Milk increases the weight of PCOD

Gynecology - Benign Diseases - Polycystic ovary syndrome
Polycystic ovarian syndrome, polycystic ovary syndrome, affects around 5-10% of women in Central Europe. It is one of the most common endocrine disorders (diseases in which hormonal disorders are the main cause and determinant of the disease) in the reproductive age.

Definition:

There are different definitions for polycystic ovary syndrome. For example, according to the Rotterdam Consensus Workshop 2003, the polycystic ovary syndrome (PCOS) is defined as follows: (2 of 3 criteria must be met)
  • Menstrual cycle disorders with oligomenorrhea and / or amenorrhea
  • Clinical and / or biochemical signs of hyperandrogenemia
  • Polycystic ovaries

The Oligomenorrheadescribes an infrequent menstrual bleeding with a cycle interval between 36 and 89 days three years after menarche. If the bleeding does not occur for at least 3 months, one speaks of one Amenorrhea. An irregular cycle is normal for up to a year after menarche. Between the first and third year after menarche, a cycle can only be considered abnormal if it is shorter than 21 or longer than 45 days.

Hyperandrogenemiais a general term for increased androgen levels in the blood. It is the cause of oligo- or amenorrhea in up to 50%.

The term "PolycysticOvaries"means an ovary with many follicles. Another expression for it is" polyfollicular ovaries ", abbreviated to PFO.

All other causes of hyperandrogenemia must be excluded (Cushing's syndrome, hyperprolactinemia, androgen-forming tumors of the ovary or the adrenal cortex, pharmacological androgenization, e.g. by taking anabolic steroids).


Causes:

It is believed that two gene variants represent the biomolecular basis for polycystic ovary syndrome. The background may be a genetic so-called insulin resistance with increased insulin levels in the blood. The hyperandrogenemia is then the result of an LH effect on the ovaries, which increase their androgen production. Other consequences for the metabolism in this case are often obesity, a lipid metabolism disorder and diabetes mellitus. The second variant is a change in a so-called P450-C17-a gene. It leads to increased androgen production in the ovaries and adrenal glands.



Clinic:

In the case of hyperandrogenemia, the clinical signs are acne, hirsutism and typical androgenetic / hyperandrogenemic alopecia.


At a acnethe skin shows numerous blackheads and more or less inflamed nodules.

As Hirsutismis understood to mean increased hairiness in women, corresponding to the male hair type.

Increased hair loss (effluvium) is when more than 100 hairs fall out every day. Very often it cannot be objectified visually. Alopecia describes visible hair loss in the scalp area. With a so-called androgenetic / hyperandrogenemic alopeciathe woman's hair thins along the parting, the hair density in the area of ​​the temples and back of the head remains normal.

Some women never develop the typical androgenization symptoms due to genetic differences in the sensitivity of the cells to male hormones, while others have (almost) normal androgen levels in their blood despite hirsutism or alopecia. In the case of hirsutism, all other symptoms can even be absent and the menstrual cycle and fertility remain unaffected. The activity of an enzyme in the hair follicle that converts testosterone into its active form, 5α-dihydrotestosterone (DHT), plays a key role in the development of alopecia and hirsutism. With an increased activity of the enzyme, the symptoms can be pronounced in spite of no or only marginally increased testosterone values. Therefore, in alopecia, a distinction is also made between androgenetic alopecia with normal testosterone levels and hyperandrogenemic alopecia with elevated testosterone levels.

Overweight women with polycystic ovary syndrome typically show what is known as android (visceral) obesity, according to their fat distribution pattern, with a waist circumference of more than 80 cm, the hip circumference is smaller (apple shape). Android obesity is one of the most important risk factors in the development of atherosclerosis, heart attack and diabetes mellitus, described as Metabolic Syndrome or Syndrome X. In contrast to android obesity, gynoid obesity has a female fat distribution pattern with emphasis on the hips, including peripheral or called gluteofemoral obesity or "pear type".

The consequence of polycystic ovaries is menstrual cycle disorders. Ovulation rarely or never occurs. The secretory transformation of the uterine lining does not occur (see cycle & hormone levels). The patients are exposed to high levels of estrogen for a long time, often develop severe breakthrough bleeding and have an increased risk of breast cancer and uterine lining cancer in the long term.

Note: The risk of endometrial cancer is 2 to 6 times higher, but the overall incidence of cancer is low. For cycles longer than 90 days, however, a transformation of the uterine lining, e.g. B. be carried out with chlormadinone acetate.

Diagnosis:


Polycystic Ovaries:The definition of polycystic ovaries is inconsistent. A frequently used guide value is based on an ultrasound examination with a determination of at least ten small cystic structures with a diameter of 2 - 9 millimeters per ovaryand / or one increased volume of the ovary(Length x cross x depth x 0.5) of more than ten milliliters. However, it is of full gynecological maturity only eight years after menarchereached. Ultrasound diagnostics can only be recommended at this point because of the physiological appearance of multifollicular ovaries in early adolescence.

Acne:Division into three forms according to their severity
  • Light (acne comedonica): many blackheads (comedones), but they rarely become infected
  • Moderately severe (acne papulopustulosa): numerous reddened nodules and pus vesicles next to blackheads
  • Severe (acne conglobata): many, often very thick, purulent, inflamed vesicles (furuncle-like)