Dense membrane on the ovaries how to treat. Signs of sclerocystic ovaries in women and methods of treating pathology

In approximately five percent of all cases of gynecological diseases, doctors diagnose ovarian sclerocystosis. What this is, not every woman imagines, so many perceive such a diagnosis as a sentence of infertility. And indeed, about a third of those who have discovered this pathology cannot have their children. But the rest have high chances to recover and give birth to a healthy baby.

Ovarian sclerocystosis 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 eighty subsequent years, the pathogenesis of the disease was thoroughly studied, methods for its treatment and diagnosis were developed, but until now, scientists 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, do not despair. In our article, we will try to tell you all the most important things about sclerocystosis of the ovaries and about the methods that allow you to cope with it.

How are healthy ovaries

In order 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 genitals. They can be represented in the form of peculiar sacs filled with brain matter. 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 the 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, starting from the period of maturity and ending with the period of menopause, they are gradually consumed, and new ones are no longer formed. Therefore, the time comes when their stock runs out.

This almost never happens in women of childbearing age, so the absence of follicles can in no way be the cause of infertility. Another thing is that in their gradual ripening, malfunctions sometimes occur. So they are the culprits of the fact that the desired pregnancy does not occur. Moreover, the 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 mellitus, heart attack, and malignant tumors in the mammary glands.

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

When the girls become sexually mature, the process of maturation of the primary follicles, which until now are as if sleeping, is included in their body. This process always goes in cycles. In each cycle, up to about 15 follicles “wake up”. They, under the action of the hormone FSH, produced by the pituitary gland, start to grow, increasing in diameter from 50 to 500 microns. During this period, a follicular fluid forms in them, and in the largest of them a cavity appears. This follicle becomes dominant, grows to 20 millimeters, protrudes. Inside it, an egg develops rapidly. The rest of the follicles from the group of “awakened” die and dissolve one after another. If everything goes according to the rules, in the female body the endocrine system is included in the work. As a result, hormones estrogen, progestins and androgens are produced, which influence the further maturation of the dominant follicle. Under the influence of the lutenizing hormone (luteotropin, lutropin, abbreviated LH), it breaks, the egg leaves it into the fallopian tube, and it turns into a yellow body and gradually dissolves.

If the rupture does not occur, the egg that has not come out is reborn, and in place of the follicle appears an ovarian cyst the size of a cherry. 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 considerable size (40-60 millimeters), but it may not manifest itself at all. Only in some cases, patients complain of pain in the ovary. After a woman normalizes the production of hormones, she slowly dissolves. If a woman has restored ovulation, the pregnancy in the ovary at that time does not prevent the occurrence of pregnancy, but if this cyst has grown to a size of 90 millimeters, it must be removed surgically.

Causes of the 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 exit of the egg cell, hormonal disorders, and in particular a malfunction in the mechanism of estrogen synthesis, are considered the main cause of ovarian sclerocystosis. The following causes of hormonal disorders are called:

• heredity;
• abnormalities 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, only with the onset of puberty can a girl discover ovarian sclerocystosis. Symptoms at this stage are blurry and mainly consist of menstrual irregularities. But this phenomenon can have many other causes unrelated to ovarian disease, including poor nutrition and nervous disorders. By twenty, by a maximum of twenty-five years, girls develop more specific symptoms of ovarian sclerocystosis. The main one 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 secretions. Much less often, patients complain about the duration and abundance of menstruation.

Other symptoms that suspect ovarian sclerocystosis are as follows:

• hirsutism (about 90 percent of patients have hairy areas around the nipples, back, abdomen, chin, and above the lip);
• overweight (70 percent of patients);
• baldness and acne on the face (found in no more than 40 percent of cases);
• some changes in body proportions;
• disturbances in the work of the nervous system;
• asthenic syndrome;
• ovarian enlargement (detected by a gynecologist on examination).

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

Laboratory research

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

• blood test for testosterone (total should be within 1.3 ng / ml, free in women under 41 years old - within 3.18 ng / ml, and up to 59 years old - no more than 2.6 ng / ml);
• analysis of glucose susceptibility, blood sugar and triglycerides;
• colpocytogram (the material is taken from the vagina, the analysis data show whether or not ovulation is present, as well as the correspondence of the colpocytogram indices to the patient's age and phase of her menstrual cycle);
• endometrial scraping (allows you to judge about dysfunctions in the ovaries);
• control of changes in basal temperature;
• tests for some thyroid, pituitary, and ovarian hormones (LH, FSH, PSSG, prolactin, cortisol, 17-hydroxyprogesterone);
• determination of estrogen excretion.

Now patients can independently conduct a simple test that allows them to suspect cystic ovarian formations. To do this, you need a microscope (you can buy in pharmacies). In the morning, just waking up and not eating or drinking anything, you need to place a drop of your saliva on a laboratory glass and let it dry. During ovulation, estrogen levels always increase, which, in turn, changes the composition of saliva. If there is ovulation, the sample of saliva 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 final diagnosis, patients are prescribed in the examination complex using medical equipment.

The most gentle and completely painless method is an ultrasound diagnosis of ovarian sclerocystosis. The procedure can be transabdominal (through the stomach), transvaginal (the most informative way), transrectal (performed only in young girls and elderly women).

Ultrasound determines 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 pelvogram, showing abnormalities in 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 surgeon makes a puncture of the peritoneal wall and inserts a carbon dioxide pump into the peritoneum in order to create a volume in the peritoneum and better examine organs. Next, a laparoscope is inserted into the patient's body, which shows the status 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 making the final diagnosis, in most cases, a woman is first prescribed medication. Her goal is to restore the normal menstrual cycle and resume ovulation. How to treat sclerocystic ovaries, the gynecologist decides together with the endocrinologist.

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

The second step is to increase insulin perception. Metformin is prescribed, which should be taken 3-6 months.

The third stage is the stimulation of ovulation. They begin therapy with the simplest medicine, Clomiphene. The initial course is to take the drug at a dose of 50 mg overnight, starting on the 5th day of the cycle for 5 consecutive days. If there is no result (menstruation), Klomifen is taken within a month. If at the same time 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 Menogon medicine. It is administered intramuscularly, and at the end of the course do injections of “Horagon”. Menogon can be replaced by Menodin or Menopur.

After completing the entire course, they make blood biochemistry, and on the basis of the results of the analysis (if there is not enough LH hormone), "Utrozhestan" or "Dufaston" are prescribed.

At the same time, doctors are trying to remove excess body hair from a woman, in connection with which she is prescribed Ovosiston and Metronidazole.

A mandatory addition to the course is vitamin therapy.

Ovarian sclerocystosis: surgical treatment

If ovulation is not observed within three months after drug therapy, a woman is prescribed surgery. It is performed by several methods. Which one to apply depends on the state of the ovaries.

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

• cauterization of cysts using a laser;
• demedulation (removal of the middle part in the ovary);
• wedge-shaped resection (removal of the affected part in the form of a wedge from the ovary);
• decortication (the doctor removes the transformed protein layer of the ovary, pierces the follicles with a needle and sutures their edges);
• electrocauterization (point destruction in the ovary of that area in which too many hormones are produced).
• incisions (their surgeon makes a depth of 1 cm in places where the follicles are visible, so that when they mature, they can release an egg).

Forecasts

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

The disadvantage of the drug “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, and a maximum in 97%. At the same time, from 7 to 65% of women become pregnant.

If ovarian sclerocystosis is treated surgically, positive results are noted with approximately 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.

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.

Pathology definition

Sclerocystosis is a pathological process that affects both ovaries. As a result of the changes, the outer protein membrane is condensed and cysts form on the surface of the organ. These cystic formations belong to the follicular.
  With scleropolycystic ovary, a large number of follicular cysts filled with light fluid form. In this case, the number of mature follicles decreases. This leads to proliferation of stromal tissues and an increase in organ size. Such metamorphoses make ovulation impossible. In addition, against the background of such changes, a woman may develop hyperplasia 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 estrogen are the main factors influencing the occurrence of a pathological process. That is why it is very important to undergo a routine examination once a year, as well as take all the necessary tests in order to notice in time the onset of changes in the degenerative nature in the woman's body.

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

It is not recommended to ignore the symptoms of the disease. Sclerocystosis is not a passing disease, but a chronic ailment that causes persistent, and in some cases irreversible, changes. Running sclerocystic appendages provokes disorders 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 that correct and compensate 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 ovarian sclerosis, was first mentioned in 1935 by American gynecologists.

The causes and types of sclerocystosis

There are two types of sclerocystic ovary syndrome: acquired and hereditary. This 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 noticeable.
  Modern gynecology and reproductive medicine do not name factors that have an absolute impact on the occurrence of pathology.
  The causes of ovarian sclerocystosis can be:

1. The factor of heredity. In this case, the predominant place is given to the insufficiency of enzymes with an additional violation 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 malfunctioning of insulin receptors, leading to a significant decrease in the sensitivity of insulin-dependent cells.
2. Infections of a chronic nature. Quite often, the cause of ovarian sclerocystosis is not inflammation in the appendages, but neuroendocrine disorders with a change in the functionality of the ovaries. In some medical sources, a connection was made between the development of sclerocystosis in women and chronic inflammation of the tonsils.
3. Complicated childbirth, abortion, oophoritis, salpingitis, endometritis.
4. Overweight occurs not only as a result of disturbances in the functioning of the hormonal system, but can also be a factor predisposing to the appearance of sclerocystosis.
5. Failures in the hypothalamus and pituitary gland entail abnormalities at the level of the ovaries. The main causes of failure are hypothalamic and diencephalic syndromes. This type of change is rare in patients and is not dangerous.
6. Pathological changes in the adrenal cortex. There is an assumption that under the influence 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 the appearance of a two-chamber ovarian cyst

An important role in the development of sclerocystic ovaries is played by the psychological factor. Against the background of changes in the neuroendocrine part, imbalance in the connections between various organs of the endocrine system is possible.

Symptomatology

The main symptom of a malfunction in the reproductive system and
the reason to consult a doctor is a violation in the menstrual cycle. With the development of Stein-Leventhal syndrome, violations are observed 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:

1. Changes in the reproductive system (menstrual irregularities). Inability to conceive a child.
2. Manifestations of an increased content of androgens of a general nature, expressed in the appearance of seborrhea, acne, increased male hair growth. With the development of pathology, the proportions of the woman’s body begin to change, and mammary gland hypoplasia is also noted.
3. Violation of susceptibility to insulin.
4. Pain during ovulation.
5. The tendency to rapid weight gain and obesity.

With violations in hormonal regulation, a decrease in the manifestations of secondary sexual female signs is noted. 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 clitoris size is noted.

The most intense symptoms of sclerocystic ovaries are observed in girls aged 20-25 years.

Almost all patients with diagnosed sclerocystosis of the ovaries have increased male type hair growth in various parts of the body. The presence of vellus hair can be observed on the face, back, areola of the chest and along the white line of the abdomen.

Complications of untimely treatment of pathology

Complications with 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. Critical changes 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 in all cases. This may be the result of disturbances in the microcirculation of the limbs and the brain.

Ovarian sclerocystosis 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 sclerocystosis 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 the diagnosis of 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 protein membrane 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 enough to make 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 the cyst of the left ovary

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

Differential diagnosis

Stein-Leventhal syndrome is important to distinguish from other ailments in a timely manner, which occur with similar symptoms. The examination should, first of all, be aimed at eliminating 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 based on the following symptoms:

• the age of the first menstruation is 12-13 years;
• disruptions in the cycle of menstruation from the beginning of the first hemorrhages of the type of oligomenorrhea;
• lack of menstruation for a long period;
• obesity from the onset of puberty in most patients with sclerocystic ovary;
• primary type infertility - the absence of pregnancy for one year with regular sex without contraception;
• anovulation of the chronic type - a 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, partly 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 is worth noting that polycystic more often causes nervous shocks and stress. With an excess of prolactin (a stress hormone), egg maturation 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, with an excess, degenerates into testosterone.
  The development of sclerocystosis occurs due to the formation of a dense and hard shell on the ovaries, which blocks the movement of follicles and prevents ovulation. In addition, this causes an accumulation of follicles, provoking the production of estradiol, which is subsequently transformed into testosterone.
In addition, these diseases differ in symptoms. Polycystic is accompanied by the following manifestations:

• overweight;
• hirsutism - increased male-type 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 sclerocystosis, the symptoms are somewhat different:

• slight increase in body weight;
• the appearance of a small amount of hair in the nasolabial zone;
• increased sexual desire.

In addition, these diseases require different treatments. With polycystic women are prescribed a drug that blocks the production of prolactin. And also a woman needs hormone therapy, which contributes to the gradual resorption of accumulated follicles.
  Patients with sclerocystosis require laparoscopy with cauterization of extra follicles.

Treatment of ovarian sclerocystosis

The methods for treating ovarian sclerocystosis do not depend on the causes,
but from the symptoms that accompany the disease. If the patient appears obese, doctors recommend reducing body weight with a special diet. Do not go to extremes and starve. When following a diet, it is very important to get physical activity. This approach in the treatment of sclerocystic ovaries will increase the sensitivity of tissue structures to insulin.
  Doctors try to strengthen the effectiveness of conservative treatment with
medications based on metformin and glitazones. These drugs belong to the group of insulin sensitizers, their intake should be carried out strictly as prescribed by the attending physician. When conducting therapy, it is mandatory to undergo glucose tolerance tests. Therapy of sclerocystosis is carried out comprehensively in coordination with the 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 allowing to increase 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, drugs created on the basis of medicinal plants have a pronounced effect in the composition of complex therapy with hormonal drugs.
Sometimes it is impossible to cure the pathology without surgery. This is because hormonal drugs do not affect the dense sclerotic membrane in any way. In this case, the patient needs an operation that can reduce the size of the ovary to normal.

Sclerocystic ovary refers to a gynecological, endocrine disease, in which the formation of a large number of small cysts leads to an increase in the ovaries. An impermeable shell forms on the surface of the ovaries. Two ovaries are most often reborn at once. Sclerocystosis leads not only to a violation of the structure, but also to serious problems with the functionality of the ovaries. The woman does not have ovulation, it is also observed (there are more male sex hormones than female).

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

Development reasons

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

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

Today, 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, at any time. If sclerocystosis develops in girls, then there are problems with the menstrual cycle. It does not occur at all or the menstruation begins 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 realize such a pathology at home, but when she begins to plan a pregnancy, she learns about sclerocystosis. First, the gynecologist can make a diagnosis - primary anovulatory infertility due to lack of ovulation.

With sclerocystosis of the ovaries occurs, which is manifested by increased hair growth in places characteristic of men.

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

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

• Lipidogramwith the help of which you can learn about fat metabolism in the body.
• Dyslipidemiashows whether cholesterol metabolism is disturbed or not.

Treatment methods

To date, there are several methods of treating the disease:

• Conservative methods (taking hormones).
• 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 failures in the menstrual cycle (delay of more than 40 days).
• Does a woman suffer from hirsutism.
• Have there been any cases of pregnancy with regular sexual activity?

The gynecologist also pays attention when ovulation is constantly absent. After vaginal ultrasound, the ovaries are significantly enlarged. In the analyzes, the concentration of luteinizing hormone is increased. Using conservative treatment methods, the ovulatory cycle can be restored.

Obesity Recovery

• A woman should adhere to a diet for some time. She will have to completely abandon the sharp, salty. Also, do not get involved in liquid, not more than 2 liters of purified water. It is important to exercise daily.
• Taking special medications so that the tissues normally perceive insulin. One of the best is Metformin, use it for 6 months.
• Drug stimulation of ovulation. Clomiphene is most often prescribed for 5 days. If the drug does not help, menogon may be administered intravenously to the woman. An effective hormonal agent is Horagon.

After a course of hormonal therapy, the doctor must prescribe a blood test, ultrasound. Dynamics can be traced using biochemical blood tests.

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

• Laparotomyin which an incision is made on the anterior abdominal wall.
• Laparoscopy lies in the fact that using 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 monitor the entire process.

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

A quick and gentle operation is cauterization. With its help, stromas 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 diagnose ovarian sclerocystosis in a timely manner and begin treatment to prevent the development of infertility.

Ovarian sclerocystosis is a condition in which the formation of small cavities up to 1 cm in size occurs in the organ. It is a natural outcome of untreated. The progression of the disease leads to a significant violation of the reproductive health of women. According to statistics, up to 70% of all cases of endocrine infertility are caused by this particular pathology.

Sclerocystic ovary - what is it? ICD-10 definition and code

In the International Classification of Diseases (ICD-10), pathology is encrypted under the code E28.2. This also includes polycystic ovary syndrome (PCOS) - a precursor of the disease under discussion. The entire E28 category combines dysfunctional disorders in the work of the gonads, including primary and unspecified.

Sclerocystic ovary syndrome makes up 4-5% of the entire gynecological pathology. According to medical statistics, the disease is detected in 11% of women of reproductive age. In the structure of all causes of endocrine infertility, focal sclerocystosis of the ovaries occupies about 70%, and this is a rather large percentage, indicating the severity of the disease. It is also noted that pathology is detected in 60% of women suffering from hirsutism.

In gynecology, sclerocystosis of the ovaries is understood to mean a phenomenon in which small cavities form in the tissues of organs. Do not confuse this condition with polycystic ovary, the precursor of this pathology. It is necessary to distinguish another concept - which is considered a variant of the norm. All these conditions have similar symptoms, so there are certain difficulties in the diagnosis. It is important to distinguish the special symptoms of sclerocystosis in order to identify the pathology in time and begin treatment taking into account the severity of the process.

Causes of sclerocystic ovary syndrome

The exact causes and mechanisms of the development of the disease have not been studied. There are several theories of the occurrence of sclerocystic ovaries:

1. Failure of the pituitary gland and hypothalamus. In the development of pathology, great importance is given to disruption in the production of gonadotropin-releasing hormones from the puberty period.
2. Excessive activity of the adrenal cortex, leading to defects in the synthesis of steroid hormones.
3. Insulin resistance is a decrease in insulin sensitivity. Metabolic failure triggers a complex chain of transformations, as a result of which the rhythm of the production of your own sex hormones changes.
4. Heredity. It is noted that half of all cases of ovarian sclerocystosis are genetically determined.

Most doctors believe that the pathology is based on the excessive production of luteinizing hormone (LH) and a decrease in the level of follicle-stimulating hormone (FSH). Against this background, the concentration of estrogen decreases and the synthesis of androgens increases. Ovarian function is suppressed, and instead of full cysts, cysts are formed, covered with a dense capsule. This is how polycystic ovary syndrome develops, on the basis of which sclerocystosis already occurs - atresia and replacement of follicles with connective tissue.

Symptoms of ovarian sclerocystosis

Sclerosis of the cortical layer of the ovaries leads to the appearance of such characteristic signs:

• Menstrual irregularities are noted with menarche - the first menstruation in a girl’s life. Oligomenorrhea is already observed in adolescence - a condition in which menstruation rarely comes with an interval of 35 days or more. Menstrual flow is scarce and lasts no more than 3 days. With age, the situation does not improve.
• Uterine bleeding associated with excessive growth of the uterine mucosa.
• The absence of menstruation (amenorrhea) for 6 months or more occurs with untreated pathology and is more often detected in women over 30 who are obese. With normal body weight, such a symptom can be observed from adolescence.
• Excessive male hair (hirsutism).
• Acne on the face and body.

Traditionally, sclerocystic ovary syndrome is combined with obesity and hirsutism, but in recent years the situation has changed. Increasingly, women with normal weight and mild hair growth come to see a gynecologist.

Ovarian sclerocystosis and pregnancy: is this possible?

In the body of a healthy woman, follicles mature every month. Within 6 days they grow, after which one dominant (less often several) stands out among them. Such a follicle is called a graaff bubble, and it is in it that the egg is located. At the time of ovulation, the egg leaves the ovary, and upon meeting with the sperm, fertilization occurs.

With sclerocystosis of the ovaries, the mechanism debugged by nature malfunctions. Excessive concentration of luteinizing hormone leads to the fact that the follicles do not mature, and cystic cavities form in their place. The egg is not formed, ovulation does not happen. The conception of a child in this situation does not occur.

Chronic anovulation is the main cause of infertility in sclerocystic ovaries. It is possible to become pregnant with this pathology only after a long course of treatment. Stimulation of ovulation is not always successful. Sclerosed ovaries respond poorly to therapy. In advanced situations with untreated pathology for a long time, medicine is powerless.

I am 34 years old, no children. I have been unsuccessfully treated for infertility for 3 years, but so far there is no result. The doctor says that the cause is ovarian sclerocystosis. Can I get pregnant with this disease and how to do it? Anastasia, 34 years old.

Infertility is a natural outcome of sclerocystic ovary syndrome. In therapy, various schemes are used, but the combination of diet and hormone intake is considered the most effective. If in three years the effect was not achieved, it is worth thinking about the operation. After laparoscopic resection, or most women manage to conceive a child within a year.

Diagnostic chart

When making a diagnosis, adhere to the criteria set at the Rotterdam Consensus in 2004. According to these data, a woman should have three signs:

• Oligomenorrhea and / or anovulation.
• Hyperandrogenism.
• Ultrasound signs of sclerocystic ovaries.

To detect pathology, the following methods are used:

• Gynecological examination. On palpation, the uterus of normal sizes and enlarged ovaries are determined. In advanced situations and severe sclerosis, gonads are reduced. During the examination, signs of hirsutism, overweight are noteworthy.
• Laboratory research. In the analysis of blood, there is an increase in luteinizing hormone and a change in the ratio of LH / FSH by more than 2.5 times. There is an increase in testosterone - a representative of male sex hormones. A quarter of women have an increase in prolactin.
•   . Ultrasound determines the increase in ovaries, the appearance of cystic inclusions - small follicles up to 1 cm in size with a number of at least 10.
• Dopplerometry. When assessing blood flow, a pronounced vascular network in the stroma of the organ is noted.
• Endometrial aspiration biopsy is performed only for uterine bleeding. Ovarian sclerocystosis often goes along with endometrial hyperplasia - a condition in which the uterine mucosa grows. The longer the duration of the disease, the higher the likelihood of developing such a pathology.

Diet for sclerocystic ovaries

Proper nutrition is the first stage of therapy. The purpose of the diet is to reduce body weight and increase the sensitivity of cells to insulin.

General principles:

• Frequent fractional meals: 6 times a day in small portions.
• Refusal of spicy, spicy, fried food. Marinades, smoked meats, pickles also fall under the ban.
• Priority is given to steamed or baked dishes.
• The daily calorie content of food is no more than 2000 kcal.
• The total volume of liquid is at least 2 liters.

When choosing a menu for dietary nutrition, you should focus on the glycemic index (GI). The basis of the diet are low GI foods. They are slowly absorbed in the body and do not lead to a sharp increase in blood glucose. If you stick to this schedule, significant improvements will be noticeable after 4 weeks.

Drug treatment of sclerocystic ovaries

The purpose of therapy:

• Restoration of ovulation and normalization of the menstrual cycle.
• Elimination of endometrial hyperplasia.
• Restoring fertility and the opportunity to conceive a child.
• Weight loss (for overweight women).
• Elimination of concomitant symptoms (acne, hirsutism).

Drug treatment is carried out in several stages:

1. Increased tissue sensitivity to insulin. Metformin and its analogues are used for up to six months.
2. Stimulation of ovulation. Clomiphene is prescribed in a minimum dosage with a gradual increase in it. In the absence of effect, other means are used: Metrodin, Menogon, etc.
3. Drugs that normalize the production of gonadotropic hormones: LH and FSH.
4. Means that regulate the exchange of estrogen and androgen. Allows you to get rid of concomitant hirsutism.

Properly selected drug therapy helps to normalize the hormonal background, start ovulation and conceive a child.

Surgical treatment for sclerocystosis of the ovaries

In the absence of the effect of conservative therapy, surgery is prescribed. Surgical intervention is performed by laparoscopy. The doctor makes several punctures of the abdominal wall, inserts the instrument and performs one of the following procedures:

• Wedge-shaped ovarian resection - excision of a part of an organ.
• Ovarian cauterization is the destruction of the stroma of an organ using a laser or an electric knife.

The choice of treatment method is determined by the technical capabilities of the clinic. After laparoscopy, the volume of ovarian tissue producing androgens decreases, and its dense capsule is destroyed. All this creates optimal conditions for egg maturation and ovulation.

Pregnancy after laparoscopy occurs within 6-12 months. If during the first three cycles of ovulation cannot be achieved, an additional appointment of hormones is indicated. Both Klomifen and combined oral contraceptives with a high estrogen content are used (Diane-35). With persistent anovulation during the year, a woman goes to IVF.

Treatment of sclerocystosis of the ovaries with folk remedies

Alternative medicine prescriptions are used only in combination with traditional methods of therapy. Popular folk remedies are:

• Fresh juice of viburnum berries mixed with honey.
• A decoction of peony flowers.
• Burdock juice.
• Tampons with mummy.
• Tincture of the pine forest or red brush.

Various medicinal herbs are used both solo and in complex collections. The course of treatment is at least 3 months. It is important to remember: folk remedies do not relieve sclerocystosis, but they help normalize the hormonal background. Similar methods are used in complex treatment in order to stimulate the immune system and increase the overall tone of the body.

Five years ago I was diagnosed with ovarian sclerocystosis. It was treated with hormones, took Diane-35 and other drugs, but so far it has not been possible to get pregnant. The doctor directs for surgery, but I hesitate. I want to try drinking female herbs - a pine forest and a red brush. Will alternative methods of treatment for ovarian sclerocystosis help or will I have to agree to surgery?

Folk remedies, including herbal supplements, help restore the hormonal background and start ovulation, but they are effective only in combination with medications. If in 5 years it was not possible to achieve success, it is worth thinking about the operation. Folk recipes in this case are unlikely to help conceive a child.

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Ovarian sclerosis (Sclerosis ovariorum)

Ovarian sclerosis is a proliferation of connective tissue with the replacement of glandular tissue.

Etiology. The cause of sclerosis is previous inflammatory processes in the ovaries, sometimes caused by mechanical damage during enucleation of the corpus luteum or crushing of the ovarian cyst. Sometimes sclerosis is observed in chronic diseases and intoxication of the body. In old animals, it develops in menopause.

Pathogenesis. With inflammation of the ovary, connective tissue gradually grows, which replaces the cortical and brain layers of the organ.

With disease and intoxication, sclerosis develops in both ovaries, while the growth and development of primordial follicles completely stops, there are no sexual cycles.

Symptoms Affected ovaries in most cases are reduced in size, and it is not uncommon to find them difficult to rectal examination.

Yellow bodies or ripening follicles in the ovaries are absent. The surface of the ovaries is often smooth, finely tuberous, homogeneous, their texture is dense, sometimes hard rocky.

Rarely, the ovaries increase in size. At the beginning of the disease, there are disturbances in the rhythms of the reproductive cycles and a mild manifestation of signs of estrus.

Diagnosis. The reasons for the diagnosis are the data obtained with a carefully collected history, analysis of feeding and rectal examination of the uterus of the ovaries. To clarify the degree of change in the endometrium, it is advisable to conduct a histological examination.

Forecast. With sclerosis of one ovary, if the functional activity of the other is normal, there are no normal changes in the endometrium, the prognosis is favorable. With deep irreversible changes in both ovaries and endometrium, constant infertility is observed. The prognosis in this case is not favorable.

Treatment. The initial period of the disease with unilateral damage to the ovary, the treatment is to create a normal feeding condition for the animal. The diet for them is prescribed foods rich in proteins, minerals, vitamins. At the same time, agents are used that normalize the pituitary gland, stimulate the growth and maturation of follicles and cause the formation of normal follicles.

Persistent corpus luteum (Corpus luteus persistens)

A persistent, or lingering, corpus luteum is such a corpus luteum, which in the ovary of a non-pregnant animal does not undergo "reverse development" and continues to function beyond its physiological term.

A persistent corpus luteum is observed in all animal species, but it is most often observed in cows. A persistent corpus luteum causes anaphrodisia, resulting in infertility. The corpus luteum and pregnancy can persist.

Corpus luteum pregnancy or genital cycle. Found in rectal examination 25-30 days after birth or during the period of the previous estrus in unfertilized cows, which continues to function as a hormonal organ, it is considered to be persistent.

At the end of the stall period, especially in the absence of exercise and unbalanced feeding, persistent corpus luteum is observed in 28.3% of infertile animals, including 47.9% in sexually mature heifers, 76.9% in heifers and adults cows - in 22.2%.

Etiology. The main reason for the formation of a persistent corpus luteum is considered to be a violation of the neurohumoral balance between the ovaries and the anterior pituitary gland. However, it is important to note that the origin of changes in the neurohumoral connections of the hypothalamus - pituitary - ovaries, which disrupt the process of "reverse development" of the yellow bodies and cause their persistence, have not yet been established. At the same time, many researchers point out that the causes of persistent corpus luteum appear due to inadequate and inadequate feeding, diet imbalance in nutrients, vitamins, micro - and macrocells.

The persistence of corpus lutes is also possible due to the lack of active exercise, excessive exploitation of working animals, keeping females in rooms with gross microclimate disorders and other reasons.

In addition, the causes of persistent corpus luteum formation can be diseases associated with a disorder of the nervous and cardiovascular systems, leading to a violation of the regulatory mechanism of the reproductive cycle, etc.

Luteinized follicle during anovulatory reproductive cycles can also persist for a long time.

Pathogenesis. The corpus luteum corpus luteum and corpus luteum continue to produce the hormone progesterone, which affects the uterine mucosa and the pituitary gland.

The morphological picture of the endometrium with a persistent corpus luteum is characterized by pronounced signs of secretion. However, the degree of manifestation of signs of secretion is not the same, which, apparently, is associated with different functional activity of the persistent corpus luteum. Prolonged saturation of the body with progesterone causes very characteristic changes in the endometrium. The integumentary epithelium is often high, prismatic, the boundaries of its individual cells are erased and not detected, the nuclei of the cells are large, swollen. The free surface of the integumentary epithelium is covered with a homogeneous rim of mucus, which sometimes forms a flat, but often winding border. The glandular epithelium is prismatic, the number of uterine glands in the aisles of the norm. The gaps of most glands are filled with homogeneous mucus, some of them are expanded. Pronounced edema of the stroma. The blood vessels are dilated and filled with blood. Follicular maturation and growth does not occur, as the secretion of follicle-stimulating and partially lutein-stimulating hormones is inhibited under the influence of high concentrations of progesterone.

Symptoms One of the first signs of the formation of a persistent corpus luteum is the absence of regular estrus and hunting for several months. The animal in this regard is often mistakenly considered pregnant. Sometimes estrus and hunting occur in the presence of a persistent body. However, ovulation does not occur, and therefore the seeded animal is barren. Sometimes pregnancy can be in the presence of a persistent body, but only if it is at the stage of resorption and does not secrete hormones.

With a persistent corpus luteum of pregnancy, subinvolution of the uterus, endometritis, and then a prolonged absence of hunting after childbirth are observed.

Diagnosis. Persistent corpus luteum and pregnancy bodies are diagnosed based on clinical signs and rectal examination findings.

For a persistent corpus luteum, the sexual cycle is characterized by detection in the ovary during rectal examination of the corpus luteum in the form of a large cone-shaped or mushroom-like formation protruding above the surface of the ovary. The persistent corpus luteum of the genital cycle is usually not painful and has a dense texture. The ovary with a persistent corpus luteum is enlarged and has a changed shape. The uterus is either normal, or more often slightly enlarged, flabby and does not contract during massage. Sometimes signs of endometritis are noted.

The diagnosis of the presence of a persistent corpus luteum of the genital cycle is made only when pregnancy is excluded. The presence of a persistent corpus luteum pregnancy is diagnosed on the basis of detection in the ovary of the corpus luteum, which lasts more than 25-30 days after childbirth.

Forecast. With persistent corpus luteum, the prognosis is favorable, since after eliminating the causes of this pathology, the corpus luteum undergoes a reverse development, and the ability to fertilize is usually restored.

Treatment. They stimulate the reverse development of the persistent corpus luteum or its removal. However, before starting treatment, it is necessary to perform a rectal examination in cows and mares and exclude pregnancy, so. how erroneous removal of the corpus luteum in pregnant animals causes abortion.

It is important to find out and eliminate the cause that led to the formation of the corpus luteum. When retaining the corpus luteum due to adverse external conditions, it is necessary first of all to eliminate errors in feeding, maintenance and operation.

To stimulate the resorption of the persistent corpus luteum, daily walks are prescribed, especially on sunny days. Cows and mares are treated with ichthyol with turpentine of 15 g in the mucous broth (inside - once every 2 to 3 days), folliculin - 2000 - 2500 units (subcutaneously - once a day or after 2 to 3 days for 2 to 3 weeks) ) and pituitary gland preparations. A single subcutaneous injection of proserin (2.0 - 2.5 ml of a 0.5% aqueous solution) is recommended, followed by (1 - 5 days) administration of sinestrol (1% oil solution) and intravaginal mud therapy.

The reverse development of a persistent corpus luteum is most successfully stimulated by massage of the ovary through the rectum. Massage is done 1 to 2 times a day every 2 to 3 days for 2 to 3 weeks. The duration of the massage session is 5 minutes.

Sometimes, in order to accelerate treatment, they resort to the direct removal of the persistent corpus luteum by squeezing it through the rectum. Contraindications to squeezing a persistent corpus luteum are increased pulsation of the ovary artery and inflammation of the ovary.

After 3 - 10 days after removal of the persistent corpus luteum, estrus and hunting usually occur.