How to treat ovarian sclerocystosis after removal of the uterus. Persistent corpus luteum (Corpus luteus persistens)

Date: 29.06.2020

Ovarian sclerosis is expressed in the fact that their epithelial tissue, primarily its highly organized glandular cells, as well as other tissues are replaced by the simplest connective tissue (fibrous). The latter gradually thickens and very slowly (months and even years) lends itself to resorption. In old mares in severe and very neglected cases, with insufficient feeding, the sclerosis () of the ovaries is not at all amenable to resorption.

Sclerosis is complete, general, if the entire ovary is involved in the painful process, and partial, local, focal, if individual parts of the ovary are affected. The cause of sclerosis is mainly microbial and toxic inflammatory processes (acute and chronic oophoritis), which spread to the ovary from the apex of the uterine horns. The tops of the horns are affected as a result of acute purulent inflammation of the uterus and horns most often after severe complicated childbirth, retention of the placenta, infectious abortion, dirty mating or artificial insemination, etc.

The main direct clinical sign of ovarian sclerosis is a very strong general or partial compaction. The ovaries become wooden, as it were, while normally they are densely elastic.

With a general lesion with sclerosis, the ovary completely loses its main function - to produce follicles and eggs; with partial damage, this function is impaired, and the more so, the greater the volume of cirrhotic areas.

The diagnosis of ovarian sclerosis is established only by rectal examination.

Complete sclerosis of both ovaries is rare in mares. Most often it occurs in old mares. Partial sclerosis of one or both ovaries is not uncommon in mares.

The prognosis for complete cirrhosis of both ovaries in old mares is hopeless or almost hopeless. With partial cirrhosis of both ovaries, the prognosis is the worse, the more significant the lesion and the older the mare. With partial cirrhosis of one ovary, the prognosis is favorable. According to our observations, in mares, the left ovary is much more active than the right ovary in relation to sexual function. The development and maturation of the follicle in the left ovary occurs much more often (by 20-30%) than in the right. We have no data to explain this observation. In practical work, when assessing the fertility of mares, of which the right ovary is affected by a painful process in one, and the left ovary in the other, we give preference to the second.

Sclerosis (cirrhosis) of the ovaries is chronic and very long-lasting, many months and even years. We know of a case when a mare (purebred Arabian under the nickname Pletka, Tersk stud farm) with severe (almost complete) cirrhosis of both ovaries for five years in a row had no sexual cycles and follicle formation. Only at the 6th year in one of her ovaries, after significant resorption of fibrous tissue, a follicle developed, the mare fertilized and foaled normally. Often, severe cirrhosis of both ovaries is a direct cause of mares' bachelorhood for 2-3 years in a row. During this time, fibrous tissue is significantly absorbed. in the ovaries, after which the sexual cycle and fruitful activity of the mare are restored.

Treatment of severe and chronic sclerosis of both ovaries in old mares takes a long time and does not always give the desired result. It is advisable to discard very old mares with complete or severe cirrhosis of both ovaries from the fruit composition and use in work, which, under normal conditions of feeding, keeping and excretion, accelerates the processes of resorption of fibrous tissue. Mares with ovarian cirrhosis first of all need to be provided with normal daily work (under the saddle, and preferably in a harness), proper maintenance and feeding.

In addition, vigorous massage of the ovaries through the rectum is required. The duration of each procedure is 3-5 minutes. Massage every other day, for 10-20 days or more (course), depending on the defeat of the ovaries by cirrhosis.

To massage the ovaries, the hand is inserted into the rectum. The diseased ovary is grasped in a handful, brought to the abdominal inguinal wall or to the middle of the ilium and squeezed with short interruptions, in addition, the crumbs of the fingers are pressed on its entire surface. Compression and pressure should be significant, but not excessive, so as not to injure the rectal mucosa.

The resorption of fibrous tissue in the ovaries is promoted by diathermy.

As for organopreparations (ovariolysate) and hormone preparations (ovaricrin, etc.), they do not always have a positive effect when the ovaries are severely affected by cirrhosis. In addition, both drugs are relatively expensive. Therefore, we recommend using them only for breeding, especially valuable mares with not old and not very pronounced ovarian cirrhosis and always in combination with work and massage. Polyanol has not justified itself in our practice with severe ovarian damage. With this disease, there is a reason to use tissue therapy in all forms, that is, in the form of infusions (see the book by Academician Filatov "Optical corneal transplantation and tissue therapy", the book by G. Ye.

"Tissue therapy", Rostov-Don, 1950; article Nesterenko 3. M. "Tissue therapy in veterinary medical practice", the journal "Veterinary" No. 2, 1951); in the form of subcutaneous injections (see the article by N. I. Kobyakova "Experience in the use of tissue therapy for mastitis and eye diseases in animals", the journal "Veterinary" No. 8, 1951); in the form of biogenic stimulants in aqueous solution (in ampoules) prepared synthetically by the method of Acad. Filatova (fibs preparation of the Odessa Chemical-Pharmaceutical Plant). The use of tissue therapy enhances the processes of resorption of diseased tissues and promotes the regeneration of healthy cells and tissues.

Prevention of sclerosis (cirrhosis), as well as acute and chronic inflammation of the ovaries, consists in observing the rules of veterinary sanitation and zoohygiene when foaling, mating and keeping mares.

In order to understand what ovarian sclerocystosis is, it is worth considering the etiology, pathogenesis and diagnostic methods. The pathology affects the gonads (ovaries) of a woman. As a result, there are unwanted complications that worsen the course and prognosis of the disease.

In simple words, ovarian sclerocystosis is a change in the structure of the epididymis, so that the follicles are filled with liquid content and grow in size. Usually the volume of one formation does not exceed 10 mm. Visually looks like a bunch of grapes. The serous membrane over the elevations is compacted and has a gray-white color.

Based on the data of morphological, cytological and hormonal studies of patients, sclerocystic ovaries - have a direct connection with a dyshormonal disorder caused by a decrease in female sex hormones - estrogens.

In domestic sources, the term Stein-Leventhal syndrome is widely used, named after a medical worker who described the clinical and morphological characteristics of pathology.

Reasons for development

The etiological factor of ovarian sclerocystosis is often difficult to determine, there is a combined effect on the woman's body. The psycho-emotional state with regular stress and emotional stress is of great importance. There is a change in the ratio of female and male sex hormones with a predominance of androgens.

Ovarian sclerocystosis is formed mainly at a young age. Cases of the disease were recorded in girls of puberty with the appearance of the first menstruation - menarche. Such cases are classified as genetically determined, and are diagnosed in the closest relatives in the family on the female line.

Such an increase in the level of male hormones is accompanied by the development of insulin resistance and diabetes mellitus. The early manifestations are nonspecific and the pathology is discovered by chance, after which the classic symptoms of endocrinopathy join.

Main reasons:

Chronic extragenital focus of infection without proper therapy: tonsillitis, sinusitis, pharyngitis.
Chronic gynecological diseases involving the inflammatory focus of the ovaries and fallopian tubes.
Complications after a difficult childbirth process.
Numerous medical and criminal abortions (more than two).
Excess body weight by more than 10% of the total. It is accompanied by changes in metabolic and hormonal reactions at the cellular level.
Disorders of the hypothalamic-pituitary communication. The ovaries are stimulated to produce uncharacteristically high levels of male sex hormones.

One of the theories of the origin of ovarian sclerocystosis in adolescents includes a change in the tropism of stimulating substances. So, instead of the effect of the hormone of the hypothalamus on the gonads, certain parts of the adrenal glands are stimulated (which is called adrenarche in puberty). Initially, secondary sexual characteristics are formed according to the male type, and then replaced by the female type.

Types of sclerocystosis:

According to the mechanism of development, ovarian sclerocystosis is subdivided into:

central;
ovarian;
adrenal.

It is classified as hereditary and acquired by origin.

Symptoms of sclerocystic ovaries

With sclerocystic ovaries, a woman's menstrual cycle is disrupted, the appendages do not fully perform their function. There is marked soreness during menstruation, scanty discharge. Cycle failure with signs of delay or early start.

Over time, amenorrhea occurs, when there are no monthly bloody departments, there is no ovulation of a mature egg, and the follicles, in turn, increase. During the period of amenorrhea, acyclic bleeding and even uterine bleeding are observed. This condition is combined with infertility.

With a moderate and severe course of the disease, there are symptoms of masculinization with the appearance of male-type hair, coarsening of the voice. The growth of hair follicles is activated along the edge of the areola of the nipple, along the midline of the abdomen below the navel and the chest between the mammary glands. Thick vellus hair appears on the face. Instead of horizontal growth of pubic hair, it forms vertical, like in men.

The work of the sebaceous and sweat glands changes. It is especially noticeable in adolescents and women under 25 years old, when many comedones are visible on the skin of the face, acne and inflamed clogged glandular ducts.

Women complain of a decrease in the volume of the mammary gland, hypertrophy of the clitoris, hair loss in the parietal zone of the head, fat deposition in the chest and abdomen.

Even with a normal balanced diet, there is a redistribution of subcutaneous fat with a tendency to obesity. The general condition worsens due to an increase in blood glucose levels: dizziness, malaise, weakness, thirst, frequent urge to urinate, dry mouth.

Methods for diagnosing sclerocystosis

An important place is occupied by timely access to medical care and diagnosis of ovarian sclerocystosis. Gynecologists note a favorable prognosis with early detection of the disease and quickly started therapy.

Hardware diagnostic techniques:

A woman can independently determine the phase of the menstrual cycle by measuring the basal temperature. In the morning, without getting out of bed, the tip of a thermometer is inserted into the rectum for 3-5 minutes. With sclerocystic ovaries, there will be no ovulatory temperature changes.

Laboratory research:

Assessment of the hormonal profile - hyperandrogenism, hypoestrogenism. Determination of active substances of the thyroid gland, adrenal glands, pituitary gland.
Analysis of glucose tolerance, determination of blood sugar levels.
Colpocytogram (smear) and scraping of the endometrium - one-phase of the menstrual cycle with the absence of an ovulatory phase.
Analysis of a smear for vaginal sterility and pathogenic microflora.
Biopsy of the obtained biological material as a result of curettage and laparoscopy.

Undoubtedly, mandatory tests are carried out with the determination of indicators of the clinical and biochemical composition of the blood, a general analysis of urine, the Wasserman reaction (diagnosis of syphilis).

Treatment of ovarian sclerocystosis

To improve the general condition and reduce body weight, it is desirable to correct the lifestyle and nutrition. A decrease in body mass index is possible with an individually selected diet from a nutritionist (reduction diet without fasting), with regular physical exertion, which has a positive effect on tissue sensitivity to insulin (increases), with the use of hypoglycemic drugs: metformin (Glucophage, Siofor), thiazolidinediones (Glutazone, Avandia).

Therapeutic treatment of ovarian sclerocystosis:

The absence of pregnancy against the background of ovarian sclerocystosis can be eliminated by taking hormonal agents. As a basic treatment, a woman is prescribed the following types of drugs:

antiandrogenic - lowering the male hormone androgen: cyproterone acetate (Androkur), oral contraceptives (Jess, Yasmin), Flutamide (Flutan), Finasteride with increased testosterone;
estrogen-gestagenic: Logest, Triziston, Microlut;
combined: Mirelle, Minisiston.

The dose, frequency of admission and the duration of the course is determined strictly by the attending gynecologist. In addition, in addition to gynecological and hormonal medications, agents are prescribed that correct extragenital pathologies.

Sometimes therapeutic treatment does not work, which is most often associated with hardening and hardening of the gonadal membrane, so that the mature egg cannot ovulate. In such a situation, an operation is indicated.

Surgical treatment of sclerocystosis:

In women of reproductive age, predominantly organ-preserving low-traumatic surgical treatment is performed. Selection method -.

Types of operations:

wedge resection - excision of the tissue of the epididymis in the form of a wedge with the base outward;
decortication - partial elimination of a dense sclerosed shell (electropuncture, perforation);
a combination of wedge resection and decortication;
demodulation - removal of the middle part of the gonad.

Total and subtotal oophorectomy is indicated for suspected malignancy.

Pregnancy with ovarian sclerocystosis

With adequate therapy, it is possible that pregnancy occurs with sclerocystic disease. In combination with the ongoing therapy, ovulation inducers are prescribed: Clomiphene, hCG injections (Pregnil, Profazi), follicle-stimulating hormone (Merional, Menogon).

The following is considered predictive and favorable:

thickening of the endometrium of the uterus;
restoration of menstruation;
cyclical hormonal fluctuations;
changes in follicles according to the phase of the menstrual cycle.

Fertilization of a mature egg after therapeutic treatment, possibly after 3-4 months, after surgery - after 6-7 months.

Complications in case of untimely treatment of pathology

The dominant undesirable complication of women of reproductive age is amenorrhea, acyclic bleeding, infertility. Even if the patient is in the perimenopausal period and some symptoms disappear, the following may join:

development and progression of type 2 diabetes mellitus;
hypercholesterolemia;
an increase in the parameters of low and very low density lipoproteins, as a result, atherosclerotic lesions of the vessels of the heart, brain and other organs;
malignancy (endometrial cancer, ovarian cancer).

Based on statistical data, it is important to conduct an examination in a timely manner and visit a gynecologist at least once a year.

Disease prevention

Primary preventive- Measures of sclerocystic disease are aimed at preventing the development of the disease and include maintaining a healthy lifestyle, balanced fractional meals, maintaining personal hygiene, limiting physical and emotional stress, as well as regular examination by a gynecologist. It is advisable to plan pregnancy in order to avoid abortion, wear clothes for the season, not hypothermia, give up bad habits, avoid casual sexual intercourse and frequent change of sexual partners. To exclude sexually transmitted infections, use a condom before intercourse.

Secondary prevention - sclerocystic disease implies timely treatment of the existing disease. It is recommended to follow the primary prevention algorithm, as well as undergo instrumental and laboratory examinations, and take medications prescribed by a gynecologist.

Ovarian sclerocystosis- a disease of the female reproductive system, leading to menstrual irregularities and infertility. With the help of hardware and laboratory techniques, it is well visualized and diagnosed. Treatment is prescribed only by a profiling specialist, taking into account complaints and examination results: gynecologist, endocrinologist, immunologist, geneticist.

One of the most common pathological processes that develops due to endocrine disorders is ovarian sclerocystosis. The disease affects 12% of women of reproductive age. According to statistics, most of the problems with conception in women are caused precisely by ovarian sclerocystosis.

Definition of pathology

Sclerocystosis is a pathological process that affects both ovaries. As a result of the changes, there is a thickening of the outer protein membrane and the formation of cysts on the surface of the organ. These cystic formations are classified as follicular.
With scleropolycystic ovaries, a large number of follicular cysts are formed, filled with a light liquid. At the same time, the number of mature follicles decreases. This leads to the proliferation of stromal tissues and an increase in the size of the organ. Such metamorphoses make ovulation impossible. In addition, against the background of such changes, a woman may develop hyperplasia of the body of the uterus.
The main factor in the development of pathology is a violation of the functionality of the endocrine system. An increased content of male sex hormones (hyperandrogenism) and a decreased content of female estrogens are the main factors influencing the onset of a pathological process. That is why it is very important to undergo a preventive examination once a year, as well as to pass all the necessary tests in order to notice the onset of degenerative changes in a woman's body in time.

According to one theory, sclerocystic disease develops against the background of insulin resistance (a pathology in which there is no insulin sensitivity). Against the background of this disease, there is a violation in the functionality of the endocrine gland. Experts note that diabetes mellitus is one of the predisposing factors for the development of ovarian sclerocystosis. Therefore, it is important to keep track of your blood sugar levels.

It is not recommended to ignore the symptoms of the disease. Sclerocystic disease is not a passing disease, but a chronic ailment that causes persistent and, in some cases, irreversible changes. Launched sclerocystosis of the appendages provokes disturbances in the metabolic system, and also combines not only endocrine disorders, but also somatic pathological conditions.
Unfortunately, there is no complete cure for sclerocystosis, but various medications are widely used in medical practice, correcting and compensating for the symptoms that the patient already has. A positive result of treatment is the woman's ability to become pregnant after therapy.
Stein-Leventhal syndrome, and this is the name that ovarian sclerosis has, was first mentioned in 1935 by American gynecologists.

Causes and types of sclerocystosis

There are two types of sclerocystic ovary syndrome: acquired and hereditary. Such a pathology usually occurs in girls during puberty and in young women who have not yet had time to become mothers. The disease can develop with multiple cysts, as well as with enlarged or shrunken ovaries. The surface of paired organs in both cases is covered with a specific dense membrane, under which cystic follicular neoplasms are visible.
Modern gynecology and reproductive medicine do not name factors that have an absolute influence on the occurrence of pathology.
The causes of ovarian sclerocystosis can be:

The factor of heredity. In this case, the predominant place is given to enzyme deficiency with additional impairment of the functionality of specific hydrogenases and dehydrogenases. These substances are actively involved in the production of steroid hormones. As a result of such violations and deviations in work, the transition of male androgens to female hormones estrogens is significantly reduced. Such internal changes in hormonal metabolism entail disruptions in the work of insulin receptors, leading to a significant decrease in the sensitivity of insulin-dependent cells.
Chronic infections. Quite often, the cause of the development of ovarian sclerocystosis is not inflammation in the appendages, but neuroendocrine disorders with a change in the functionality of the ovaries. Some medical sources have drawn a link between the development of sclerocystosis in women and chronic inflammation of the tonsils.
Complicated labor, abortion, oophoritis, salpingitis, endometritis.
Excess weight arises not only as a result of disturbances in the work of the hormonal system, but can also be a factor predisposing to the appearance of sclerocystosis.
Malfunctions of the hypothalamus and pituitary gland entail disturbances at the ovarian level. The main causes of failures are hypothalamic and diencephalic syndromes. This type of change is rare in patients and is not dangerous.
Pathological changes in the adrenal cortex. There is an assumption that under the action of specific hormonal substances produced by the pituitary gland, not the ovaries, but the adrenal glands begin to be stimulated. According to the hypothesis, this occurs during puberty.

Read also Primary symptoms and causes of a bicameral ovarian cyst

The psychological factor also plays an important role in the development of ovarian sclerocystosis. Against the background of changes in the neuroendocrine part, an imbalance in the connections between various organs of the endocrine system is possible.

Symptoms

The main symptom of a malfunction in the reproductive system and
the reason to see a doctor is a violation in the menstrual cycle. With the development of Stein-Leventhal syndrome, there are violations in the regularity of critical days with a pronounced tendency to delays of an uneven type. From time to time, spotting may occur between menstrual bleeding. The basic symptoms of the development of ovarian sclerocystosis are:

Changes in the functioning of the reproductive system (menstrual irregularities). Inability to conceive a child.
Manifestations of an increased content of androgens of a general nature, expressed in the appearance of seborrhea, acne, increased male pattern of hair growth. With the development of pathology, the proportions of the woman's body begin to change, and hypoplasia of the mammary glands is also noted.
Impaired insulin sensitivity.
Pain during ovulation.
Propensity for rapid weight gain and obesity.

With violations in hormonal regulation, there is a decrease in the manifestations of secondary female sex characteristics. In a woman, the size of the mammary glands decreases, and the timbre of the voice changes to a lower one. In some cases, an increase in the size of the clitoris is noted.

The most intense symptoms of ovarian sclerocystosis are observed in girls aged 20-25 years.

Almost all patients with diagnosed ovarian sclerocystosis have increased male-pattern hair growth in various parts of the body. The presence of vellus hair can be noted on the face, back, areolae of the chest and along the white line of the abdomen.

Complications in case of untimely treatment of pathology

Complications of ovarian sclerocystosis lie not only in problems with the reproduction of offspring. So, in patients with Stein-Leventhal syndrome, a set of hormones inherent in the male sex is formed. As a result of such changes, there is a risk of arterial hypertension and systemic atherosclerosis.
The likelihood of developing problems in the cardiovascular system increases.
A change in glucose sensitivity suggests the onset of type 2 diabetes mellitus. Changes of a critical nature occur in those women who have diseases of the endocrine system, there is a sharp decrease or weight gain. Insulin resistance and diabetes are not always diagnosed at the same time. This can be the result of disturbances in the microcirculation of the limbs and the brain.

Ovarian sclerocystic disease does not cause cancer and does not threaten the patient's life. But the presence of pathology increases the risk of developing malignant neoplasms. The most likely pathology is endometrial cancer, since the mucous membrane of the genital organ is considered hormone-dependent. In addition, ovarian sclerocystic disease leads to infertility.

Some patients with Stein-Leventhal syndrome also have inflammation in the walls of the uterus. But there is no scientific evidence that ovarian sclerocystosis leads to endometriosis.

Methods for diagnosing sclerocystosis

The main criteria for the diagnosis of ovarian sclerocystosis is an increase in the size and density of the ovaries, which is confirmed by clinical signs and laboratory tests. The research plan includes:

gynecological examination;
a range of tests to determine the level of hormones in the body;
insulin resistance test;

Ultrasound diagnostics is aimed at measuring the utero-ovarian index and confirming the presence of pathological changes in the tunica albuginea of the ovary. In addition to ultrasound diagnostics, X-ray examination is widely used, as well as computed tomography, magnetic resonance imaging and laparoscopy. The latter type of research is used not only for diagnosis, but also for the treatment of pathology.
In most clinical cases, such a study is sufficient to establish the correct diagnosis. Additional techniques are:

measurement of basal temperature indicators;
determination of the level of ketosteroids in urine;
specific tests with follicle-stimulating hormone;
specific tests with progesterone.

Read also How does a cyst of the left ovary manifest itself?

In the process of infertility treatment, specific studies are carried out aimed at assessing the functional characteristics of the endometrium. The specialist performs special diagnostic curettage or targeted biopsy.

Differential diagnosis

It is important to distinguish Stein-Leventhal syndrome in a timely manner from other ailments, which proceed with similar symptoms. The examination should, first of all, be aimed at excluding the increased proliferation of the adrenal cortex in adrenogenital syndrome. In addition, diagnostic studies are carried out in order to exclude Itsenko-Cushing's disease, hormone-dependent tumors, ovarian tekomatosis, as well as diseases affecting the thyroid gland.
The final diagnosis is made on the basis of the following symptoms:

the age of the appearance of the first menstruation is 12-13 years;
disruptions in the cycle of menstruation from the onset of the first bleeding as oligomenorrhea;
absence of menstruation for a long period;
obesity from the onset of puberty in most patients with ovarian sclerocystosis;
infertility of the primary type - the absence of pregnancy for one year with regular sexual activity without the use of contraception;
chronic anovulation - the constant absence of mature eggs;
an increase in the total size of the ovaries according to transvaginal echographic studies;
an increase in the total number of luteinizing hormone and the ratio of LH to FSH by more than 2.5 times.

What is the Difference Between Sclerocystic and Polycystic

Many patients do not understand the difference between these diseases. Indeed, in part, these pathologies are similar, they both cause female infertility. But there are a number of factors that make it possible to distinguish between diseases.
It should be noted that polycystic disease often causes nervous shocks and stress. With an excess of prolactin (stress hormone), the maturation of the egg is blocked. Against this background, there is a multiple accumulation of follicles that do not reach ovulation. Ultimately, the follicles degenerate into small cysts, which reach a size of 1.5-2 cm. Against the background of their formation, the production of estradiol (female hormone) increases, which, in excess, is reborn into testosterone.
The development of sclerocystic disease occurs due to the formation of a dense and tough membrane on the ovaries, which blocks the movement of the follicles and prevents ovulation. In addition, it causes the accumulation of follicles, provoking the production of estradiol, which is further transformed into testosterone.
In addition, these diseases differ in symptomatology. Polycystic disease is accompanied by the following manifestations:

overweight;
hirsutism - increased male pattern of hair growth. Hair grows mainly on the abdomen, lower back and sacrum;
the appearance of acne and acne;
hair loss on the head (alopecia).

With sclerocystic disease, the symptoms are somewhat different:

slight increase in body weight;
the appearance of a small amount of hair in the nasolabial area;
increased sex drive.

Moreover, these diseases require different treatments. For women with polycystic disease, a drug is prescribed to block prolactin production. And also a woman needs hormone therapy, which promotes the gradual resorption of accumulated follicles.
Patients with sclerocystic disease require laparoscopy with cauterization of excess follicles.

Treatment of ovarian sclerocystosis

Treatment methods for ovarian sclerocystosis do not depend on the cause,
but from the symptoms accompanying the disease. When a patient is clearly obese, doctors recommend to reduce body weight with the help of a special diet. Do not go to extremes and starve. It is very important to get physical activity while following a diet. This approach in the treatment of ovarian sclerocystosis will enhance the sensitivity of tissue structures to insulin.
Doctors are trying to strengthen the effectiveness of conservative treatment with the help of
medicinal drugs based on metformin and glitazones. These drugs belong to the group of insulin sensitizers, and they should be taken strictly as directed by the attending physician. During therapy, it is mandatory to pass tests for glucose tolerance. Therapy of sclerocystosis is carried out in a comprehensive manner in consultation with an endocrinologist.
A decrease in body mass index helps to remove the severity of disorders in the endocrine system. Pathological stimulation of the pituitary gland is reduced, thus increasing the effectiveness of treatment with hormonal drugs. The main treatment involves the appointment of various combinations of antiandrogenic drugs. The treatment regimen is selected individually, based on the characteristics of the patient's body.
Treatment of ovarian sclerocystosis with folk remedies is not effective.
But at the initial stages, preparations based on medicinal plants have a pronounced effect as part of complex therapy with hormonal drugs.
Sometimes it is impossible to cure the pathology without surgical intervention. This is due to the fact that hormonal drugs do not affect the dense sclerosed membrane in any way. In this case, the patient needs an operation to reduce the size of the ovary to normal.

Ovarian cystosis refers to a gynecological, endocrine disease in which the formation of a large number of small cysts leads to an enlargement of the ovaries. An impermeable membrane forms on the surface of the ovaries. Most often, two ovaries are reborn at once. Sclerocystic disease leads not only to structural disruption, but also to serious problems with the functionality of the ovaries. A woman does not ovulate, it is also observed (there are more male sex hormones than female).

Is it possible to get pregnant with ovarian sclerocystosis? To preserve the reproductive function, a special operation is performed, in modern medicine there are several of them. Whether a woman recovers or not will depend on the individual characteristics of the female body. As statistics show, a woman with ovarian sclerocystosis is most often infertile.

Reasons for development

Until now, in clinical practice, there are no unambiguous reasons for the development of sclerocystosis. There are only theories. A widespread theory is that the secretion of a special hormone is impaired, which is responsible for the stimulation or follicular production of luteinizing hormones. It is this hormone that regulates the menstrual cycle in a woman.

Some researchers believe that the main cause of sclerocystosis is the increased production of follicle-stimulating hormone, which is produced by the pituitary gland. It is this hormone that is responsible for the number of follicles in the ovary; it must burst in the middle of the cycle and release an egg. When there is a lot of follicle-stimulating hormone, a large number of follicles with an immature egg begins to appear. They are filled with liquid and covered with a dense shell.

To date, the hereditary factor is significant in the diagnosis of sclerocystosis. It is important to find out the cause of the pathology in a timely manner, because it leads to women. Girls at puberty, as well as nulliparous women, are at risk of getting sick.

Symptoms

The disease can manifest itself for the first time, anytime. If sclerocystosis develops in girls, then there are problems with the menstrual cycle. It doesn't come at all or your period starts too late.

The main symptom in women is the absence of menstruation for a long time. Girls may experience bleeding. Often a girl does not even know about such a pathology at home, but when she starts planning a pregnancy, she learns about sclerocystic disease. First, the gynecologist can diagnose primary anovulatory infertility due to the absence of ovulation.

With ovarian sclerocystosis, it occurs, which is manifested by increased hair growth in places typical for men.

Quite often, a woman with sclerocystic disease is overweight. In some women, a concomitant disease is fibrocystic mastopathy, in which the mammary glands are affected. The disease develops because the woman has a constantly high level of estrogen.

With sclerocystosis, androgens are produced in excess. A woman must be additionally assigned:

Lipidogram, with which you can learn about fat metabolism in the body.
Dyslipidemia shows whether cholesterol metabolism is impaired or not.

Treatment methods

Today there are several methods of treating the disease:

Conservative methods (hormone intake).
Surgical methods are used as a last resort.

Finally, the doctor makes a diagnosis after interviewing the patient, his interested in such questions :

At what age did the first menstruation appear.
There were disruptions in the menstrual cycle (delay of more than 40 days).
Does the woman suffer from hirsutism.
Have there been any cases of pregnancy during regular sex life?

Also, the gynecologist pays attention when ovulation is constantly absent. After ultrasound of the vagina, it is seen that the ovaries are significantly enlarged. In the analyzes, the concentration of luteinizing hormone is increased. With the help of conservative treatment methods, you can restore the ovulatory cycle.

Recovery that accompanies obesity

A woman should adhere to a diet for a while. She will have to completely abandon spicy, salty. Also, do not get carried away with liquid, no more than 2 liters of purified water. It is important to exercise daily.
Taking special medications so that the tissues perceive insulin normally. One of the best is Metformin, which is used for 6 months.
Medication stimulation of ovulation. Clomiphene is most often prescribed for 5 days. If the drug does not work, Menogon may be administered intravenously to the woman. Horagon is an effective hormonal agent.

After the completed course of hormone therapy, the doctor must prescribe a blood test, ultrasound. The dynamics can be traced using biochemical blood tests.

If hormone therapy is ineffective, the woman needs surgery. In modern medicine, 2 types of surgery are used:

Laparotomy, in which an incision is made in the anterior abdominal wall.
Laparoscopy consists in the fact that with the help of a laparoscopic instrument through a small hole, the formation on the ovaries is removed. During this operation, all information is displayed on the monitor, so the doctor can control the entire process.

Additionally, wedge-shaped resection can be used, with its help it is possible to reduce the volume of the ovarian stroma, restore the required level of hormones and the size of the organ.

Cauterization is a quick and gentle operation. With its help, the stroma are completely destroyed by acting on them with an electrode. Within a year, a woman can recover and become pregnant.

Thus, it is very important to timely diagnose ovarian sclerocystosis and start treatment in order to prevent the development of infertility.

Scleropolycystic ovary disease is a polyendocrine gynecological pathology in which menstrual irregularities occur, which is accompanied by the formation of multiple small cysts in the appendages. Moreover, each ovary is in size and "overgrows" with a thick membrane, which makes ovulation impossible.

Deviations are indicated not only by a change in the structure of paired organs, but also by hormonal imbalance, which leads to anovulation and an increase in the amount of male sex hormones.

Views on the etiology of the disease are different. Previously, the opinion was leading that it is caused by disturbances in the cirhorial rhythm of luliberin production. Not so long ago, another approach was proposed, based on the theory of insulin resistance. It is believed that insufficient glucose processing leads to an increase in insulin concentration, as a result of which LH rises and the ovaries increase in size.

Some scientists believe that sclerocystosis is caused by excessive production of FSH by the anterior pituitary gland. This hormone is responsible for the growth of a dominant follicle in the epididymis, from which an egg is released at the time of ovulation. However, an increased amount of FSH leads to the appearance of many immature follicles.

The hereditary nature of the disease was established, which served as an impetus to the search for genetic defects responsible for a complex hormonal disorder. Modern science considers ovarian sclerocystic disease as a multifactorial pathology, in the development of which a leading role is played by a genetic abnormality leading to the triggering of cytochrome P-450 and steroidogenesis in the appendages.

Other causes of pathology are:

chronic infectious diseases accompanied by neuroendocrine disorders;
difficult childbirth, multiple abortions, chronic pathologies in the field of gynecology;
obesity;
diseases of the adrenal glands of a primary nature.

The factors that provoke sclerocystic ovaries are constant stressful situations. However, by themselves, nervous shocks do not lead to a change in the structure of the appendages. They provoke neuroendocrine shifts, which aggravate the existing disorders.

Symptoms of sclerocystic ovaries

Signs of the disease are often found during adolescence. The main manifestation of scleropolycystic disease is a violation of the cycle by the type of oligomenorrhea (when the intervals between menstruation are more than 40 days) or amenorrhea (in the complete absence of menstruation).

In 15% of women, dysfunctional uterine bleeding is observed, that is, not caused by anatomical changes in the internal organs. In this case, spontaneous pregnancy is possible, but the likelihood that this will happen is low. In addition, there is a risk of miscarriage.

Other signs of ovarian sclerocystosis are:

Diagnosis of the disease

The diagnosis of "ovarian sclerocystosis" is made with the following deviations:

untimely start of the cycle;
irregularity or absence of menstruation;
hirsutism;
obesity;
primary infertility;
persistent anovulation;
excess ovaries of normal size (according to ultrasound);
the ratio of LH to FSH is more than 2.5.

To detect the disease, the following are used:

examination on a gynecological chair;
assessment of hormonal levels;
checking insulin resistance;

basal temperature tracking;
diagnostic curettage;
hysteroscopy;
biopsy;
determination of the content of the amount of 17-KC in urine;
tracking ovulation by ultrasound;
CT, MRI,;
dexamethasone test.

Treatment of sclerocystic appendages

Therapeutic tactics are determined by the severity of the disease. If the patient is overweight, diet and moderate exercise are recommended. Additionally, metformin and glitazones are often prescribed. The described activities increase the sensitivity of tissues to insulin and normalize the cycle. In addition, a decrease in body weight reduces the severity of endocrine abnormalities, since subcutaneous adipose tissue is considered the main site of the synthesis of extra-ovarian estrogen.

The treatment is based on estrogen-progestogenic and antiandrogenic medicines. Ideally, therapy is carried out after weight normalization.

Ovarian sclerocystic disease does not always require conservative treatment. Sometimes it does not give positive results, since ovulation is hampered by a dense sclerosed capsule of the epididymis, the condition of which hormonal drugs cannot affect. In this regard, some patients require surgery, in which part of the ovarian tissue is excised, which leads to a decrease in the production of male sex hormones and increases the production of FSH.

Previously, the main type of operation used for sclerocystic appendages was considered. Today it is possible to carry out the following types of manipulations in a laparotomy way:

2/3 paired organs;
a similar sparing operation with the joint intact segments of the appendages;

Treatment with various folk remedies is usually not effective, however, many women use a combination of a boron uterus and a red brush to normalize the cycle.

Sclerocystic ovary syndrome: complications

Since the disease leads to a rearrangement of the hormonal system, a woman has an increased risk of developing arterial hypertension, atherosclerosis, and serious cardiovascular disorders.

Decreased glucose tolerance sometimes provokes acquired diabetes mellitus. Patients with endocrine abnormalities suffering from weight surges are especially susceptible to this pathology.

Scleropolycystic ovary disease is not a precancerous pathology, but it increases the likelihood of developing a malignant endometrial tumor. In extremely rare cases, there is a malignancy of the cystic tissue of the appendages.

Sclerocystic ovaries and pregnancy

A woman suffering from pathology needs to normalize the cycle and recreate the normal thickness of the endometrium. For this purpose, ovulation inducers are used. If the growth of the dominant follicle is observed during therapy, then an ovulatory dose of a hCG-based drug is administered. After 2 days from the moment of the injection, the egg matures.

In practice, conception sometimes occurs after the withdrawal of oral contraceptives. The appendages begin to work actively, and spontaneous ovulation occurs. However, the "undo effect" does not always work.

Scleropolycystic ovary disease and a desired pregnancy are compatible. The operation is performed with the ineffectiveness of hormonal stimulation, a thick ovarian capsule and patients over 30 years old. Pregnancy usually occurs within 3-5 cycles. Further, the excised epididymis membrane is restored, and conception becomes difficult.

If pregnancy does not occur, IVF is used. Indications for it are also the presence of tubal infertility and the inability to conceive a child due to reproductive abnormalities in the health of the woman and her partner.

Ovarian sclerosis in women is an endocrine gynecological pathology, the treatment of which is aimed at normalizing hormonal levels and the functioning of the reproductive system. First of all, conservative therapy is carried out. The operation is performed when it is ineffective.