This medical problem is very relevant: women with diagnosed polycystic ovary syndrome (PCOS) have certain difficulties with the possibility of becoming pregnant. Consider the latest published data on this syndrome in the scientific literature.
Physical activity and rational nutrition vs hormonal drugs
American doctors conducted a study involving 149 women. All patients were divided into equal groups: a group taking pills (hormonal drugs), a group engaged exclusively in lifestyle correction (increasing physical activity, optimizing nutrition) and a group combining both therapeutic methods. The effectiveness of one or another tactic was determined by the onset of pregnancy. After four months, it was found that in the drug therapy group, pregnancy occurred in five out of 49 women, in the “healthy lifestyle” group – in thirteen out of 50 and in the combined treatment group — in twelve out of 50.
It is not difficult to conclude that lifestyle changes greatly contribute to the onset of the desired pregnancy, especially in patients who are overweight or obese. “A healthy diet and regular physical activity increase female fertility,” says Dr. Richard S. Legro.
Modern ideas about the factors of the development of this syndrome
It is known that unhealthy lifestyle (insufficient physical activity, bad habits, overeating) can play a role in the development of this disease. But the determining factor in the etiology of PCOS is genetic disorders. Currently, there is a lot of published data that a violation of the coding of a number of genes plays a role in the development of a particular symptom in PCOS. Geneticists point out that the predisposition to the development of the disease can be transmitted not only on the maternal side, but also on the paternal side: insulin resistance, early baldness, as well as a low concentration of the so-called steroid-binding globulin can be determined in relatives of sick women.
There are more and more reports from researchers about the role of adverse conditions during the prenatal period. The second vulnerable period for the development of metabolic, hormonal and reproductive changes in a woman’s body is the period of puberty. In addition, the importance of vitamin D deficiency in the development of obesity, monthly cycle disorders, insulin resistance and excessive hair loss is actively discussed.
New data on medicines
Medications containing low doses of human hormone analogues have been used and studied for a long time. But the first research review and extensive analysis of the data obtained was conducted relatively recently, in 2014. The review confirms the fact that when taking combined oral contraceptives (COCs), the level of the male sex hormone testosterone decreases. In addition to antiandrogenic properties, when selecting a drug individually, it is necessary to take into account the safety profile. In addition, the components of contraceptives have a certain effect on the indicators of carbohydrate metabolism, this fact also needs to be borne in mind. Only a specialist can choose the optimal contraceptive therapy.
It has been shown that the intake of COCs containing drospirenone (Midiana) by patients in combination with metformin has a beneficial effect on fat, carbohydrate metabolism and the properties of the vascular wall. KOC, which includes chlormadinone (Belara), reduces the risks of complications from the cardiovascular system. Taking oral contraceptives reduces the likelihood of endometrial cancer.
Expert comments
— Can exercise and proper nutrition increase a woman’s fertility?
— The main problem in the treatment of infertility in patients with PCOS is anovulation (lack of ovulation), in which pregnancy is impossible.
If PCOS is accompanied by obesity, which happens quite often — because this disease develops against the background of endocrine disorders — increased physical activity and the transition to a healthy diet really help to cope with it.
Obesity cannot be called a decisive factor in the development of PCOS. But because of the increased level of insulin in the blood and insulin resistance (a condition in which the body does not respond to the action of the hormone insulin) it aggravates endocrine disorders, including the lack of ovulation.
In order to restore it, it is necessary first of all to cope with hyperinsulinemia, i.e. to lower the insulin content in the patient’s blood — including with the help of physical therapy and diet.
— Modern approaches to the diagnosis of the syndrome?
— Some innovative methods of PCOS diagnosis have not appeared in recent years. The diagnosis is made by a doctor based on the study of the patient’s anamnesis, in which, as a rule, there will be menstrual cycle disorders, abnormal bleeding during menstruation, etc., as well as the results of hormonal examination and ultrasound of the pelvic organs.
Hormonal examination — a blood test for hormones — should confirm or deny the presence of hyperandrogenism, and in addition — to identify the level of insulin in the blood. I recommend checking the insulin levels of all women with suspected PCOS. Ultrasound in this case helps to identify persistent anovulation and other signs of polycystic ovaries, as well as to assess the condition of the endometrium.
— The most effective and safe combined oral contraceptives (COCs) for the treatment of the syndrome?
— There is no specific drug that would be ideal for the treatment of all women with PCOS. As a rule, the drug of choice in this case is a contraceptive with an antiandrogenic effect, that is, lowering the level of so-called male hormones. Which one exactly depends on the characteristics of a woman’s health status, her tolerance of a particular substance in the composition of COCs, her somatic status.
In general, this pathology should be treated using an integrated approach and requires the efforts of several specialists at once, especially if we are talking about a patient planning a pregnancy. This is a gynecologist, an obstetrician, an endocrinologist, and a reproductologist, and in some cases, a cosmetologist, since PCOS is often accompanied by serious cosmetological problems.
Every twentieth woman suffers from this syndrome. One of the first steps in PCOS therapy is the normalization of body mass index. Diet therapy and physical therapy helps in the fight against obesity, which accompanies women with PCOS, with any type of course of the disease. Elimination of excess fat leads to a good result with complex treatment: normalization of the endocrine profile of the blood, restoration of regular menstruation and, consequently, increased fertility.
Currently, the first line of drugs in the treatment of PCOS are metformins and glitazones in combination with antiandrogenically active drugs. I also want to note the effectiveness of COCs (combined oral contraceptives) in PCOS. It is preferable to choose antiandrogenic active drugs and their combinations. When they are used, a persistent effect is observed (regular menstruation, reduction of hirsutism, improvement of skin quality, normalization of the endocrine profile), which leads to an increase in fertility of women of reproductive age with PCOS.
This syndrome is a genetically determined disease in which the normal functioning of the ovaries fails, leading to problems with the menstrual cycle and even infertility.
To date, it is known that the mutation of certain genes contributes to the development of PCOS. It is quite easy to diagnose PCOS by the following signs:
- Violation of the secretion of gonadotropins: a significant increase in the level of luteinizing hormone, a change in the ratio of luteinizing hormone / follicle-stimulating hormone more than 2.5;
- Multicystic ovarian transformation (more than 12 follicles up to 8-10 mm in diameter) with an increase in their volume over 12 cubic cm and thickening of the ovarian capsule;
- Hyperandrogenism (an increase in the level of androgens — male sex hormones), which is detected in 50-70% of cases. This condition manifests itself in the form of excessive hair growth on the back of the thighs, along the white line of the abdomen, around the nipples, on the face;
- Insulin resistance is a violation of the susceptibility of tissues to insulin, a violation of fat metabolism or obesity (body mass index more than 25-30);
- Chronic absence of ovulation, violation of the menstruation cycle;
- Infertility.
PCOS treatment is always a complex and complex task, in which the patient’s desire to cope with the problem occupies an important place. With PCOS, it is necessary to significantly change your lifestyle: gradually, without stress for the body, reduce excess body weight, change habits. Proper nutrition without “breakdowns” and competent physical exercises will help here. There is no need to exhaust yourself with diets and heavy workouts — the diet should be balanced and saturated with all useful substances, and the loads are feasible for your body. As you adapt, the amount of exercise will need to be increased. You can practice both in the gym and at home. Why is this important? Weight loss helps to reduce insulin resistance and even restore the menstrual cycle.
In the treatment of PCOS, it is impossible to do without drug therapy. It should be understood that problems with hormonal background are treated with hormonal drugs, which scares many patients. But there is absolutely no need to be afraid, because with this disease, the same hormones are produced in the female body, just in insufficient quantities, but male sex hormones are produced in excess. Medications will correct this imbalance.
The drugs of choice at the moment include safe combined low-dose oral contraceptives with an antiandrogenic effect in combination with hypoglycemic drugs.