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Modern methods of treatment of Polycystic Ovary Syndrome
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-47-48
Gulammahmudova Dilobar Valijanovna, JSC Republican specialized scientific-practice medical center of obstetrics and gynecology, Tashkent, Uzbekistan E-mail: [email protected]
Modern methods of treatment of Polycystic Ovary Syndrome
Abstract: One of the most frequent reasons of infringements of reproductive function and health in women at the reproductive age is polycystic ovary syndrome (PCOS). According to, the given pathology is under steadfast attention of doctors in the various countries, including, and in our republic.
Keywords: Polycystic Ovary Syndrome, drospirenon, reproductive age, hyperandrogenemia.
Introduction. One of the most frequent reasons of infringements of reproductive function and health in women at the reproductive age is polycystic ovary syndrome (PCOS). According to, the given pathology is under steadfast attention of doctors in the various countries, including, and in our republic. For today the problem of protection of reproductive health of the population is high on the list in legislations and policy of modern progressive society and is one of the priority directions in the Republic of Uzbekistan. One of the most frequent reasons of violations of reproductive function and health at women of fertile age is PCOS. [1; 5; 6; 7]. Communications with that, this pathology is under close attention of doctors in various countries, including, and in our republic. At the same time, clinical practice dictates need to give help to the patients suffering from PCOS and to help them with the solution of problems, basic ofwhich, undoubtedly, is infertility [2; 3; 4]. Besides, violation ofa menstrual cycle, excess growth ofhair, an acne, excess weight are symptoms which are available in various combinations for all patients to PCOS and demand treatment. Unfortunately, questions of quality of life and the state of health of women with PCOS are not investigated adequately. The variety of clinical manifestations of PCOS always caused a set ofdifficulties at its diagnostics. Therefore, the most reliable criteria of its diagnostics interest obstetricians-gynecologists for this reason certain standards for this pathology are developed. The most significant are the conclusions after the seminars held by European Society of Human Reproduction and Embryology and American Society for Reproductive Medicine in Rotterdam (2003), Thessaloniki (2007), Amsterdam (2010) [6; 7; 8].
Aim: Estimate of clinical efficiency from application of the complex oral contraceptive with the anti-androgenic action containing in the structure drospirenon in treatment of PCOS and also influence on a condition of reproductive health at women with PCOS at women of the reproductive age.
Materials and methods research: We conducted the research devoted to studying of clinical efficiencyJess in treatment of patients
Influence on body weight — one of possible metabolic effects the COC, in particular a progestagen component. According to data of literature, drospirenon in combination with etinilestradioly does not cause an increase in weight.
Results of the analysis of the data obtained by us did not reveal statistically significant difference in indicators of body weight and body weight index before therapy in both clinical groups. The hor-
with PCOS. The research included 70 patients with PCOS of an androgenic phenotype, ovulate and anovulate genesis (the main group) which selection was made according to the following criteria:
1. Age: the age of patients corresponded to the reproductive period and made 27,3±2,3 years (from 25 to 33 years).
2. Violation of menstrual cycle: in the anamnesis of all patients permanent violations of a menstrual cycle with menarche were noted.
3. Hormonal violations: at a laboratory research the diagnosis of PCOS was verified by criteria in total with increase in a ratio of LG/FSG more than 2,5.
4. Acceptability application Complex Oral Contraception (COC): Contraindications to appointment the COC were absent.
5. Hyperandrogenemia: in all observations external signs of a hyperandrogenemia.
Patients are divided into 2 groups:
1-the group took place from 35 patients who accepted the COC Jess (an ethenylestradiol of 20 mg drospirenon 3 mg).
2-the group took place from the 35th group of patients who Yarin's COC was appointed (an ethenylestradiol of 30 mg drospirenon 3 mg).
For comparison of the hormonal and metabolic status of 20 women of volunteers were included to group control. To all patients appointed a course of treatment medicine Jess (the 1st group) or Yarina (the 2nd group) consisting of 12 cycles on 21 days with 7-day breaks.
The results: The positive clinical effect was reached at 75% of patients against the background of treatment Jess. In 18,8% observations reduction of intensity of growth of hair, but, according to patients, insufficiently expressed was noted. Only at 6,2% of the patient reduction of expressiveness of a girsutizm was not noted, i. e. the effect of therapy was absent. Thus, according to our data, Jess at sick PCOS leads application to improvement of clinical and laboratory symptomatology that is the basis for use of medicine in a complex of treatment of this contingent of patients.
monal status of women of reproductive age with PCOS depending on various methods treatment is presented in table 2.
In 1st group concentration of LG decreased to 10,7±0,16A, and in 2nd group to 9,86±0,56, with simultaneous increase in an estradiol in both groups. Concentration of testosterone in 1 group decreased to 0,58±0,02; and in 2 group 0,62±0,05. Considerable decrease in concentration of DGEA-S in 2 group is noted.
Table 1. - Anthropometrical features at the examined women of reproductive age on (n=60)
Indicators 1 group (n=35) 2 group (n=35)
After After
weight 67,73±2,6 67,5±3,1 54,6±2,9 55,4±2,7
Body weight index 20,1±1,0 20,3±1,2 20,4±0,75 20,3±0,72
Section 7. Medical science
Both medicines actively suppress development of gonadotropins, more LG. The expressed antigonadotrophin action is shown by normalization of a ratio of LG and FSG, reduction of volume of the cages producing androgens in ovaries, improvement of biochemical conditions of activity of follicles of an ovary. Ultrasonic diagnostics bodies of a small pelvis before treatment revealed PCOS at 71% of patients. In 6 months after treatment in both compared groups these changes were not registered.
The anti-androgenic effect is caused by ability of a drospirenon to interact with receptors of androgens as competitive inhibition
that provides direct influences on hair follicles and sebaceous glands, bringing in a result to obvious cosmetic result.
Efficiency of the medicine "Jess" in treatment of acne rash and moderate severity it was easy it is comparable with the medicine "Yarina". After 6 months of administration of drugs later in group of women of active reproductive age Jess, expressiveness of acne rash decreased by 53%, and in the group receiving Yarina — 46%. Had side effects as intermenstrual bloody allocations on the first packings Jes 10% of women of reproductive age 1 groups.
Table 2. - A condition of the hormonal status against the background of treatment at the studied groups of women reproductive age with PCOS (n=70)
Indicators 2 group (n=35) 1 group (n=35) Control group n=20
After After
FSG 7,0±0,71* 5,8±0,11 5,98±1,1 5,5±0,13 5,6±0,15
LG 29,4±4,8* 10,7±0,16л 17,63±1,2* 9,86±0,56 11,6±0,11
Е2 53,1±9,9* 63,9±5,2 64,9±4,5 69,3±1,79 75,81±4,5
Prolactinum 16,1±1,63 11,2±0,41л 61,0±21,*3 20,5±2,19л* 12,9±2,2
Testosterone 1,1±0,10* 0,58±0,02л* 1,15±0,18* 0,62±0,05л* 0,50±0,02
DGEA-S 1,5±0,09 1,6±0,17 2,5±0,25* 1,3±0,28л 1,29±0,19
Cortisol 163,3±34,2 169,5±13,1 130,24±9,1* 166,4±15,5Л 172,2±20,5
Note: * — reliability of data in comparison with control group (P <0,05-0,01); A — reliability of data after treatment (P <0,05-0,01)
Thus, generalization of results of the carried-out analysis allow to conclude that both medicines are effective in treatment of women of reproductive age with PCOS. Clinical anti-androgenic efficiency is slightly higher at appointment 0.03 etinilestradiol in combination with drospirenony. Influence on hormonal indicators (bystry decrease in the LG level, testosterone normalization) is identical in both clinical groups.
Conclusion: Thus, anti-androgenic properties of Dzhessa are confirmed in clinical trials and allow to recommend this hormonal medicine and as contraceptive means with favorable additional properties, and as remedy at a functional ovary hyperandrogenemia.
1. For treatment of SPKYa and correction of a giperandrogen-iya, and also improvement the condition of reproductive health at women with SPKYa by an androgen phenotype as well as ovulate and anovulate genesis by medicine of the choice is the COOK consisting of gestagen structure drospirenon.
2. In quality the COC, containing drospirenon (gestogen) the most optimum and clinically effective is Jess containing 30 mkg an ethenylestradiol and 20 mg drospirenon.
3. Jess has to be appointed in the faltering mode (7 day) during up to 12 months.
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