Approximately five percent of all cases of gynecological diseases are diagnosed by doctors as "ovarian sclerocystosis". Not every woman imagines what it is, so many perceive such a diagnosis as a sentence of infertility. Indeed, about a third of those who have been diagnosed with this pathology cannot have their own children. But the rest have a high chance of being cured and giving birth to a he althy baby.
Sclerocystosis of the ovaries 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 was thoroughly studied, methods for its treatment and diagnosis were developed, but scientists still do not know all the causes of its occurrence.
If you have been given such a disappointing diagnosis and you really want to have children, there is no need to despair. In our article we will try to tell allthe most important thing about ovarian sclerocystosis and how to deal with it.
How he althy ovaries work
To better understand how ovarian sclerocystosis and pregnancy are related, you need to know how these organs are arranged and how they work if there is no pathology in them. The ovaries are female paired reproductive organs. They can be represented as a kind of sacs filled with medulla. The walls of the ovaries are lined with a layer of dense connective tissue; a layer of cortical substance is located 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 approximately one to two million, are laid in the body of each girl at the fetal stage. Throughout life, starting from the period of puberty and ending with the period of menopause, they are gradually consumed, and new ones are no longer formed. Therefore, the hour comes when their supply runs out.
This almost never happens in women of childbearing age, so the absence of follicles cannot be the cause of infertility. Another thing is that sometimes there are failures in their gradual maturation. So they are the culprits of the fact that the desired pregnancy does not occur. Moreover, improper development of follicles in one hundred percent of cases leads to gynecological diseases, without treatment of which women increase the risk of thrombosis, thrombophlebitis, diabetes, heart attack, malignantformations in the mammary glands.
How does an ovarian cyst appear and what does it have to do with pregnancy
When girls become sexually mature, the process of maturation of primary follicles, which until now seem to be sleeping, starts to work in their body. This process is always cyclical. In each cycle, up to about 15 follicles “wake up”. They, under the influence of the hormone FSH produced by the pituitary gland, start growing, increasing in diameter from 50 to 500 microns. During this period, follicular fluid is formed in them, and a cavity appears in the largest of them. This follicle becomes dominant, grows up to 20 millimeters, protrudes. An egg cell develops rapidly inside it. The remaining follicles from the group of "awakened" one by one die and dissolve. If everything goes according to the rules, the endocrine system starts working in the female body. As a result, the hormones estrogen, progestins and androgens are produced, which affect the further maturation of the dominant follicle. Under the action of the luteinizing hormone (luteotropin, lutropin, abbreviated as LH), it ruptures, the egg from it goes into the fallopian tube, and it turns into a corpus luteum and gradually dissolves.
If the rupture does not occur, the unreleased egg is reborn, and an ovarian cyst the size of a cherry appears in place of the follicle. Those of the "awakened" follicles that did not have time to die also turn into cysts, only smaller in size. A cyst formed from a follicle sometimes grows to a significant size (40-60 millimeters), but it can notdo not show. Only in some cases, patients complain of pain in the ovarian region. After a woman's hormone production normalizes, it slowly resolves. If ovulation is restored in a woman, the follicular cyst existing at that time in the ovary does not prevent pregnancy, but if this cyst has grown to a size of 90 millimeters, it must be removed surgically.
Causes of disease
Scientists know in detail how ovarian sclerocystosis is formed. The reasons for this phenomenon have not yet been precisely established, there are only assumptions. Since hormones play an important role in the normal development of the follicle and the release of the egg from it, hormonal disorders, and in particular a failure in the mechanism of estrogen synthesis, are considered the main cause of ovarian sclerocystosis. The following causes of hormonal disorders are called:
- heredity;
- anomalies in the structure of genes;
- disturbances in the pituitary-ovarian system;
- psychic 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 to detect ovarian sclerocystosis in a girl only with the onset of puberty. Symptoms at this stage are blurred and mainly consist of menstrual irregularities. But this phenomenon can have many other reasons, not related toovarian disease, up to poor nutrition and nervous disorders. By the age of twenty, a maximum of twenty-five years, girls have more definite symptoms of ovarian sclerocystosis. The main is still a violation of the cyclicity and nature of menstruation (in 96 percent of patients). More often there are long delays in menstruation (about six months or more) or too small amounts of discharge (hypomenstrual syndrome). Much less often, patients complain about the duration and profusion of menstruation.
Other symptoms suggestive of ovarian sclerocystosis are as follows:
- hirsutism (approximately 90 percent of patients have hair around the nipples, back, abdomen, chin and above the lip);
- overweight (70 percent of patients);
- baldness and acne on the face (occurs in no more than 40 percent of cases);
- some changes in body proportions;
- disturbances in the functioning of the nervous system;
- asthenic syndrome;
- ovarian enlargement (detected by a gynecologist during examination).
In addition, some women may experience symptoms common to many diseases: pain in the lower abdomen, malaise, inexplicably fatigued.
Laboratory studies
Based on external signs, ovarian sclerocystosis is only suspected, and the final diagnosis is made after additional examinations. These are:
- blood test for testosterone (general should be within 1.3 ng / ml, free in women under 41 - within 3.18 ng / ml, andup to 59 years - no more than 2.6 ng / ml);
- analysis for glucose sensitivity, blood sugar and triglycerides;
- colpocytogram (the material is taken from the vagina, the analysis data shows whether or not there is ovulation, as well as the correspondence of the colpocytogram indices to the age of the patient and the phase of her menstrual cycle);
- endometrial scraping (allows to judge dysfunctions in the ovaries);
- monitoring changes in basal body temperature;
- tests for some thyroid, pituitary, ovarian hormones (LH, FSH, PSSH, prolactin, cortisol, 17-hydroxyprogesterone);
- determining the amount of estrogen excretion.
Now, patients can independently conduct a simple test that allows them to suspect cystic ovarian formations. This will require a microscope (can be bought at pharmacies). In the morning, just waking up and not having eaten or drunk anything yet, you need to place a drop of your saliva on a laboratory glass and let it dry. During ovulation, the level of estrogen always rises, which, in turn, changes the composition of saliva. If there is ovulation, the saliva sample under 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 final diagnosis, patients are prescribed a complex examination using medical equipment.
The most gentle and absolutely painless method is ultrasound-diagnosis of ovarian sclerocystosis. The procedure is transabdominal (through the abdomen), transvaginal (the most highly informative method), transrectal (performed only in young girls and older women).
Using ultrasound to determine the size of the ovaries, their shape, structure, the number of follicles in them, the diameter of which is up to 8 mm, the presence or absence of a dominant follicle, the presence or absence of ovulation, the presence of cysts in the ovary.
Another type of examination is a gas pelveogram showing deviations from the normal size of the ovaries and uterus.
One of the most difficult types of diagnostics is laparoscopy. It is performed in a hospital under general anesthesia. The algorithm of the procedure is as follows: the surgeon makes a puncture in the peritoneal wall of the patient and introduces an apparatus that injects carbon dioxide into the patient in order to create volume in the peritoneum and better examine the organs. Next, a laparoscope is inserted into the patient's body, which shows the state of the ovaries on the screen. Laparoscopy is the most accurate diagnostic method, but after it a woman needs a rehabilitation period.
Conservative treatments for ovarian sclerocystosis
After a definitive diagnosis is made, in most cases a woman is given medication first. Its goal is to restore a normal menstrual cycle and resume ovulation. How to treat ovarian sclerocystosis, the gynecologist decides together with the endocrinologist.
If the patient is obese, weight loss is the first step in treatment. womanprescribed diet, feasible exercise.
The second step is to increase insulin uptake. Metformin is prescribed, which must be taken for 3-6 months.
The third stage is the stimulation of ovulation. They begin therapy with the simplest medicine - Clomiphene. The initial course consists in taking the drug at a dose of 50 mg at night, starting from the 5th day of the cycle for 5 days in a row. If there is no result (menstruation), Clomiphene is taken for a month. If the effect is still not obtained, the dose is increased to 150 mg per day.
The next stage (in the absence of positive dynamics) is the appointment of the medicine "Menogon". It is administered intramuscularly, and at the end of the course, injections of "Horagon" are made. "Menogon" can be replaced with "Menodin" or "Menopur".
After completing the entire course, they do blood biochemistry, and based on the results of the analysis (if there is not enough LH hormone), Utrozhestan or Duphaston is prescribed.
In parallel, doctors are trying to remove excess hair from the woman, in connection with which she is prescribed Ovosyston and Metronidazole.
Vitamin therapy is a mandatory addition to the course.
Sclerocystosis of the ovaries: surgical treatment
If ovulation is not observed within three months after drug therapy, the woman is prescribed surgery. It is done in several ways. Which one to use depends on the indication of the condition of the ovaries.
At the present stage, there are the following types of operations:
- cauterization of cysts withlaser;
- demedulation (removal of its middle part in the ovary);
- wedge resection (removal from the ovary of the affected part in the form of a wedge);
- decortication (the doctor removes the transformed protein layer of the ovary, pierces the follicles with a needle and sutures their edges);
- electrocautery (point destruction in the ovary of the area in which too many hormones are produced).
- notches (their surgeon makes them up to 1 cm deep in places where the follicles shine through so that they can release an egg when they mature).
Forecasts
Women who agree to any methods offered by doctors are interested in the only question: is it possible to get pregnant with ovarian sclerocystosis? Statistics show that without treatment, infertility is diagnosed in 90% of cases. Drug therapy with Clomiphene improves ovarian function in 90% of patients, but pregnancy occurs in only 28% of them. True, according to some reports, positive results can reach 80%.
The disadvantage of Clomiphene is that it is effective only at the very beginning of the disease or after surgery as an adjuvant.
Treatment with stronger drugs, such as "Gonadotropin", according to statistics, leads to ovulation in at least 28% of patients, a maximum of 97%. At the same time, from 7 to 65% of women become pregnant.
If ovarian sclerocystosis is treated surgically, positive results are observed at about the same frequency as with conservative therapy. According to statistics, after ovarian surgery, 70-80% of women get a chance to get pregnant.
Reviews
For many women, it becomes a great misfortune to be diagnosed with ovarian sclerocystosis. Patient reviews about treatment are very different. Pills helped someone, surgery helped someone, and someone did not get pregnant, despite any methods taken.
There is also a small proportion of patients reporting pregnancy without treatment at all, although the diagnosis of ovarian sclerocystosis has not been withdrawn. Such contrary results are possible due to the individual characteristics of each person and should not be taken as the norm.
But the majority of women write about the improvement of he alth after treatment in the reviews. Only a few patients report that their periods returned to normal for a short time, after which they again needed to take hormonal drugs.
Finally, there are some reviews in which women note the appearance of prolonged pain in the ovaries and peritoneum after treatment with surgery.
