Polycystic ovary syndrome (PCOS)
PCOS (Syndroma ovariorum polycysticarum) requires a comprehensive approach depending on the patient's pregnancy plans.
- Ovulation induction: Clomifene is prescribed at 100 mg from cycle days 5 to 10. In case of resistance, gonadotropins are used.
- Medical treatment without pregnancy plans: Combined oral contraceptives (e.g., Diane-35) lower androgens and protect the endometrium. The antiandrogenic effect is enhanced with cyproterone or spironolactone.
- Surgical treatment: Endoscopic methods (wedge resection, cauterization, vaporization) reduce the volume of androgen-secreting tissue and are effective in the typical form.
- Oncological vigilance: High risk of endometrial cancer requires hysteroscopy with fractional diagnostic curettage.
Resistant and depleted ovary syndromes
These conditions are characterized by premature decline of reproductive function in young women:
- Resistant ovary syndrome (ROS): Occurs in women under 35. Manifests as amenorrhea, infertility, and high gonadotropins with normal ovarian size containing follicles. Pregnancy is possible only via IVF with a donor egg.
- Premature ovarian failure (POF): Develops in women under 38 against the background of follicular apparatus deficiency. Accompanied by secondary amenorrhea, vasoneurotic symptoms, and severe hypoestrogenism. Hormone replacement therapy is indicated.
Adrenal amenorrhea
Adrenal dysfunction leads to menstrual disorders via excessive production of androgens and glucocorticoids.
- Cushing's disease-like syndrome: Characterized by moon facies, dysplastic obesity, striae, and arterial hypertension due to glucocorticoid excess.
- Adrenogenital syndrome (AGS): Congenital adrenal hyperplasia due to $C_{21}$-hydroxylase enzyme deficiency. The classical form presents as pseudohermaphroditism in newborns, while the non-classical form manifests at an older age under stress or pregnancy.
PCOS means COCs, early menopause (POF/ROS) means HRT, and the adrenals (AGS) are associated with enzyme deficiencies and virilization.
Class and exam questions
What are the goals of medical therapy for PCOS in the absence of pregnancy plans?
The goals of therapy are to restore the menstrual cycle, treat hirsutism, prevent long-term complications, and improve the patient's quality of life.
What is the main difference between resistant ovary syndrome and premature ovarian failure?
In ROS, the follicular apparatus in the ovaries is preserved, and gonadotropins are high, but the receptors do not respond to them. In POF, follicles are completely absent, and the ovaries are shrunken and depleted.
What is the primary enzymatic defect underlying adrenogenital syndrome?
The disease is caused by a congenital deficiency of the $C_{21}$-hydroxylase enzyme, leading to decreased cortisol production and compensatory enhancement of androgen synthesis.
What else to study on this topic
- Mechanisms of ovarian hyperstimulation syndrome (OHSS) development during medical stimulation
- Histological picture of the ovarian biopsy in resistant ovary syndrome
- Features of ectopic ACTH syndrome in tumors of other organs
- The role of autoimmune processes in the development of ovarian pathology
- Differential diagnosis of various forms of ovarian and adrenal hyperandrogenism
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