoz ovaries, the gynecologist together with the endocrinologist solves.

If a patient has obesity, the first stage of treatment is weight reduction. A woman is prescribed a diet, feasible physical exercises.

The second stage is an increase in the perception of insulin. It is prescribed "Metformin", which should be taken 3-6 months.

The third stage is the stimulation of ovulation. Begin therapy with the simplest medication - Clomiphene. The initial course consists in taking a drug at night 50 mg, starting from the 5th day of the cycle for 5 consecutive days. If there is no result (menstruation), "Clomifen" is taken within a month. If the effect is not obtained, the dose is increased to 150 mg per day.

The next stage (in the absence of positive dynamics) is the prescription of the medicine Menogon. It is injected intramuscularly, and at the end of the course, injections of "Horagon" are made. "Menogon" can be replaced by "Menodine" or "Menopur".

After completing the entire course, blood biochemistry is done, and on the basis of the analysis results (if LH hormone is not enough), appoint "Utrozhestan" or "Dyufaston".

In parallel, doctors are trying to remove the woman from excessive hair, in connection with which she is appointed "Ovosiston" and "Metronidazole".

A compulsory supplement to the course is vitamin therapy.

Osteoarthritis: surgical treatment

If within three months after drug therapy there is no ovulation, a woman is prescribed surgery. It is executed in several ways. Which one to apply depends on the indication of the state of the ovaries.

At the present stage, there are the following types of operations:

• Cauterization of cysts with a laser;
• Demedulation (removal in the ovary of its middle part);
• Wedge resection (removal from the ovary of the affected part in the form of a wedge);
• Decortication (the doctor removes the transformed white layer of the ovary, pierces the follicles with the needle and sutures their edges);
• Electrocautery (point destruction in the ovary of its area in which too many hormones are produced).
• Incisions (their surgeon makes a depth of 1 cm in places where the follicles show through so they can release an egg from them when they are ripe).

Forecasts

Women who agree to any methods offered by doctors are interested in the only question: is it possible to become pregnant with sclerocystosis of the ovaries? Statistics show that, without treatment, infertility is diagnosed in 90% of cases. Drug therapy Clomiphene improves ovarian function in 90% of patients, but pregnancy occurs only in 28% of them. True, according to some reports, positive results can reach as high as 80%.

The lack of the drug "Klomifen" - it is effective only at the very beginning of the disease or after the operation as an auxiliary.

Treatment with stronger drugs, for example, "Gonadotropin", according to statistics, leads to ovulation in at least 28% of patients, a maximum - in 97%. In this case, 7-65% of women become pregnant.

If ovarian sclerosis is treated surgically, positive results are noted with about the same frequency as with conservative therapy. According to statistics, after surgery on the ovaries, 70-80% of women get a chance to get pregnant.

Reviews

For many women, it is a great misfortune to make him diagnosed as "ovarian sclerocystosis." The patients' comments about the treatment are very different. Someone helped pills, someone - an operation, and someone did not get a pregnancy, despite any methods undertaken.

There is also a small proportion of patients reporting a pregnancy in general without treatment, although the diagnosis of "ovarian sclerosis" was not withdrawn. Such opposite results are possible because of the individual characteristics of each person and should not be perceived as a norm.

But the improvement of health after treatment is written in the reviews of most women. Only a few patients report that their normalization of the menstruation has come for a short time, after which they again had to take hormonal preparations.

And finally, there is a part of the reviews, in which women note the appearance of prolonged painful sensations in the ovaries and peritoneum after treatment with the help of surgery.