Chithandizo cha thumba losunga mazira

PCOS ndi vuto lambiri la mahomoni pakati pa azimayi amsinkhu wobala, zomwe zimapangitsa kuti azikhala osabereka. Ngakhale vutoli likufunika, zomwe zimayambitsa PCOS sizikudziwika.

Amadziwika kuti pafupifupi azimayi onse omwe ali ndi polycystic ovary amakhala ndi insulin kukaniza, i.e., chidwi chawo cha insulin, mahomoni apachirengedwe omwe amayendetsa shuga wamagazi, amachepetsedwa. Zonsezi zimabweretsa kuti insulin imazungulira m'magazi ambiri. Malinga ndi kafukufuku, zitha kulingaliridwa kuti insulini yowonjezera imapangitsa mazira kuti azitha kupanga mahomoni ogonana amuna, ndi androgen, zomwe zimasokoneza kapangidwe kake ndi thumba losunga mazira.

Choyambirira, androjeni amasokoneza kwambiri dongosolo la ovulation, popanda kutenga pakati sikungatheke, kuletsa mazira kukula msanga. Mothandizidwa ndi mahomoni achimuna, chigoba chakunja cha mazira amayamba kukula ndipo masamba ake akakhwima sangathe "kung'amba" kuti dzira lithe kutenga gawo la umuna. Chithunzi chosagawika chimadzazidwa ndimadzimadzi ndikusintha. "Zomwe zimachitikanso ndimitundu ina - amakula ndikusiya kugwira ntchito, kukhala cysts. Chifukwa chake, thumba losunga mazira la mkazi yemwe ali ndi matenda a polycystic ndi kuchuluka kwa cysts zambiri zazing'ono. Chifukwa cha izi, thumba losunga mazira ku PCOS ndilokulirapo kuposa labwinobwino.

Zizindikiro za PCOS

Zizindikiro za PCOS ndizosiyanasiyana. Chinthu choyamba chomwe mkazi amakhala nacho nthawi yayitali. Kuchedwa kwa msambo mu PCOS kumatha kukhala miyezi kapena miyezi isanu ndi umodzi. Popeza kuphwanya kwa ntchito ya m'mimba mwa thumba losunga mazira kumayamba ndi kutha msambo, zovuta za mkombazo zimayamba ndi kutha kwa msambo ndipo sizimasinthasintha. Tiyenera kudziwa kuti zaka zakusamba zikufanana ndi zomwe zimagwirizana ndi anthu - zaka 12 mpaka 13 (mosiyana ndi adrenal hyperandrogenism mu adrenogenital syndrome, nthawi ikayamba kutha). Pafupifupi 10-15% ya odwala, kusamba kwa msambo kumadziwika ndi kukanika kwa uterine kutsutsana ndi maziko a endometrial hyperplastic process. Chifukwa chake, azimayi omwe ali ndi PCOS ali pachiwopsezo chotenga endometrial adenocarcinoma, fibrocystic mastopathy, ndi khansa ya m'mawere.

Mitsempha ya mammoni imapangidwa molondola, mkazi aliyense wachitatu amakhala ndi micopathy ya fibrocystic, yomwe imapangidwa motsutsana ndi maziko a kutulutsa kwatsoka ndi hyperestrogenia.

Kuphatikiza pa kusamba kwa msambo, chifukwa cha kuchuluka kwama mahomoni amphongo, pakukula kukula kwa tsitsi m'thupi lonse (hirsutism). Khungu limakhala mafuta, ziphuphu ndi mutu wakuda zimawonekera kumaso, kumbuyo, pachifuwa. Maonekedwe a mawanga akuda pakhungu limodzi ndi ntchafu zamkati, m'mphepete, m'mikono ndikuwonekera. Tsitsi pamutu limayamba kuthira mafuta chifukwa chosokonekera gps. Hirsutism, yamitundu yosiyanasiyana, imayamba pang'onopang'ono kuyambira nthawi ya kutha msambo, mosiyana ndi adrenogenital syndrome, pomwe hirsutism imayamba kutha msambo, kuyambira pomwe ntchito ya mahomoni a adrenal glands imayamba kugwira ntchito nthawi ya adrenarche.

Pafupifupi odwala onse omwe ali ndi PCOS awonjezera thupi. Zikatero, mafuta ochulukirapo amawayika, nthawi zambiri pamimba ("pakati" mtundu wamafuta). Popeza mulingo wa insulin mu PCOS umakwezedwa, nthawi zambiri matendawa amaphatikizidwa ndi matenda a shuga a 2. PCOS imathandizira pakukula koyambirira kwamatenda a mtima monga matenda oopsa ndi atherosulinosis.

Ndipo pamapeto pake, chimodzi mwazizindikiro zazikulu komanso zosasangalatsa za PCOS ndi kusabereka chifukwa chosowa ovulation.Nthawi zambiri, kusabereka kwenikweni (mu 85% yamilandu), i.e. sipanakhalepo mimba. Kusabereka nthawi zina ndi chizindikiro chokhacho cha ovary ya polycystic. Kusabereka ndikofunikira kwambiri kusiyana ndi adrenal hyperandrogenism, momwe mayi amatha kutenga pakati ndikusokonezeka kwake.

Popeza pali zambiri za matendawa, PCOS imatha kusokonezeka mosavuta ndi vuto lililonse la dishormonal. Paubwana, khungu lamafuta, ziphuphu ndi ziphuphu zimatengedwa pazinthu zokhudzana ndi msinkhu, ndipo kuwonjezereka kwa tsitsi ndi mavuto okhala ndi kulemera kowonjezereka nthawi zambiri kumadziwika ngati mawonekedwe amtundu. Chifukwa chake, ngati msambo suli wosweka ndipo mayiyo sanayesere kukhala ndi pakati, ndiye kuti odwala otere nthawi zambiri satembenukira kuchipatala cha gynecologist. Ndikofunikira kudziwa kuti mawonekedwe aliwonse otere sakhala achizolowezi ndipo ngati mungapeze zomwezi mwa inu nokha, muyenera kufunsa katswiri wa gynecologist-endocrinologist.

Kuzindikira kwa PCOS

Kusintha kwanyumba mu thumba losunga mazira mu PCOS amadziwika ndi:

• zamakhalidwe hyperplasia,
• hyperplasia ya theca cell yokhala ndi luteinization malo,
• kukhalapo kwa ma cystic-atresizing follicles ndi awiri a 5-8 mm., omwe ali pansi pa kapisozi mu mawonekedwe a "khosi",
• ovarian kapisozi kukula

Kuzindikira kwa PCOS kumaphatikizapo:

- Kafukufuku wofufuza ndi kufufuza kwa gynecologist-endocrinologist. Pakufufuzidwa, adokotala akuwonetsa kuwonjezeka kwa thumba losunga mazira ndi zizindikiro zakunja za PCOS,

- Ultrasound yamchiberekero yokhala ndi masensa kumaliseche. Kafukufuku wofikira m'mphepete mwa thumba losunga mazira akuwulula ma follicles ambiri mpaka 10 mm, kuchuluka kwa thumba losunga mazira kumakulitsidwa kwambiri

Miyezo yomveka ya chithunzi cha PCOS: voliyumu yam'mimba imaposa 9 cm 3, Hyperplastic stroma ndi 25% ya voliyumu, kuposa ma foto khumi atretic mpaka 10mm m'mimba mwake, yomwe ili mphepete pansi pa kapulasitiki wokulira. Voliyumu ya ovary imatsimikiziridwa ndi kachitidwe: V = 0.523 (L x Sx H) cm3, pomwe V, L, S, H motsatira kuchuluka, kutalika, m'lifupi ndi makulidwe a m'mimba mwake, 0.523 ndi mgwirizano wokhazikika. Kuwonjezeka kwa voliyumu ya ovari chifukwa cha hyperplastic stroma ndi mawonekedwe a malo omwe mapikowo amathandizira kusiyanitsa thumba losunga mazira kuchokera kwa abwinobwino (patsiku la 5-7th la kuzungulira) kapena multifollicular. Zotsirizazi ndi chikhalidwe cha kutha msanga, hypogonadotropic amenorrhea, kugwiritsa ntchito nthawi yayitali COCs. Ma thumba losunga mazira angapo amakhala ndi ma ultrasound okhala ndi ma follicles ochepa a 4-10 mm., Amapezeka m'chiberekero chonse, chithunzi chazovomerezeka cha stroma ndipo, koposa zonse, kuchuluka kwazinthu zosunga mazira (4-8 cm 3)

- kafukufuku wamahomoni a m'madzi a m'magazi (LH, FSH, prolactin, testosterone yaulere, DHEA-s, 17-OH progesterone). Mahomoni amayenera kutengedwa masiku ena a msambo, ngati sichoncho maphunziro amakhala osathandiza. LH, FSH ndi prolactin zimapereka patsiku la 3-5, testosterone yaulere ndi DHEA-s patsiku la 8-10, ndi progesterone ya 17-OH patsiku la 21 mpaka 22 la mkombero. Monga lamulo, ndi polycystosis, mulingo wa LH ukuwonjezeka (kuchuluka kwa chiŵerengero cha LH / FSH ndi oposa 2,5), prolactin, testosterone ndi DHEA-s, ndipo FSH ndi 17-OH progesterone imatsitsidwa.

- kuyezetsa kwamwazi wamagazi (ndi PCOS, cholesterol, triglycerides ndi glucose akhoza kuchuluka),

- kuyesedwa kwa glucose pakamwa kumachitika kuti mudziwe insulin sensitivity,

- diagnostic laparoscopy ndi yamchiberekero biopsy - chidutswa cha tiziwalo timene timatengedwa kuti timayeserepo kwa mbiriyakale. Endometrial biopsy imasonyezedwa kwa azimayi omwe ali ndi magazi acyclic chifukwa cha pafupipafupi njira za endometrial hyperplastic.

Pambuyo pa sampuli yokhala ndi dexamethasone, zomwe Androgen amachepetsa pang'ono, pafupifupi 25% (chifukwa cha gawo la adrenal).

Kuyesedwa ndi ACTH ndikosakhala bwino, komwe sikumapatula adrenal hyperandrogenism yodziwika ndi adrenogenital syndrome. Kuwonjezeka kwamankhwala a insulin komanso kuchepa kwa PSSG m'magazi kunadziwikanso.

Muzochita zamankhwala, kupindika kwa shuga ndi njira yosavuta komanso yotsika mtengo yotsimikizira kulolera kwa glucose kwa insulin. Mwazi wa magazi umatsimikiziridwa koyamba pamimba yopanda kanthu, ndiye - mkati mwa maola 2 mutatha shuga a g. Ngati atatha maola awiri kuchuluka kwa shuga safika pa manambala oyamba, izi zikuwonetsa kulolerana kwa glucose, i.e, insulin kukana, komwe kumafunika chithandizo choyenera.

Mikhalidwe yodziwira matenda PCOS ndi:

• nthawi yakusamba,
• kusokonekera kwa msambo kuyambira nthawi ya kusamba nthawi zambiri, monga oligomenorrhea,
• hirsutism ndi kunenepa kwambiri kuyambira nthawi yakusamba kwa akazi opitilira 50%,
• kusabereka kwenikweni
• kusokonekera kwachinyengo
• kuchuluka kwa yamchiberekero chifukwa cha stroma malinga ndi transvaginal ultrasound,
• kuchuluka kwa T,
• Kuchulukitsidwa kwa LH ndi chiyezo cha LH / FSH> 2,5.

Chithandizo cha PCOS

Chithandizo cha PCOS chakhazikika chifukwa cha kuwuma kwa zizindikiro komanso kufunitsitsa kwa mkazi kuti akhale ndi pakati. Nthawi zambiri amayamba ndi njira zochizira, mosakhazikika, chithandizo cha opaleshoni chimasonyezedwa.

Ngati mayi ali ndi kunenepa kwambiri, ndiye kuti chithandizo chikuyenera kuyamba ndi kukonza thupi. Kupanda kutero, chithandizo chosasamala mu odwala sichimapereka zonse zomwe mukufuna.

Pamaso pa kunenepa kumachitika:

• Gawo loyamba la chithandizo ndi kufalikira kwa thupi. Kuchepetsa thupi kumbuyo kwa chakudya chochepetsera kumabweretsa matenda a carbohydrate ndi mafuta metabolism. Chakudyachi chimapatsa kuchepetsa chakudya chama calorie chonse mpaka 2000 kcal patsiku, pomwe 52% ndi chakudya chamagulu, 16% ndi mapuloteni ndipo 32% ndi mafuta, ndipo mafuta odzaza sayenera kupitirira 1/3 yamafuta onse. Chofunikira m'zakudya ndizoletsa zakudya zazonunkhira komanso zamchere, zamadzimadzi. Mphamvu yabwino imawonedwa mukamagwiritsa ntchito masiku osala kudya; kusala kudya sikulimbikitsidwa chifukwa chakumwa protein mkati mwa gluconeogeneis. Kuchulukitsa zolimbitsa thupi ndichinthu chofunikira osati kungolimbitsa thupi, komanso kuwonjezera kukhudzika kwa minofu ya minyewa kupita ku insulin. Chovuta kwambiri ndikutsimikizira wodwalayo kufunika kosintha kulemera kwa thupi, ngati gawo loyamba la chithandizo PCOS,
• Gawo lachiwiri la mankhwala ndi mankhwala osokoneza bongo a m'magazi,
• Gawo lachitatu la mankhwala ndi kukondoweza kwa ovulation mutatha kulemera kwa thupi ndi PCOS ndi thupi labwinobwino. Kukondoweza kumachitika pambuyo pa kuphatikizidwa kwa ma tubal ndi amuna chifukwa cha osabereka.

Zolemba zaukadaulo wazachipatala

Cholinga chachikulu chothandizira kuchitira ovaries polycystic ndikubwezeretsa ovulation kwathunthu ndikuchepetsa kuchuluka kwa hyperandrogenism. Kukwaniritsa kumayambitsa kuchotsedwa kwa kudalira kachipangizidwe ka matenda: kusabereka, kusokonezeka kwa msambo, hirsutism. Izi zimatheka ndi othandizira osiyanasiyana, komanso maopareshoni - mawonekedwe a ovarian resection.

Mwa mankhwala osungika, kapangidwe ka estrogen-progestogen (AEGP) amtundu wa bisecurin, osakhala ovlon, ovidone, rigevidone, etc. amagwiritsidwa ntchito kwambiri .. AEEGP imalembedwa kuti iyimitse ntchito ya poniti ya gonadotropic kuchepetsa milingo yayikulu ya LH. Zotsatira zake, kukondoweza kwa ma ovarian androgens kumachepa, ndipo mphamvu yolumikizira TESH imakulanso chifukwa cha gawo la estrogen la SEGP. Zotsatira zake, zoletsa za androgenic zama cyclic za hypothalamus zimachepetsedwa, hirsutism imafooka. Komabe, ziyenera kudziwika kuti nthawi zina, chifukwa cha progestogen yopanga SEGP, yomwe ndi yotengera Cig-steroids, hirsutism ikhoza kukulira. Pali umboni kuti SEHPs amachepetsa androgenic ntchito ya adrenal glands. Kutsika kwa kuchuluka kwa kugunda kwa diurnal vibrations a A synchronous ndi cortisol, kuchepa kwa kukonzanso kwake kwa kunja kwa ACTH, ndi kuchepa kwa kuchuluka kwa kuzungulira kwa DHEA sulfate kumawonedwa.Pambuyo pa mankhwala, mphamvu ya disinhibition (rebound athari) yamchiberekero yamagazi imayang'aniridwa, komwe ndiko cholinga chachikulu cha mankhwalawa. Zotsatira zamankhwala, monga lamulo, kukula kwa mazira amachepa. Nthawi zambiri, maphunziro a 3-6 amachitidwa, piritsi limodzi patsiku kuyambira pa 5 mpaka tsiku la 25 la ozungulira kapena lozungulira. Pankhani ya amenorrhea, mankhwala amayamba pambuyo poyesa progesterone (1% progesterone, 1 ml IM kwa masiku 6) kapena kugwiritsa ntchito gestagen iliyonse (Norcolut 0.005 g 2 pa tsiku kwa masiku 10), kapena njira yozunza ya SEGP (1) piritsi patsiku la masiku 7-10). Pokhapokha ngati pali zotsitsimutsa zambiri mukatha kulandira chithandizo, mutha kutenga nthawi yopuma (miyezi iwiri) kuchitira yachiwiri, yayifupi, kuchokera kuzungulira 2 mpaka 4. Ndi osakwanira kwenikweni (kusungidwa kwa hypoluteinism), chithandizo chowonjezereka chitha kuchitika: 1 mankhwala ozungulira, ndiye kuzungulira kwa 1 popanda iwo, motsogozedwa ndi TFD. Chithandizo chotere ndikofunika kuchitidwa mobwerezabwereza. Chowonetsa kwa iye ndi kuchepa kwa ntchito ya Corpus luteum kuchokera kuzungulira kupita kuzungulira (kufupikitsa gawo lachiwiri kutengera kutentha kwapansi). Kugwiritsa ntchito kwa SEHP kwa polycystic ovary syndrome kumakhalabe otsika, osapitirira 30%. Mukamagwiritsa ntchito, zotsatira zoyipa ndizotheka: nseru, kusungunuka kwa madzi m'thupi, kunenepa kwambiri, kuchepa kwa libido. Nthawi zina, kuwonjezeka kwa hirsutism kumawonedwa. Contraindication ogwiritsa ntchito ndi matenda a chiwindi ndi impso, mitsempha ya varicose ndi thrombophlebitis, chizolowezi cha thrombosis.

Kuphatikiza pa SEGP, mankhwalawa polycystic ovary syndrome, progestogens "oyera", mwachitsanzo norkolut, angagwiritsidwe ntchito. Amasankha 0,005-0.01 g / tsiku kuyambira 16th mpaka 25th tsiku la kuzungulira. Kutalika kwa chithandizo kuchokera pa miyezi iwiri mpaka itatu. Cholinga cha mankhwalawa ndi chofanana ndi SEHP (kuponderezedwa kwa LH, kuchepetsedwa kwa ovarian T, rebound athari). Kugwiritsa ntchito bwino kwa progestogens "koyera" pochiza polycystic ovary syndrome kumakhala kocheperako kuphatikiza ndi estrogens (kuponderezedwa kwapang'onopang'ono kwa LH, mphamvu yomangika ya TESH sikukula), komabe, zotsatira zoyipa zochepa zimawalola kuti azigwiritsidwa ntchito kwambiri, makamaka kuphatikiza ndi mankhwala ena. "Oyeretsa" gestagens amasonyezedwa makamaka kwa endometrial hyperplasia. Amayikidwa kwa nthawi yayitali, maphunziro 6, pa 0,01 g / tsiku. Ndizotheka kugwiritsa ntchito norkolut kuyambira pa 5 mpaka tsiku la 25 la mkombero, koma kufalikira kwa chiberekero nthawi zambiri kumawonedwa ndi chiwembuchi. Kumwa mankhwalawa pa 0,01 g kuyambira pa 16 mpaka tsiku la 25 sikungathandize kwenikweni ndipo pafupifupi sikumapereka zotsatira zoyipa.

Pozindikira khansa ya endometrial, chithandizo chanthawi yayitali chokhala ndi hydroxy-progesterone-capronate (OPK) nthawi zambiri chimachitika ndi 12.5% ​​mu 2 ml / m 2 kawiri pa sabata. Mlingo wa "oncological" nthawi zambiri umadzetsa magazi ambiri, koma umapewa njira zopangira opaleshoni yayikulu.

Kusintha keni keni mwa kuthekera kwa chithandizo chododometsa cha polycystic ovary syndrome kunachitika chifukwa cha mawonekedwe achire osakanikirana a Clomiphene citrate (clomid, clostilbegit) kuyambira 1961. Kugwiritsa ntchito kwambiri kwa mankhwalawa kunapezeka ndendende mu polycystic ovary syndrome. Pafupipafupi kukondoweza kwa ovulation kumafika 70-86%, kuchira kwachuma kumawonedwa mu milandu ya 42-61%.

Mwamwambo, clofimena citrate (K) ndi kabuku kamene kamapezeka ka diethylstilbestrol, i.e., sanali-estrogenidal estrogen. Imakhala ndi zochita za estrogenic ofooka. Nthawi yomweyo, K ndi antiestrogen yolimba, yomwe imatsimikiziridwa ndi mpikisano wake wambiri pokhudzana ndi ma receptor onse amkati ndi ma exrojeni achilendo. Katundu wa antiestrogenic mwachidziwikire ndiwofunika kwambiri pakugwiritsidwa ntchito kwake, i.e., amachotsa mphamvu yotsitsimutsa ya estrone Oi) pamalo opatsa tonic a hypothalamus ndipo, nthawi yomweyo, amathandizira kutulutsidwa kwa LH kuchokera ku chithokomiro cha pituitary. Malo ogwiritsira ntchito K ndi hypothalamus, gland planditary, mphamvu zake mwachindunji pamazira osaphatikizidwa. Monga tawonetsera maphunziro ambiri, K imagwira ntchito ndi gawo lokwanira la E2. Kuphatikiza apo, kugwira ntchito kwake kumadalira mulingo wa T (kukwera kwake, kutsika kwake), kuchuluka kwa LH / FSH (kufupi ndi 1, kukwera kwambiri), komanso kuchuluka kwa hyperprolactinemia.Kukhazikitsa 50-150, osawerengeka 200 mg / tsiku kwa masiku 5-7, nthawi zina masiku 10, kuyambira tsiku la 5 (nthawi zambiri kuchokera tsiku lachitatu) lazungulira. Pofuna kupewa kuthamanga kwa mankhwalawa, munthu ayenera kuyamba maphunziro a 1st ndi kumwa kwa 50 mg / tsiku kuyambira 5th mpaka tsiku la 9 lazungulira. Odwala onenepa kwambiri amawonetsedwa 100 mg / tsiku. Pakusowa kwa chithandizo kuchokera ku njira yoyamba ya chithandizo, maphunziro obwerezedwa ayenera kuchitika mpaka katatu, mpaka 66, ndikuwonjezera pang'onopang'ono mlingo wa tsiku ndi tsiku (koma osapitirira 200-250 mg) ndi / kapena nthawi yayitali ya chithandizo mpaka masiku 7-10 (makamaka ndi kuchepa kwambiri pamlingo FSH). Maonekedwe a nthawi zonse ngati msambo kapena mawonekedwe a hypolutein amawonetsa osakwanira. Kusakhalapo kwa msambo komanso kuwonjezeka kwa kutentha kwa rectal kumawonetsa kusathandiza kwa mankhwalawa. Ndi mphamvu yosakwanira ya K (hypolutein cyges), imatha kuphatikizidwa ndi kuyambitsa kwa chorionic hormone (CG) pa mlingo wa 3000-6000 IU / m kamodzi kapena kawiri panthawi yomwe akuyenera kutsata ovulation, monga momwe akuwonera kutentha kwa mapesi ozungulira. Komabe, ndi polycystic ovary syndrome, makonzedwe owonjezera a hepatitis C sakugwira ntchito monga momwe amachitira mitundu ina yotsatsira, ndipo nthawi zina amatha kuonjezera hirsutism (chifukwa cha kukondweretsedwa kwa stroma ya ovarian). Kutalika kwa chithandizo K ndi munthu payekha ndipo nthawi zina amatha kufikira maphunziro 20. Pambuyo pakufika pazinthu za ovulatory kuzungulira K K, kupumula kwa mankhwalawa kuyenera kuchitidwa ndikuwonetsetsa kuti ikugwira bwino ntchito kuyenera kuyang'aniridwa ndi TFD. Mchitidwewo ukazima, maphunziro obwereza kapena mtundu wina wa chithandizo awonetsedwa. Zotsatira zabwino ziyenera kumvedwa kuti zikwaniritse ovulation yonse ndikugwira ntchito kwa Corpus luteum, osati kuyambika kwa kutenga pakati, monga odwala ena omwe amakhalabe ndi pakati pomwe ovulation wabwinobwino amabwezeretsedwa amakhulupirira kuti mtundu uwu wa chithandizo suwathandiza. Tiyeneranso kudziwa kuti kutenga pakati kumachitika kawirikawiri pambuyo poti chithandizo chathetsedwa, mkombelo wotsatira, popeza mukamamwa mankhwalawa chifukwa cha antiestrogenic yake, kapangidwe ka khosi lachiberekero kamasinthasintha, zomwe zimapangitsa kuti zikhale zovuta kulowa umuna kudzera mmimba. Tiyenera kudziwa kuti pankhani yovomerezeka ya ovulation, mlingo wa T umayamba kuchepa, ndipo pafupifupi 15% ya odwala amawona kuchepa kapena kuchepa kwa kukula kwa tsitsi. Kuphatikizidwa kwa K ndi menopausal human gonadotropin ndi CG kumachepetsa mlingo wa mankhwala onse omwe amagwiritsidwa ntchito. Chiwopsezo cha kuchepa kwamchiberekero chofotokozedwa ndi olemba angapo kumayambiriro kwa mankhwalawa chimakokometsedwa bwino. Amawonedwa kangapo ndipo samatengera mlingo wa mankhwalawo, koma amatsimikiza ndi chidwi chake. Zotsatira zina zoyipa, monga kuwonongeka kwa mawonedwe, kusowa kwa tsitsi pamutu, ndizosowa komanso kuzimiririka atasiya kugwiritsa ntchito mankhwalawa. Ngakhale chithandizo chofunikira kwambiri cha polycystic ovary syndrome K, olemba angapo amakhulupirira kuti izi ndizakanthawi ndipo mwa odwala ambiri sizitsogolera kukhululukirana. Malinga ndi chidziwitso chathu, zotsatira zake zimapitilira kudalira kofanana ndi kufalikira kwa chithandizo cha matenda a T, LH / FSH ndi zizindikiro zina zamankhwala.

Mwanjira zatsopano zowonjezera zotseguka zimatsegulidwa ndikubwera kwa mankhwala okhala ndi antiandrogenic katundu (cyproterone acetate - C). Mu 1962, F. Neumann et al. kaphatikizidwe C, kamene kamachokera mu hydroxyprogesterone. Gulu la methyl ndilofunika kwambiri pakuchitapo kanthu kwa antiandrogenic. C imachita mpikisano ndi dihydrotestosterone (DHT) pokhudzana ndi ma cytoplasmic receptors, kuphatikiza apo, imalepheretsa kusamutsidwa. Chifukwa chake, pali kuchepa kwa zochita za androgenic, ndiye kuti, kuyambika kwa kupikisana kwa ziwonetserozo m ziwalo za chandamale. Pamodzi ndi antiandrogenic katundu, C imakhalanso ndi mphamvu yotchedwa gestagenic ndi antigonadotropic. Imapitilira kugulitsa pansi pa dzina ndirocourt.

Mankhwalawa amagwiritsidwa ntchito pochiza matenda amtundu wa androgen omwe amadalira pakhungu ndi zowonjezera zake, makamaka ndi hirsutism, mafuta a seborrhea, ziphuphu, androgenetic alopecia, omwe amapezekanso ndi polycystic ovary syndrome. Kugwiritsa ntchito kwa androcur mu syndrome kumapangitsa munthu kuti azitha kupeza zodzikongoletsera zokha, komanso kuchitapo kanthu pazolumikizana za pathogenetic, makamaka, chifukwa cha antigonadotropic zotsatira, ndizotheka kuchepetsa milingo yayikulu ya LH ndikuchepetsa ovarian T. Androcur imagwiritsidwa ntchito limodzi ndi estrogens (0,05 mg microfollin) / tsiku). Chifukwa chakuti mankhwalawa amadziunjikira mu minofu ya adipose, I. Hammerstein adati "njira yofanana", kutanthauza, androcur (monga progestogen) adalembedwa kumayambiriro kwa kuzungulira, kuyambira pa 5 mpaka tsiku la 14, 50-100 mg / tsiku, ndipo kudya kwa estrogen kumadutsa ndi androcure, ethinyl estradiol imayikidwa pa 0,05 mg (kuyambira pa 5 mpaka tsiku la 25 la mkombero). Kugwiritsa ntchito mankhwalawa kwa maphunziro a 6-9 kungathandize kwambiri kuchepetsa vuto la hirsutism, maphunziro 9-12 ndi othandiza mu androgenetic alopecia. Kugwira bwino kwambiri komwe kumachitika ndi ziphuphu. Zotsatira za chithandizo chotere, kuchepa kwa kukula kwa ovari kumawonedwanso. Gawo la estrogenic limathandizira kugwa kwa hirsutism powonjezera mphamvu yomanga ya TESG. Mankhwalawa nthawi zambiri amaloledwa bwino, mavuto ochepa (mastodynia, mutu, kuyabwa, kuchepa libido) ndi osowa komanso owopsa. Kukhumudwitsa kwokhudzana ndi ntchito ya adrenal cortex, yomwe imafotokozedwa kwa ana panthawi ya chithandizo ndi kugonana kwa msanga ndi androcur, nthawi zambiri samawonedwa mwa akulu omwe ali ndi polycystic ovary syndrome. Kugwiritsidwa ntchito kwake kumapangidwa mu thrombophlebitis, pakati.

Therapy yokhala ndi Mlingo waukulu wa androcura imachitika nthawi yoyamba ya mankhwalawa, ndipo, ngati kuli koyenera, amasinthira ku mlingo wokonza. Pachifukwa ichi, mankhwala a Diana amagwiritsidwa ntchito, piritsi limodzi lomwe 0,05 mg wa ethinyl estradiol ndi 2 mg ya androcura. Diana amagwiritsidwa ntchito molingana ndi chiwembu chazomwe amalembera pakamwa: kuyambira pa 5 mpaka tsiku la 25 la kuzungulira, piritsi limodzi patsiku. Ngati kuchepa kwa msambo kutha, kuyambika kwa makonda kungasunthidwe ku tsiku la 3 komanso tsiku la 1 lazungulira. Chithandizo chimawathandiza kusamalira bwino zotsatira za androcourt waukulu. Kuphatikiza apo, mankhwalawa atha kubwezeretsanso SEHP. Derivatives of Cig-steroids, yomwe imatha kukongoletsa hirsutism, imaphatikizidwa muzipangidwe zawo monga progestogen. Contraindication ndi zoyipa ku Diana ndizofanana ku Androkur. Zomwe tidakumana nazo zimatsimikizira magwiridwe antchito apamwamba a antiandrogen mu hirsutism wamavuto osiyanasiyana.

Veroshpiron imagwiritsidwanso ntchito ngati antiandrogen. Kapangidwe ka kachitidwe kake ndikulepheretsa kupanga kwa T pa 17-hydroxylation site, kupikisana mpikisano kumanga kwa DHT ku zotumphukira zolandilira, kupititsa patsogolo katemera wa androgens, komanso kukhazikitsa kutembenuka kwapadera kwa T ku ma estrogens. Veroshpiron adayikidwa mu Mlingo wosiyanasiyana, kuyambira 50 mpaka 200 ngakhale 300 mg / tsiku, mosalekeza kapena kuyambira pa 5 mpaka tsiku la 25 la mzunguko. Nthawi zambiri ndi chiwembu chotere, kuwonekera kwamtambo kumawonekera, komwe kumatha kuthetsedwa ndi kayendetsedwe ka gestagens (norkolut, norethisterone acetate) kapena veroshpiron ikhoza kugwiritsidwa ntchito pokhapokha theka lachiwiri lazungulira. Kuchiza kuyenera kuchitika kwa nthawi yayitali, osachepera miyezi isanu. E. K. Komarov anena zabwino zake zamankhwala. Pankhaniyi, kuchuluka kwa chimbudzi mu mkodzo wa 17-KS sikusintha, zomwe T zimacheperachepera, kuwonjezeka kwakukulu kwa Efu komanso kusowa kwa kusintha kwa mulingo wa progesterone m'magazi kumawonedwa. Ngakhale kuchuluka kwa zowonjezera za Eze, kuchuluka kwa LH ndi FSH m'magazi sikusintha kwambiri. Kutentha kwamtondo kumakhalabe monophasic. Chifukwa chake, veroshpiron angagwiritsidwe ntchito pochiza matenda ovarian hyperandrogenism, makamaka chifukwa cha zodzikongoletsera, kuchepetsa hirsutism.

Malo apadera pa mankhwalawa a polycystic ovary syndrome amakhala ndi glucocorticoids (prednisone, dexamethasone). Funso la kugwiritsa ntchito kwawo matendawa limatsutsanabe. Olemba ntchito zapakhomo amalimbikitsa kugwiritsa ntchito glucocorticoids mu adrenal mawonekedwe a polycystic ovary syndrome - dexamethasone 1/2 piritsi 1 patsiku.Kutalika kwa mankhwalawa ndikosiyana: kuyambira miyezi itatu mpaka chaka chimodzi kapena kupitirira apo. Olemba ena amati mitundu yocheperako panjira imagwiritsa ntchito glucocorticoids pokhapokha gawo lachiwiri lazungulira. Dongosolo loterolo limasemphana ndi cholinga chamankhwala - mmalo mopondereza ntchito ya androgenic ya adrenal cortex, kutsegulira kwake kumatha kupezeka chifukwa cha kupatsanso mphamvu. EM Vikhlyaeva akuwonetsa kuyipa kwa kuphatikiza kwa clomiphene ndi dexamethasone mu mawonekedwe osakanikirana a polycystic ovary syndrome. Kuwunika kuyendetsa bwino kuponderezera kwa androgenic ntchito ya adrenal cortex ndikulondola kwambiri pakuwona DHEA sulfate ndi 17-OH progesterone m'magazi kuposa kuwonetsa kwam'mimba kwa 17-KS. Monga tafotokozera ndi S. S. S. Ye, zotsatira za corticosteroid therapy zimawoneka zolimbikitsa kwa odwala omwe ali ndi polycystic ovary syndrome yokhala ndi chidziwitso chachikulu cha adrenal androgen. Kuponderezedwa kwa ntchito ya adrenal gland kuyenera kuchepetsa dothi lathunthu la androgen, chifukwa chake, kuphatikiza kwa glandular ya estrone. Komabe, vutoli mwina ndizovuta kwambiri, monga zapezeka posachedwa kuti corticosteroids imakhala ndi chopinga chosankha cha FSH-indised aromatase shughuli mu granulosa cell of ovaries mu vitro. Chifukwa chake, corticosteroid suppressapy pamafunika kuwunikira kwakukulu kuti muwone kufunikira kwake. Kugwiritsa ntchito dexamethasone ndikulimbikitsidwa, makamaka ndi kuwonjezeka kwa DHEA sulfate.

M'zaka zaposachedwa, polumikizana ndi hyperprolactinemia yomwe imapezeka kawirikawiri ndi polycystic ovary syndrome, amayesedwa kuti agwiritse ntchito parlodel. Monga mitundu ina ya ovulation chisokonezo ndi hyperprolactinemia, zimatsogolera kuti matenda a prolactin achulukane. Mu polycystic ovary syndrome, parlodel monga dopamine agonist imatha kubweretsanso kuchepa kwapadera kwa milingo yayikulu ya LH, yomwe imapangitsa kutsika kwina kwa T. Komabe, mwazonse, kugwiritsa ntchito kwa parlodel mu polycystic ovary syndrome kwatsimikizira kuti sikothandiza. Nthawi yomweyo, atayambitsa, tinawona kuwonjezeka kwa kumva kwa K. Chifukwa chake, mankhwalawa amatha kukhala ndi malo enaake pazovuta za polycystic ovary syndrome.

Kutchulidwa kuyenera kupangidwa kuti ndizotheka kuchiza odwala omwe ali ndi polycystic ovary syndrome ndi pergonal kapena MCH (75 U FSH ndi 75 U CG) kuphatikiza CG. Mankhwalawa amathandizira kulumikizana ndi chimodzi mwa zigawo zikuluzikulu za pathogenetic za thumba losunga mazira la polycystic - kusangalatsa kwa kusasitsa kwa follicle, maselo a granulosa ndi ntchito yake yovuta. Koma zambiri sizikumveka pankhaniyi. Pali umboni kuti kuperekedwa kwa pergonal kwa odwala omwe ali ndi polycystic ovary syndrome kumapangitsa kuchuluka kwa T m'magazi. Nthawi yomweyo, pamakhala malipoti okhudza kuthandizira kwa mankhwalawa, komabe, pali hypersensitivity ya ovary polycystic to pergonal ndi mwayi wa hyperstimulation. Chithandizo chimachitika pa 75-225 IU MCH mu / m tsiku lililonse, kuyambira tsiku lachitatu la kuzungulira. Atafika pa pre-ovulatory level of E2 (300-700 pg / ml), yopuma imapangidwa tsiku limodzi, pambuyo pake mlingo waukulu wa hepatitis C (3000-9000) umaperekedwa kamodzi, zomwe zimayambitsa ovulation wa follicle okhwima. Ndi osakwanira mu zotsatirazi, mlingo wa mankhwalawa utha kuchuluka. Kutalika kwa mankhwalawa kumachokera muzinthu zingapo. Mankhwala, kuwunikira tsiku ndi tsiku ndi dokotala, kuyang'anira ndi TFD ndikakamizidwe, kufufuza kwa kusasitsa kwa follicle pogwiritsa ntchito ultrasound ndi kutsimikiza kwa E2 m'magazi ndikofunikira. Kuthekera kogwiritsa ntchito kukonzekera koyera kwa FSH kukufotokozedwa. Pali chidziwitso chogwiritsidwa ntchito moyenera pokhudzana ndi polycystic ovary syndrome yoliberin kuti ichititse ovulation. Komabe, machitidwe a MCH ndi choliberin mu polycystic ovary syndrome nthawi zambiri amakhala otsika kuposa mankhwala ena achikhalidwe (progestins, clomiphene).

Zonsezi zothandizira pochiza matenda a ovary polycystic zitha kugwiritsidwa ntchito m'njira zonse zamatenda komanso mitundu yosakanikirana ya hyperandrogenism (kumbuyo kapena pamodzi ndi glucocorticoids), komanso mitundu ya atypical kapena yapakati. Ndi mafomu apakati, pali zina mwa mankhwalawa. Malo oyamba omwe amathandizidwa ndi chithandizo chamankhwala ndi choletsa chakudya, mafuta, mchere, umalimbana ndi kuchepetsa thupi. Zakudya zonse zopatsa mphamvu zonse ndi 1800 kcal / tsiku (tebulo 8). Masiku osala kudya a 1-2 pa sabata amayambitsidwa. Zizindikiro zakuchulukirachulukira kwachulukidwe, microsymptomatics, ndi zotsatira za endocraniosis pa X-ray ya chigaza zikadziwika, chithandizo cha kuchepa kwa madzi amthupi chimachitika, kuphatikiza kuletsa kokhazikika kwa mchere, diuretics (furosemide, triampur). Mankhwala othandizanso amagwiritsidwa ntchito, monga aloe, ulusi, vitreous, bioquinol No. 15-20, 2-3 ml im tsiku lililonse. Kutikakamiza kutikita minofu ya khomo lachiberekero, ma electrophoresis am'mimba ndi mavitamini B Kwa nthawi yayitali, funso lofunikanso kulumikizana munthawi yomweyo mankhwala a mahomoni ndi kuthekera kochita opaleshoni kwa gulu la odwala lidatsutsidwa. Pakadali pano, amavomerezedwa kuti chithandizo cha mawonekedwe a atypical polycystic ovary syndrome chiyenera kuphatikizapo kuphatikiza kwa mankhwalawa pamankhwala limodzi ndi kugwirizana kwa estrogen-progestogen kapena mankhwala a progestogen kuti matenda abwinidwe gonadotropic. Monga akuwonetsera V. N. Serov ndi A. A. Kozhin, chinthu chofunikira mu chithunzi cha pathogenetic cha matendawa ndi kusintha kwa gawo lotchulidwa. Kuwongolera kwachipatala pazigawo zoyambirira za neuroendocrine masinthidwe (hyperfunction of hypothalamic patterns) zitha kugwiritsidwa ntchito moyenera kuthana ndi mitu ikuluikulu yomwe ili munthawi yogwira ntchito. Kumayambiriro kwa njirayi, olemba amalimbikitsa kugwiritsa ntchito njira zochizira zomwe zimalepheretsa hypothalamus, kuchepa kwapang'onopang'ono kwa zochitika za hypothalamic-pituitary. Pachifukwa ichi, ndikofunikira, pamodzi ndi zakudya, osakhazikika mtima, mavitamini a gulu B, kugwiritsa ntchito mankhwala a estrogen-progestogen, progestins. Amalimbikitsanso othandizira kuti azisintha kubisalira kwa ma neurotransmitters (parlodel, diphenin).

Ngakhale akuwonjezeka kwa zida zamagetsi zamakono za mahomoni obwezeretsanso kwa odwala omwe ali ndi polycystic ovary syndrome, kuthekera kwa chithandizo chokhazikika kumatha malire, ndipo opaleshoni yakale imakhalabe njira yayikulu yothandizira. Pakadali pano, sikufanana ndi momwe amaikira m'mimba mwake, koma kuwunika kwa gawo lalikulu kwambiri la chisa chake ndi kuteteza kwambiri kotakata, kotsekera ndi makoko a follicular malinga ndi mtundu woperekedwa. Kubwezeretsa m'mimba kumafika pa 96%, chonde - 72% kapena kupitilira. Kutha kwathunthu kwa kukula kwa tsitsi la pathological kunadziwika mu 10-12% ya odwala. Njira yopangira opaleshoni yamankhwala sichidziwikabe bwinobwino. Olemba ambiri amati kuchepa kwa kuchuluka kwa ma ovarian androgens, komwe kumakupatsani mwayi kuti muwononge ozungulira. Pambuyo pa opareshoni, gawo lokwera la LH limatsika, chiŵerengero cha LH / FSH chimasintha. Malinga ndi A.D. Dobracheva, kugwiritsa ntchito bwino kwa maopaleshoni kumadalira kuchuluka kwa LH pawiri ndi minyewa yapakati pa thumba losunga mazira la polycystic: zotsatira zabwino zimawonedwa ndikusunga dzira limodzi.

Posachedwa, panali lingaliro loti mayendedwe a mawonekedwe a ovari amakhala osakhalitsa, ndipo opaleshoni idalimbikitsidwa chifukwa chodandaula. Komabe, kuwerengetsa kwa mbiri yotsatila kunawonetsa kuti zotsatira zabwino kwambiri zimachitika zaka ziwiri pambuyo pa opareshoni.Monga momwe zimachitikira, mphamvu ya opaleshoni yamankhwala okalamba mu gulu lakale ndi yotsika kuposa kwa odwala aang'ono. Kuchiza kwa nthawi yayitali kapena kuwongolera kwa odwala kumayambitsa kusintha kosasintha m'mimba, ndipo muzochitika izi, chithandizo cha opaleshoni chimakhalanso chothandiza. Izi ziyenera, mwachidziwikire, ziyenera kukumbukiridwa pakuwunika kuthekera kwa chithandizo cha opaleshoni chapakati pa polycystic ovary syndrome, pamene, monga lamulo, chithandizo cha Conservative chimachitika nthawi yayitali. Pakadali pano, olemba ambiri akuwonetsa kuti ngati vuto lakusoyoka sikuyenera kupitilira miyezi 6-12 - muzochitika izi, kulowererapo kwa opaleshoni kukuwoneka.

Maukadaulo opangira opaleshoni amasonyezedwanso ku chiopsezo chokhala ndi endometrial hyperplastic, mpaka khansa, yomwe Y. V. Bohman amawona kuti ndi vuto lakumapeto kwa nthawi yayitali yomwe sipanachitike ovomerezeka ya polycystic ovary. B. I. Zheleznov akuti, malinga ndi deta yake, zochitika za endometrial hyperplasia zinali 19.5%, adenocarcinomas - 2,5%. Kubwezeretsa ovulation ndi ntchito yonse ya Corpus luteum chifukwa cha opaleshoni ndikupewa khansa ya endometrial. Olemba ambiri amalimbikitsa kuti azizindikira kupuma kwa chibelekero mkati mwazithunzi.

Ndi ma stromal ovarian tekomatosis, ziyenera kukumbukiridwa kuti nthawi zambiri zimayendera limodzi ndi zizindikiro za hypothalamic-pituitary syndrome. Ndi matenda awa, chithandizo chambiri chokhazikika sichitha. Chithandizo cha opereshoni chimaperekanso gawo lotsika lachiwonetsero cha ntchito yamchiberekero, koma kwambiri kuposa mankhwala. Tiyeneranso kudziwa kuti mitundu yosiyanasiyana ya polycystic ovary syndrome, komanso strecal ovarian tecomatosis, chithandizo sichitha pambuyo poti maukwati apangidwe. Kutsatira kofunikira kumafunikira, ndipo miyezi 3-6 itatha opareshoni, ngati singagwire ntchito mokwanira, chithandizo chamankhwala chimachitika, momwe njira zonse zomwe zimagwiritsidwira ntchito ngati njira yodziyimira payokha ya polycystic ovary syndrome. Tiyenera kudziwa kuti, malinga ndi deta yathu, atachitidwa opaleshoni, chidwi cha Clomiphene chikuwonjezeka. Izi ziyenera kukumbukiridwa posankha mtundu wa mankhwalawa kuti mupewe hyperstimulation ya ovari. Kuchepetsa kotereku kwa chithandizo chamankhwala kumawunikira kungakulitse kwambiri chithandizo cha odwala omwe ali ndi polycystic ovary syndrome, kuphatikizapo chonde.

Chithandizo chowongolera cha PCOS

Zolinga za chithandizo chosasamala cha PCOS ndikulimbikitsa njira yovundikira (ngati mayi ali ndi chidwi ndi pakati), kubwezeretsa nthawi yofananira ya kusamba, kuchepetsa kuwonetsa kwa hyperandrogenism (kuwonjezerera tsitsi, ziphuphu, ndi zina), ndi kusakanikirana kwa matenda a carbohydrate ndi lipid metabolism.

Pankhani ya kufooka kwa kagayidwe kazakudya, kusabereka kumayambira poika mankhwala a hypoglycemic kuchokera ku gulu la Biguanide (Metformin). Mankhwalawa amawongolera kuchuluka kwa shuga m'magazi, njira ya mankhwala ndi miyezi 3-6, Mlingo amasankhidwa payekhapayekha.

Kupititsa patsogolo ovulation, amagwiritsa ntchito antiqurogen Clomiphene citrate wa mankhwala osokoneza bongo, omwe amathandizira kutulutsa dzira kuchokera ku ovary. Mankhwalawa amagwiritsidwa ntchito patsiku la 5 mpaka 10 la msambo. Pafupifupi, mutatha kugwiritsa ntchito Clomiphene, ovulation imabwezeretsedwa mu 60% ya odwala, mimba imachitika 35%.

Pokhapokha ngati zotsatira za Clomiphene, mahomoni a gonadotropic monga Pergonal, Humegon amagwiritsidwa ntchito polimbikitsa ovulation. Kukondoweza kwa mahomoni kuyenera kuchitika moyang'aniridwa ndi katswiri wa gynecologist. Mphamvu ya chithandizo imayesedwa pogwiritsa ntchito ultrasound ndi basal body kutentha.

Ngati mayi sakukonzekera kutenga pakati, njira zakulera zophatikizira pakamwa (COCs) ndi antiandrogenic kuti azikonzanso msambo zimayikidwa pochizira PCOS Awa ndi omwe ma COCs Yarina, Diane-35, Janine, Jes. Ndi mphamvu yokwanira ya antiandrogenic yama COCs, ndizotheka kugwiritsa ntchito mankhwala okhala ndi antiandrogens (Androcur) kuyambira tsiku la 5 mpaka tsiku la 15 lazungulira. Chithandizo chimachitidwa ndikuwunikira kwamphamvu mphamvu ya m'magazi. Njira ya mankhwala ambiri kuyambira miyezi 6 mpaka chaka.

Veroshpiron ya potaziyamu-yosungirako, yomwe imagwiritsidwanso ntchito ngati ovary ya polycystic, ili ndi katundu wotsutsa kwambiri wa androgenic. Mankhwala amachepetsa kapangidwe ka androgens ndikuletsa zomwe zimapangitsa m'thupi. Mankhwala wololedwa osachepera miyezi isanu ndi umodzi.

Kukondoweza kwa ovulation mu PCOS. Clomiphene

Clomiphene ndi estrogen wopanda mankhwala. Makina a zochita zake amatengera blockade ya estradiol receptors. Pambuyo pa Clomiphene kuthetsedwa ndi mayankho amachitidwe, GnRH secretion imalimbikitsidwa, yomwe imapangitsa kutulutsidwa kwa LH ndi FSH ndipo, motero, kukula ndi kusasinthika kwa masamba mu ovary. Chifukwa chake, clomiphene simalimbikitsa thumba losunga mazira, koma limapereka tanthauzo kudzera mu dongosolo la hypothalamic-pituitary. Kukondwerera kwa Clomiphene ovulation kumayamba kuyambira pa 5 mpaka tsiku la 9 la msambo, 50 mg patsiku. Ndi regimen iyi, kuwonjezeka kwa gonadrtropins yoyambitsidwa ndi clomiphene kumachitika panthawi yomwe kusankha kwa follicle yotchuka kumalizidwa kale. M'mbuyomu makonzedwe a Clomiphene amatha kulimbikitsa kukula kwama follicle angapo ndikukulitsa mwayi wokhala ndi pakati ambiri. Popeza ovulation molingana ndi ultrasound ndi basal kutentha, mlingo wa clomiphene ukhoza kuwonjezereka muzotsatira zilizonse ndi 50 mg, mpaka 200 mg patsiku. Komabe, akatswiri ambiri azachipatala amakhulupirira kuti ngati palibe phindu mukamapereka mankhwala a 100-150 mg wa clomiphene, ndiye kuti kuwonjezereka kwa mlingo kumakhala kopanda tanthauzo. Popeza ovulation pazipita mlingo 3 miyezi, wodwalayo angayesedwe kugonjetsedwa ndi clomiphene. Zomwe mungagwiritse ntchito polimbikitsa kukoka kwa ovulation ndi:

• Kubwezeretsa nthawi zonse kwa msambo ndi kutentha kwa kutentha kwa masiku 12-16,
• mulingo wa progesterone pakati pa gawo lachiwiri lazungulira ndi 5 ng / ml. ndi zina zambiri, pre-ovulatory peak of LH,
• Zizindikiro za Ultrasound za ovulation patsiku la 13-16 mkombero:
• kukhalapo kwa follicle wotchuka kwambiri ndi mainchesi pafupifupi 18 mm.,
• makulidwe endometrial osapitirira 8-10 mm.

Pamaso pa zizindikirozi, tikulimbikitsidwa kuperekera mlingo wa 7500-10000 IU wa chorionic gonadotropin - hCG (prophase, choragon, kuzunguliridwa), pambuyo poti ma ovulation amadziwika pambuyo pa maola 36-48. ntchofu ("khosi louma"), lomwe limaletsa kulowerera kwa umuna ndikulepheretsa kuchuluka kwa endometrium ndikuwatsogolera kulowetsedwa ngati dzira latsala. Kuti muthane ndi mavuto osafunikawa a mankhwalawa, tikulimbikitsidwa kuti mutenge 1-2 mg ya estrogens zachilengedwe mutatenga clomiphene. kapena ma analogues awo opanga (microfollin) kuyambira pa 10 mpaka tsiku la 14 la kuzungulira kuti awonjezere kupezeka kwa khomo lachiberekero komanso kuchuluka kwa endometrium.

Pankhani yakusakwanira kwa gawo luteal, tikulimbikitsidwa kusankha magawo awiri azungulira kuchokera pa 16 mpaka tsiku la 25. Nthawi yomweyo, kukonzekera kwa progesterone (duphaston, utrozhestan) ndikofunikira.

The pafupipafupi ovulation kumachitika pa mankhwala ndi clomiphene pafupifupi 60-65%, kuyambika kwa mimba mu 32-35% ya milandu, pafupipafupi angapo mimba, makamaka mapasa, ndi 5-6%, chiopsezo cha ectopic pakati komanso pangozi yomweyo padera siwachuluka kuposa kuchuluka kwa anthu. Pakakhala kutenga pakati pa ovulatory m'zinthu, kupatulidwa kwa peritoneal osabereka zinthu nthawi laparoscopy amafunikira.

Ndi kukana clomiphene, gonadotropic mankhwala zotchulidwa - mwachindunji kukondoweza ovulation. Ntchito menopausal gonadotropin (hMG), yokonzedwa ndi mkodzo wa akazi a postmenopausal. Kukonzekera kwa HMG kuli ndi LH ndi FSH, 75 IU iliyonse (pergonal, menogon, menopur, etc.). Popereka mankhwala a gonadotropins, wodwalayo ayenera kudziwitsidwa za chiwopsezo cha kutenga pakati ambiri, kutukuka kotheka ovarian hyperstimulation syndrome, komanso mtengo wokwanira wa chithandizo. Kuchiza kuyenera kuchitika pokhapokha kupatula kwa matenda a chiberekero ndi machubu, komanso chifukwa chachimuna. Mothandizidwa ndi mankhwalawa, kuwunikira kwa transvaginal Ultr foluloulois ndi endometrial ndikofunikira. Ovulation imayambitsidwa ndi makonzedwe amodzi a hCG pa mlingo wa 7500-10000 IU, pomwe pali follicle imodzi ndi mainchesi 17 mm. Ngati ma follicles opitilira 2 okhala ndi mulifupi mwake 16mm atapezeka. kapena ma follicles a 4 omwe ndi mainchesi opitilira 14 mm. kayendetsedwe ka hCG ndi osafunika chifukwa choopsa cha kuchuluka kwa pakati.

Pamene ovulation imakhudzidwa ndi gonadotropins, kuchuluka kwa mimba kumakwera mpaka 60%, chiwopsezo cha kubereka kambiri ndi 10-25%, mimba ya ectopic ndi 2.5-6%, kusokonekera kwazovomerezeka pamizere yomwe imatha mu mimba kufika 12-30%, ovarian hyperstimulation syndrome imawonedwa mu 5 -6% ya milandu.

Kodi chiwopsezo cha mankhwala a mahomoni ndi chiyani?

Matenda a Polycystic si matenda osiyana, koma amayimira zomwe zimayambitsa kapena zovuta zina zamatenda ena. Musanachiritse matenda a polycystic ovary, muyenera kutsimikizira kupezeka kwa matendawa. Kuti muchite izi, pazizindikiro zoyambirira zamavuto ndi magwiridwe antchito a kubereka, muyenera kupita ku chipatala komwe katswiri azidzakuwunikirani njira zingapo zodziwitsira, zomwe zimatengera anamnesis. Pali chinsinsi chowonjezeka cha androgens ndi estrogens, insulin hypersecretion.

Hormone therapy ikhoza kuyambitsa kusokonekera kwa mahomoni.

Vutoli limatanthauzira kuchuluka kwa matenda amomwe amayamba chifukwa cha kusokonekera kwa mahomoni. Nthawi zambiri, polycystic yophatikizidwa ndi kusamba kwa msambo komanso mavuto ndi kubereka kwa mwana. Zinthu zazikulu zomwe zikufunika kuthana ndi vutoli ndi:

• kuwona zakudya zoyenera,
• masewera mwatsatanetsatane
• kupewa zoipa zomwe zimawonetsedwa pakumwa mowa ndi kusuta,
• nokha kulemera.

Chithandizo chachikulu pakuchitidwa kwa mankhwala a mahomoni ndi kugwiritsa ntchito mankhwala apadera. Tsoka ilo, palibe njira zapadera zochiritsira matendawa, koma mankhwala ena amachepetsa kwambiri zovuta zina, mwachitsanzo, shuga, uterine oncology, osabereka, matenda amtima, ndi zina zambiri.

Ngati wodwala safuna kukhala ndi mtsogolo m'tsogolo, ndiye kuti njira zakulera zimagwiritsidwa ntchito pochiritsa. Chifukwa cha zake antiandrogenic, kayendedwe ka kusamba kwa msambo kumachitika. Mankhwala otsatirawa ali ndi izi:

Mapiritsi oletsa kubereka a Chloe

Ngati pali kulephera kwa zotsatira za antiandrogenic zotsatira za COCs, ndiye kuti zimaphatikizidwa ndi kudya kwa antiandrogens (Androcur) kuyambira pa 5th mpaka tsiku la 15 la msambo. Onetsetsani kuti mankhwalawa akuphatikizidwa ndikuwongolera kuchuluka kwa magazi onse. Kutalika kwa mankhwalawa kumatha miyezi 6-12.

Tiyenera kudziwa kuti mankhwala a mahomoni amabweretsa mavuto osiyanasiyana, makamaka chifukwa chakuti mkazi sangakhale ndi ana mtsogolo. Kuphatikiza apo, msambo umasokonezeka ndipo mavuto akulu azaumoyo amawonekera.Ndikofunika kwambiri kusiya njira yodzichiritsira nokha ndikusasamala za zomwe muli nazo, chifukwa chake muyenera kupita kuchipatala pafupipafupi kuti adokotala azikuphunzirani.

Ndi chithandizo choyenera komanso chapanthawi yake, vutoli limakhala labwino, zizindikilo zimatha kuchokapo, ndipo mkazi amatha kubereka ndi kubereka mwana wathanzi. Komabe, zidzakhala zofunikira kuwongolera momwe gawo la mahomoni lakhalira ndi moyo wonse. Komabe, ngati sichinachitike kapena nthawi itatayika, kusabereka kumatha kukhala zaka. Ndipo pambuyo pakutha kwa kusintha kwa kubereka, mtundu wa 2 matenda ashuga umatha kujowina, chifukwa chake zimakhala zovuta kwambiri kuyankha funso loti mungachiritse thumba losunga mazira.

Ambiri ali ndi chidwi ndi momwe angathandizire ovary ya polycystic, m'njira zambiri, mankhwalawa amatengera kuchuluka kwa kuwonongeka kwa thupi, mawonekedwe ndi mitundu ya matendawa, chifukwa chake, zinthu izi zimayenera kulipira chidwi.

SIOPHORUS NDI GLUCOPHAGE MU POLYCYSTOSIS YA OVARIES

Siofor ndi Glucophage (Siofor, Glucophage, Glucophage yaitali) ndizopanga zamankhwala zomwe zimakhala ndi metformin ndipo nthawi zambiri zimaperekedwa kwa amayi omwe ali ndi PCOS (polycystic ovary syndrome). Awa ndi amtundu wa insulin-sensitizing biguanides omwe amagwiritsidwa ntchito kwambiri pochiza shuga m'magazi mwa anthu odwala matenda ashuga a 2. Mankhwalawa adayamba kupatsidwa kwa azimayi omwe ali ndi PCOS chifukwa chofanana ndi zotsatirapo zabwino.

Ngati mtsikana ali ndi ovary ya polycystic, ndiye kuti mwina akhoza kukhalanso ndi insulin. Poterepa, kuthekera kwa maselo poyankha zochita za insulin panthawi ya kayendedwe ka glucose (shuga) kuchokera m'magazi kupita ku minofu ndi minyewa kumachepa. Metformin imasintha mayendedwe a cell ku insulin ndipo imathandizira kutulutsa glucose mu cell. Zotsatira zake, thupi silisowa kutulutsa insulin yowonjezera.

Hormone yopanda macycystic matenda

Chithandizo nthawi zambiri chimagwiritsidwa ntchito osati ndi dokotala wazamankhwala, koma ndi dokotala wazamankhwala a gynecologist-endocrinologist. Zonse zimayamba ndi chithandizo chamankhwala, mankhwala omwe amathandizira kukhazikika kwa mahomoni. Dokotala atha kukufunsani zakudya zapadera zomwe zimakupatsani mwayi wochepetsera kunenepa, kutsimikizira zamasewera, chifukwa kukwera kwambiri kwa thupi, kumawonjezera mavuto m'thupi. Mwa mitundu yofatsa yamatendawa, zovuta zonse zimatha kudutsa kuwonda.

Metformin itha kutumizidwa kuti izithandiza thupi kugwiritsa ntchito bwino insulin. Mwanjira pamene mkazi akhudzidwa makamaka ndi kusabereka, adokotala amathandizira kuyambika kwa ovulation pogwiritsa ntchito clostilbegit pakati pazungulira kapena mankhwala ena. Kukhazikika kwa ovulation kumayendetsedwa ndi ultrasound. Katswiri amawona ovomerezeka ya polycystic, mankhwala osokoneza bongo amawonetsa kugwira ntchito bwino,

Ngati mankhwalawa sagwira ntchito, endocrinologist-gynecologist akuonetsa laparoscopy (opaleshoni kapena laser excision ya ovarian cysts). Opaleshoni ili ndi zoopsa zake: zipsera zingapangike, thumba losunga mazira lingakhale lopunduka. Nthawi zambiri imasankhidwa ngati njira yomaliza. Popeza zomwe zimayambitsa matendawa sizikumveka bwino, njira zopewera sizingatsimikizenso kuti matendawa sadzachitika. Komabe, azimayi akuyenera kuwongolera chilichonse, kuyang'anitsitsa thanzi lawo, ndikuyang'ana kwa dokotala ngati zizindikiro zoyambitsa zisanachitike.

Kuchiza nthawi zambiri kumayikidwa ndi gynecologist-endocrinologist

Malinga ndi ziwerengero, m'nthawi yathu ino, pafupifupi amayi 8-10 mwa azimayi amsinkhu wobereka amapezeka ndi polycystic ovary, yomwe imayambitsa kulephera kwa msambo, nthawi zina imakulitsa mkhalidwe wa mkazi komanso moyo wake. Komabe, vuto lalikulu kwambiri limatchedwa kuti vuto lakubala, komanso mwa azimayi omwe sanaberekepo,.

The etymology ndi zomwe zimayambitsa matenda a polycystic mwachindunji zimatsogolera kupititsa patsogolo chithandizo cha matendawa. Matendawa ndi amtundu wa endocrine matenda amadziwika ndi kusintha kwa thumba losunga mazira.Mwambiri, izi zimachitika chifukwa cha vuto la neuroendocrine. Chiwerengero chambiri cha ma cysts chimagwira m'mimba mwake, chomwe chimapangidwa pakubwezeretsa.

Zina mwazomwe zimayambitsa kukula kwa ovary ya polycystic ndi kusalinganika kwa mahomoni mwa akazi, zinthu za chibadwa, matenda amtundu osiyanasiyana komanso zovuta zina. Kuphatikiza apo, zomwe zimapangitsa kuti matendawa apezekeke zimaphatikizira matenda a shuga, kunenepa kwambiri, kuchuluka kwa anthu ochita kuchotsa mimba kapena matenda azachipatala.

Zina mwazinthu zomwe zimapangitsa kukula kwa ovary ya polycystic ndi kusalinganika kwa mahomoni mwa amayi, cholowa chamtundu, komanso matenda amtundu

Ndizofunikira kudziwa kuti iyi ndi njira yayitali, yomwe ili ndi magawo motsatizana. Poyamba, ndikofunikira kuchepetsa kulemera msanga momwe mungagwiritsire ntchito zakudya zochepa zopatsa mphamvu. Nsomba zamafuta, nkhuku ndi nyama, zakudya zonunkhira, mowa ndi confectionery samachotsedwa muzakudyazo. Chotsatiracho ndikuchiritsa pogwiritsa ntchito mankhwala okhala ndi mahomoni omwe amayendetsa nthawi ya kusamba ndikuchepetsa mphamvu ya androgens. Kuphatikiza apo, pokonzekera kutenga pakati, spironolactone ikhoza kutumikiridwa.

Ngati chithandizo cha mankhwala osakhazikika kwakanthawi sichikukhudza, pali zisonyezo zonse za laparoscopy. Chifukwa chake, kale pambuyo pa miyezi itatu mu 75% ya odwala amatenga pakati, 50% - mkati mwa miyezi 6 pambuyo pa laparoscopy, ndipo 25% - pambuyo miyezi 9. Koma ngati mayi satenga pakati, amamuika kukondoweza.

Njira iti yothandiza kwambiri?

Atsikana ambiri kwa nthawi yayitali amakhala ndi matenda oopsa komanso oopsa monga polycystic. Ena mwa iwo sakhala ndi chiyembekezo chodzakhala ndi mtsogolo mtsogolomo, motero amanyalanyaza thanzi, pomwe ena sakhulupirira kukhalapo kwa njira zakuchiritsira popanda kugwiritsa ntchito mahomoni. Komabe, kafukufuku akuwonetsa kuti njira zoterezi zilipo ndipo zimagwiritsidwa ntchito mwachangu pazamankhwala amakono, ndipo izi zimatsimikiziridwa ndi ndemanga zabwino kuchokera kwa amayi omwe ali pamagulu osiyanasiyana.

Njirazi zimaphatikizapo izi:

1. Zolozerani pamawu ogwira ntchito. Hirudotherapy, acupuncture, acupressure, ndi zina chifukwa cha izi, kuchuluka kwa mahomoni amphiri kumatsika, kugwira ntchito kwa ma gren adrenal kumayendetsedwa, ndipo mahomoni abwereranso mwakale.
2. Anti-kutupa mankhwala. Nthawi zambiri, polycystic imayamba chifukwa cha zovuta zazing'onoting'ono zamtundu wotupa, zopezeka m'chigawo cha akazi. Chifukwa cha chithandizo choyenera, ndikotheka kuthetsa kuyang'ana kwa kutupa, kuonjezera ntchito zoteteza, zomwe zingakhale njira yabwino kwambiri yopeweretsera matenda.
3. Kuwongolera kwamanjenje. Dongosolo ili limakhudzana mwachindunji ndi endocrine. Kukumana kwa mahomoni achimuna mwa akazi kumatengera magwiridwe antchito amanjenje amanjenje. Panthawi yake yozama, zomwe zili mu testosterone zimawonjezeka, chomwe ndi chimodzi mwazifukwa zomwe zimawonekera ndi polycystosis.
4. Zakudya. Mavuto ndi chiwindi amachititsa kuti mahomoni azisintha. Kukhala moyo wongokhala komanso kulemera kwambiri thupi kumadzetsa vuto. Mukatembenukira kwa katswiri wabwino, ndiye kuti azikupatsani zakudya zoyenera, zomwe zimaphatikizapo zinthu zofunika komanso zoletsedwa. Ndikofunika kuphatikiza zakudya zoyenera ndi masewera olimbitsa thupi.

Matenda a ovary a polycystic ndi matenda oopsa omwe amadziwika ndi mawonekedwe owopsa omwe mkazi amatha kutaya ntchito yake yobereka kwathunthu. Ndiye chifukwa chake, pakuwonetsa matendawa pachiwonetsero, ndikofunikira kulumikizana ndi chipatala komwe amayeza mayeso mthupi ndikupereka mankhwala othandiza kwambiri.Matenda a Polycystic ndendende kuti matenda owopsa omwe amafunika chithandizo cham'tsogolo komanso chofunikira; mahomoni, chithandizo chamankhwala chosafunikira ndikuthandizira opaleshoni zimagwiritsidwa ntchito pamenepa.

Mankhwala othandizira opangira PCOS

Chithandizo cha opaleshoni chimagwiritsidwanso ntchito ku PCOS, nthawi zambiri pochiza matenda osabereka. Opaleshoniyo amachitidwa ndi laparoscopic kupeza; Pali njira ziwiri zoyesera zochizira PCOS - mawonekedwe ogwedeza m'mimba mwake (chotsani tinthu tokhala ndi ma ovari, omwe amatulutsa androgens mopitilira muyeso) ndi ma electrocautery a thumba losunga mazira (kutulutsa chiwopsezo cha minofu ya androgen yopanga ma ovari, opaleshoniyo siyowopsa komanso yotalikirapo poyerekeza ndi mawonekedwe a wedge. Ubwino wa laparoscopic resection ndikutha kuthetsa zomwe zimachitika nthawi zambiri chifukwa cha kusabereka (zomata, kutsekeka kwa machubu a fallopian).

Zotsatira za opaleshoni, ovulation imabwezeretseka ndipo pakatha miyezi 6-12 mkazi amatha kutenga mwana. Nthawi zambiri, mu postoperative nthawi itatha masiku 3-5 kumakhala kofanana ndi kusamba, ndipo pambuyo pa masabata awiri - ovulation, omwe amayesedwa pamtunda wa basal. Kusakhalapo kwa ovulation kwa mizere 2-3 kumafuna kuphatikizika kwa clomiphene. Monga lamulo, kutenga pakati kumachitika pakadutsa miyezi 6-12, mtsogolo pafupipafupi mimba imachepa. Ngati pambuyo pa opaleshoni mimba yomwe ikuyembekezeka kwa nthawi yayitali sinachitike mchaka chimodzi, kuyembekezerabe sikumveka ndipo mkazi akulimbikitsidwa kuti atembenukire ku IVF (mu vitro umuna).

Ngakhale kukwera kwakukulu pakukondoweza kwa kuvunda kwam'mimba ndi kuyambika kwa pakati, madokotala ambiri akuti akubwereranso ku matenda a PCOS patatha pafupifupi zaka 5. Chifukwa chake, atakhala ndi pakati komanso pobereka, kupewa kubwezeretsanso kwa PCOS ndikofunikira, komwe kuli kofunikira, chifukwa chokhala ndi chiopsezo chokhala ndi endometrial hyperplastic process. Pachifukwa ichi, ndizoyenera kwambiri kupereka ma COC, makamaka monophasic (chodabwitsa, chikazi, diane, mercilon, ndi zina). Ndi kulekerera bwino ma COCs, omwe amachitika ndi onenepa kwambiri, gawo lachiwiri la mkombero lingalimbikitsidwe: Duphaston pa 20 mg. kuyambira 16 mpaka tsiku la 25 lazungulira.

Amayi omwe sakonzekera kutenga pakati, gawo loyambirira la kukondoweza kwa ovulation ndi clomiphene, lomwe likufuna kudziwa momwe mphamvu zakulera zingakhalire, amalimbikitsidwanso kuti apereke COCs kapena gestagens kuti azitha kuyendetsa mkombero, kuchepetsa hirsutism komanso kupewa ma hyperplastic.

Chifukwa chiyani ovary ya polycystic imachitika komanso momwe mungazindikirire

Choyambitsa chenicheni cha kupezeka kwa polycystic ovary syndrome mwa akazi sichikudziwika, chifukwa chake, njira yosasinthika yamankhwala sichinafotokozedwe. Malingaliro osiyanasiyana amaperekedwa patsogolo, pamaziko omwe njira yochiritsira imapangidwira:

• Kulephera kwa hypothalamic-pituitary system komanso kuwonongeka kwa mahomoni a hypothalamus. Mkhalidwe woterewu ungakhale chifukwa cha kusintha kwa majini kapena kuchitika pamoyo motsutsana ndi maziko a zinthu zina zowonongeka (kusamutsa matenda opatsirana, kupsinjika, autoimmune pathology, etc.),
• Kukana insulini. Komanso, kuphatikiza kosinthika kwamitundu yosiyanasiyana kumabweretsa kusintha kwa ma horoni. Kupanga kwa insulin kumachulukitsa, kuchuluka kwa ma luteinizing mahomoni ndi androjeni kumakwera, zomwe estrogen zimachepa,
• Matenda am'mimba. Malinga ndi chiphunzitsochi, kuphatikiza kwa androgens kwambiri komanso kusakhazikika kwa mahomoni amayamba chifukwa chophwanya kapangidwe ka cytochrome P450c17.

Malinga ndi asayansi ambiri, ndi PCOS motsutsana ndi kunenepa kwambiri, kukana insulini kumathandizira kwambiri pakukula kwa matendawa. Polycystic pa kulemera kwabwino nthawi zambiri kumachitika chifukwa cha kulephera kwa ma genetic.

Pozindikira PCOS, malingana ndi muyezo wa European Society for Human Reproduction and Embryology ndi American Society for Reproduction Medicine (ESHRE / ASRM), zizindikiro zazikulu zitatu ndizosiyanitsidwa:

• Hirsutism (kukula kwambiri kwa tsitsi) ndi / kapena hyperandrogenemia (kuchuluka kwa androjeni m'magazi) mwa akazi,

Chimodzi mwazinthu zazikulu za polycystic ovary ndikukula kwambiri kwa tsitsi laimuna.

• Kudukiza ndi mkhalidwe womwe mawonekedwe omwe samakhazikika m'mimba mwake. Zimatsogolera ku kusabereka
• Zotsatira za ovary ya polycystic: molingana ndi zotsatira za ultrasound, masamba opitilira 10 mpaka 8mm atsimikiza, komanso kuchuluka kwa thumba losunga mazira ndi kukula kwa kapisolo wawo.

Matenda a scleropolycystic ovary amapezeka koyamba mwa atsikana achinyamata kapena amayi achichepere (nthawi zambiri amafika zaka 30). Zimachitika kuti mkazi amakwanitsa kukhala ndi pakati ndikubereka mwana, koma nthawi zambiri PCOS imayambitsa kubalalika ndi kubereka. Ndi vutoli amatembenukira kwa dokotala. Ndikofunika kukumbukira: kudziwitsidwa koyambirira kupangidwa, kumakhala kosavuta kupirira vutoli ndikuchepetsa zovuta. Ndi zaka, chidwi cha thumba losunga mazira kwa mankhwala omwe adalandira amatha, ndipo zimakhala zovuta kwambiri kubwezeretsa bwino kwa mahomoni.

Kodi ndifunika kuchiza matenda amisamba?

PCOS ndi matenda opatsirana, ndipo kungochotsa kamodzi sikungathandize. Mutha kukwaniritsa kukhazikika kwa msambo ndikuyamba ovulation. Kusamba kumabwera pafupipafupi komanso pa nthawi, popanda kuchedwa, masamba amapsa m'mimba, ndipo amatha kubereka mwana. Kukula kwa matendawa kumachepetsa, koma sikutha kwathunthu. Popita nthawi, PCOS ibwerera, ndipo ndikofunikira kuti mkazi akhale ndi nthawi osati kuti azitha kuchiritsa ndikubwezeretsa kuzungulira, komanso kuzindikira ntchito yake yobereka.

Polycystic ovary syndrome siziwopseza kusokonezeka kokha komanso kuzungulira kwa kubereka. Njira yayitali ya matendawa imayenderana ndi chiopsezo cha concomitant pathology. Izi zitha kukhala matenda:

• Mchitidwe wama hyperplastic wa endometrium, womwe umatsogolera kutuluka kwa chiberekero komanso chifukwa china chosabereka,
• Type 2 matenda a shuga obwera chifukwa cha kukana insulini,
• Hypertension komanso zovuta zina mu mtima.

Ovary ya polycystic imatha kudzetsa matenda oopsa komanso matenda ena okhudzana ndi ntchito ya mtima.

Kukana chithandizo sikuwopseze kuchepa kokha kwa kusamba, komanso kuwonongeka konsekonse mu thanzi. Chiwopsezo chotenga zotsatirapo zoipa zimachuluka ndi ukalamba.

Momwe GLUCOFAGE NDI NTCHITO YA SIOFOR IN SPK

1. Glucophage ndi Siofor amachepetsa kuyamwa kwamatumbo kuchokera ku chakudya.
2. Glucophage amachepetsa kupanga shuga m'magazi.

Chiwindi chimagwiritsa ntchito chakudya kusunga shuga. Thupi likapanikizika, chiwindi chimatulutsa shuga wosungika kuti upatse ubongo ndi minofu ndi gwero lachindunji lamphamvu ndikuwongolera kupsinjika. Mankhwala okhala ndi metformin, monga Siofor ndi Glucofage, amalepheretsa kupanga gasiyu.

1. Chachitatu, mwina chofunikira kwambiri, zimakulitsa chidwi cha maselo am'mimba kuti apange insulin.

Insulin ndi timadzi timene timatulutsa glucose m'maselo. Amayi omwe ali ndi PCOS nthawi zambiri amakhala ndi "insulin kukana," momwe zimafunikira kuti inshuwaransi yambiri ilowe m'maselo. Glucophage ndi Siofor zimathandiza kunyamula glucose ndi insulin yocheperako, potero kumachepetsa mphamvu ya timadzi timeneti.

Mwa azimayi ambiri, kukana insulini ndiye chifukwa chachikulu cha ovary ya polycystic, ndipo nthawi zina matenda a shuga.

Matenda a glucose okwera kwambiri komanso chifukwa chachikulu cha insulin ndicho chifukwa chachikulu chomwe chimapangitsa kuti mayi asamayendetse nkhawa, amakhala osabereka komanso ali ndi chiopsezo chotenga matenda amtima, mitundu ina ya khansa komanso matenda ashuga.

SIOPHOR MU POLYCYSTOSIS YA OVARIES: ZOONA ZA AMAKONZITSA

Polycystic ovary syndrome ndi zizindikiro zake, monga hyperandrogenism (ziphuphu zakumaso, tsitsi lowonjezera, dazi), mavuto obeleka (osakhazikika nthawi, akufalitsika, kusabereka, kuperewera kwa mazira a polycystic) ndi zovuta zama metabolic (kulemera, kunenepa kwambiri), mwa azimayi ambiri amagwirizana ndi hyperinsulinemia ndi kukana kwa insulin.

Siofor zochizira polycystic ovary: kuphunzira zazokhudza PCOS

Kafukufuku awonetsa kuti kulandira chithandizo ndi Glucophage kapena Siofor kumachepetsa hirsutism, kumayambitsa kuvunda komanso kusintha msambo ndi kusintha kwa msambo ndi polycystic. Chifukwa chake, malinga ndi kafukufuku wina, yemwe adakhudza azimayi 39 omwe ali ndi polycystic ovary syndrome ndi hyperinsulinemia (insulin yambiri m'magazi), chithandizo cha metformin chinayambitsa kutsika kwa kuchuluka kwa insulin, komanso kuchuluka kwathunthu ndi testosterone yaulere, yomwe idasintha kwambiri mkhalidwe wawo, kuphatikizapo kuchipatala. mawonetseredwe a hyperandrogenism (kupanga kwambiri androgens mwa akazi), komanso kusintha kwa msambo. Komabe, kafukufuku adawonetsanso kuti kuchepa thupi chifukwa cha zochitika zolimbitsa thupi komanso kudya kumatha kuthandizanso chimodzimodzi pakuwongolera kusamba ndi zizindikiro za hyperandrogenism.

SIOPHOR IN POLYCYSTOSIS OF OVARIES: MUNGATANI

1. PCOS chithandizo chokha ndi Glucophage kapena Siofor

Mankhwalawa amatengedwa pa mlingo womwe mkazi yemwe ali ndi polycystic ovary amatha kulolera bwino. Anthu ambiri amatha kumwa 500 mg katatu patsiku ngati mankhwalawa sanalembedwe mwachangu, koma adakwaniritsidwa chifukwa chowonjezeka pang'onopang'ono.

Madokotala nthawi zambiri amapereka mankhwala ndi metformin, kuyambira 500 mg kamodzi patsiku, ndikuwonjezera mlingo wa 500 mg kawiri patsiku sabata iliyonse, kenako mpaka 500 mg katatu pakatha sabata limodzi. Ngati mayi sangathe kulekereranso kumwa kwa masiku atatu patsiku chifukwa chotsatira zoyipa, ndiye kuti amatsala pang'ono masiku awiri.

Mlingo wothandiza kwambiri wa Glucophage pochiza PCOS nthawi zambiri amakhala 500 mg katatu patsiku. Muyenera kumwa Glucophage ndi ovomerezeka ya polycystic mpaka ovval yokhazikika itakhazikitsidwa kapena monga momwe adokotala adalimbikitsira.

1. Kulandila kophatikizana kwa clomiphene ndi metformin wokhala ndi polycystic ovary

Ngati Glucofage kapena Siofor sikupangitsa kuti azimayi azisamba komanso azisamba nthawi zonse, gawo lotsatira nthawi zambiri limawonjezera Clomiphene pamankhwala.

Ngati kuphatikiza kwa metformin ndi Clomiphene sikumabweretsa ovulation, dokotala amapitilira pazinthu zina. Nthawi zambiri imodzi mwazochita zotsatirazi zimachitika kuti munthu akonzekere kutenga pakati:

Amayi ambiri amakhala ndi polycystic ovary syndrome ndi kusasamba kapena kusowa kwa msambo, mosasamala kanthu za thupi. Mwa ena, PCOS imakula ndikulemera thupi. Amayi oterewa amatha kuyambiranso kuvomereza ngati abwereranso ku thupi lomwe kale linali ndi ovomerezeka komanso athanzi.

Ngakhale madotolo sawona kuti kuchepa thupi ndi "kuchiritsa," kumathandizanso kubereka kapena kuthandizira chithandizo chakubereka, kupangitsa thupi kukhala lovuta kugwiritsa ntchito mankhwala. Kunenepa kwambiri kumathandizanso kuti azimayi omwe ali ndi PCOS akhale ndi thanzi labwino;

GLUCOFAGE NDI SIOPHOR: ZOPHUNZITSIRA ZOTHANDIZA ZA MANKHWALA

Metformin ndi ma analogues ake (Glucofage ndi Siofor) ali ndi zovuta komanso zotsatira zoyipa. Amayi ambiri omwe ali ndi ovary ya polycystic, omwe adapangidwira mankhwalawa, amakakamizidwa kusiya kumwa iwo chifukwa cha zotsatira zoyipa zamagetsi osiyanasiyana amthupi.

10-25% ya amayi omwe amatenga Glucofage amadandaula kuti samva bwino. Amakhala ndi nkhawa komanso kutopa, komwe kumatha nthawi yambiri. Uzani dokotala ngati mukukumana ndi zotsatirapo zina za mankhwalawo.

Pafupifupi gawo limodzi mwa magawo atatu a amayi omwe amatenga mapiritsi a metformin a polycystic ovary uzoefu wam'mimba, kuphatikizapo nseru, kusanza, ndi m'mimba. Vutoli limachitika nthawi zambiri mukamadya zakudya zokhala ndi mafuta kapena shuga, ndiye kuti kudya zakudya zopatsa thanzi kumatha kuthandizanso. Zizindikiro zimachepa pakapita nthawi ndipo zimatha milungu ingapo. Kuperekera kwa glucophage yotsika mtengo kwa akazi ena ndikuwonjezereka kwapang'onopang'ono kumathandiza kupewa kukhumudwa m'mimba.

1. Malabsorption wa Vitamini B12

Zotsatira zobisika kwambiri za Siofor ndi Glucophage ndi kuchepa kwa vitamini B12. Metformin imalepheretsa thupi kuyamwa B12. Mukupita kwa nthawi, kuchepa kwa Vitamini. B12 imabweretsa chiopsezo chachikulu cha thanzi. B12 ndiyofunikira pakukula koyenera ndikugwira ntchito kwa khungu lililonse m'thupi. Zimafunikira pakupanga kwa DNA ndi ntchito zina zambiri zofunika zamitundu mitundu. Palinso ulalo pakati pa kuchepa kwa B12 ndi matenda amtima. Malinga ndi kafukufuku, 10-30% ya odwala ku Glucofage kapena Siofor amachepetsa mayamwidwe a vitamini B12. Mmodzi mwa anthu atatu odwala matenda ashuga omwe amatenga metformin kwa chaka chimodzi amakhala ndi vuto la kuchepa kwa B12. Mwanjira ina, mzimayi atatenga metformin kapena mawonekedwe ake, ndizotheka kuti apange kuchepa kwa B12.

Kugwiritsa ntchito mapiritsi nthawi yayitali kumapangitsanso kuchepa kwa folic acid (Vit N B9) komanso kuwonjezeka kwa milingo ya Homocysteine. Kulephera kwa B12 ndi folic acid, komanso kuchuluka kwa Homocysteine, kumakhala kovulaza kwa mwana ngati muli ndi pakati kapena ngati mukufuna kubereka.

Kafukufuku wocheperako akuwonetsa kuti ngakhale metformin itachotsedwedwa, vuto la vitamini B12 malabsorption mwa anthu ena limatha kupitiliza. Vutoli litha kutha potenga vitamini B wapamwamba kwambiri wokhala ndi B12 ndi folic acid.

Amayi omwe ali ndi PCOS omwe ali vegans ndipo amatenga Glucophage, makamaka amafunikira zowonjezera za B12 chifukwa cha kusowa kwa izi m'zakudya zawo.

Anthu omwe amatenga Siofor amakonda kukhala ndi milingo yayikulu ya homocysteine. Amayi omwe ali ndi PCOS amathanso kuichulukitsa.

Homocysteine ​​ndi amino acid. Zikakhala m'magazi mulibwinobwino, sizimabweretsa mavuto, koma kuchuluka kwakukulu kumatanthauza kuti njira za metabolic m'thupi zimasokonekera. Kuchulukitsa kwa homocysteine ​​kumalumikizidwa ndi matenda am'mitsempha, matenda a mtima, kutopa kwambiri, fibromyalgia, kuchepa kwa chidziwitso, komanso khansa yamchiberekero.

Vitamini B12, komanso Vitamini B6 ndi folic acid, amachititsa kagayidwe ka homocysteine ​​mu zinthu zomwe sizingakhale zovulaza. Chifukwa chake, metformin ikachepetsa mayamwidwe a vitamini B12, mkazi amataya chimodzi mwazinthu zofunikira kuti achepetse homocysteine, ndipo potero amawonjezera ngozi ya matenda amtima.

Kuchuluka kwaochedwa Homocysteine ​​ndi zovuta zapakati

Preeclampsia ndimavuto panthawi yapakati, yodziwika ndi kuwonjezeka kwa kuthamanga kwa magazi ndi edema. Ngati atasiyidwa, preeclampia imatha kudzetsa eclampsia, matenda oopsa omwe amaika mkazi ndi mwana wake pachiwopsezo. Kuwonjezeka kwa kuchuluka kwa homocysteine ​​mu trimester yachiwiri kumalumikizidwa ndi chiopsezo chowonjezereka cha preeclampsia ndi nthawi 3.2.

Dipatimenti ya Obstetrics ndi Gynecology ya Netherlands idawunikanso kafukufuku wambiri pa ubale womwe ulipo pakati pa kuchuluka kwa Homocysteine ​​ndi kutaya mimba koyambirira. Iwo adaganiza kuti kuchuluka kwambiri kwa ma homocysteine ​​ndi chiopsezo cha kutaya kwapadera koyambirira kwa mimba.

Mafuta a follicular a ovary amakhala ndi kuchuluka kwa ma homocysteine ​​limodzi ndi mavitamini B12, B6 ndi folic acid.Follicular fluid imapereka chakudya kwa dzira, zimathandizira kutengerapo kwa michere kuchokera ku madzi a m'magazi. Kuchuluka kwa ma homocysteine, komanso kuchepa kwa mavitamini a B, kumatha kusokoneza dongosolo la umuna ndi kukula koyambirira kwa mwana wosabadwayo.

Mwadzidzidzi, kuchuluka kwapadera kwa homocysteine, osati Metformin pakokha, kumatha kuyambitsa zovuta zapakati mwa amayi ena. Komabe, Glucophage imadziwika kuti imachulukitsa milingo ya homocysteine.

Chenjezo pa mimba

Amayi ambiri amagwiritsa ntchito Siofor kuti azitha kubereka bwino. Komabe, Glucophage m'maiko ena ndi mankhwala a Gulu B, zomwe zikutanthauza kuti chitetezo chake akagwiritsidwa ntchito panthawi yoyembekezera sichinakhazikitsidwe. Katunduyu amapezeka mkaka wa m'mawere, motero ndikosayenera kuyamwitsa mukamamwa Glucofage kapena Siofor.

Mwa kusokoneza mayamwidwe a mavitamini B12 ndi folic acid, metformin ingayambitse kuchepa kwa magazi m'thupi. Anemia ya MeWIblastic imachitika pakalibe mavitamini B okwanira m'mafupa kuti apange maselo ofiira amwazi. Mafuta a fupa pamenepa amatulutsa maselo ofiira am'mimba komanso osagwira ntchito.

Ngakhale kuchepa kwa magazi sikufala pakati pa anthu omwe amatenga Glucophage kapena Siofor, amatha kuchitika mwa omwe omwe B12 ndi folic acid anali poyamba otsika kumayambiriro kwa chithandizo cha Glucophage.

1. Mavuto a chiwindi kapena impso

Ngati mayi, kuphatikiza ndi ovary ya polycystic, ali ndi vuto lililonse ndi chiwindi kapena impso, kutenga Siofor kumatha kuvulaza, chifukwa amasintha ntchito ya chiwindi ndipo amamuchotsa kudzera mu impso. Impso zathanzi komanso chiwindi zimasintha zotsatira za Glucofage ndi Siofor. Ntchito ya chiwindi ndi impso iyenera kuwunikira musanamwe metformin ndikubwereza kuyesedwa kamodzi pachaka panthawi yamankhwala.

1. Kuchita ndi mankhwala ena

Mavuto azaumoyo kapena zotsatira zoyipa zimachitika nthawi zambiri ngati mayi amamwa metformin kuwonjezera pa mankhwala ena. Mukamamwa mankhwalawa kwambiri komanso kuchuluka kwa mankhwalawa, kumakhala kwakukulu kuti pakhale kulumikizana pakati pa mankhwalawo kapena zotsatira zina mosayembekezereka chifukwa chophatikiza. Kuyesedwa kwa kuphatikiza mankhwala osiyanasiyana kumadaliranso mkhalidwe waumoyo, ma genetics, kadyedwe ndi moyo wanu. Nthawi zonse muzifunsana ndi dokotala ngati mukuwonjezera kapena mukusintha mankhwala kapena ngati muli ndi vuto lililonse.

Kuchepa tsitsi ndi vuto lalikulu kwa azimayi omwe ali ndi polycystic ovary kapena androgenetic alopecia. Metformin imatha kuthandizira kuchepa kwa abambo kwa amuna pamakachisi ndi pamwamba pamutu. Ngakhale palibe m'mabuku azachipatala omwe angatsimikizire ubalewu, azimayi ena omwe ali ndi matenda a ovary a polycystic adanenanso kuti kutaya tsitsi lawo kumakulirakulira akamatenga Glucofage ndi Siofor.

Pafupifupi anthu atatu mwa 100,000 aliwonse omwe amatenga Glucophage kapena Siofor amakhala ndi vuto lotchedwa lactic acidosis. Lactic acid ndi chinthu chopangidwa ndi metabolism, chomwe chimatha kukhala chowopsa ngati chitha msanga kuposa chomwe chimapangitsa. Lactic acidosis imapezeka kwambiri mwa anthu omwe ali ndi matenda ashuga, impso kapena chiwindi, kuchepa mphamvu kwa madzi, kupsinjika kwamphamvu, kapena kumwa mankhwala ambiri.

Lactic acidosis imatha kukula pang'onopang'ono. Zizindikiro zomwe zimaphatikizana ndi izi zimaphatikizapo kufunikira kwa kupumira kwamphamvu komanso pafupipafupi, kugunda kwapang'onopang'ono kwa mtima, kumva kufooka, kupweteka kwa minofu, kugona, komanso kumva kuti mwasweka. Chithandizo chimafuna kulowetsedwa kwa sodium bicarbonate. Ngati muli ndi zizindikirozi, onani dokotala kapena imbani ambulansi.

1. Mavuto a ndulu

Chitsulo chimapangidwa ndi chiwindi, chimadziunjikira mu ndulu ndipo chimasungidwa m'matumbo kuti chimangire mafuta.Chimodzi mwazomwe chimayambitsa mavuto a ndulu ndichoti mankhwala omwe ali ndi metformin, monga Glucoazh ndi Siofor, amachepetsa kubwezeretsanso kwa bile kuchokera m'matumbo kubwerera m'magazi, zomwe zimapangitsa kuchuluka kwa mchere wa bile mu colon. Kafukufuku ambiri akuwonetsa kuti mchere wa bile umapangitsa kuwonongeka kwa ma radicals aulere a DNA ndipo umatha kupangitsa khansa ya colon. Kuphatikiza apo, ma asidi a bile amatha kulimbikitsa maselo mu colon kuti apange leukotriene B4 (LTB4), chinthu chotupa. LTB4 idzathandizira kumayambiriro kwamatumbo otupa. Zinthu zokhala ndi michere ya mchere wa bile zimatha kuwononga matumbo ndipo zimayambitsa ma molekyulu achilendo, monga chakudya kapena tinthu tomwe timagazi, kulowa m'magazi, zomwe zingayambitse ziwopsezo zina ndi zina.

Kuphatikiza apo, azimayi ambiri omwe ali ndi polycystic ovary (PCOS) ali pachakudya chachikulu cha protein. Ngati mapuloteniwa amakhala ndi ng'ombe ndi mitundu ina ya nyama, kuchuluka kwa asidi wa m'matumbo kumawonjezeka. Chakudya chamagulu ambiri chimaphatikizidwanso ndi chiopsezo chachikulu cha khansa ya colon.

Asanapereke mankhwala ndi metformin - Glucofage kapena Siofor - dokotala ayenera kupenda mosamala mbiri ya zamankhwala ndikupanga kuyesa kwa metabolic. Sikuti aliyense amene ali ndi PCOS amafunikira mankhwalawa. Mukamamwa mankhwalawa, mkazi amayenera kuwunika kamodzi pachaka. Pogwiritsa ntchito nthawi yayitali, pali chiopsezo chokhala ndi kuchepa kwa vitamini B12.

Siofor mankhwalawa polycystic ovary ndi mahomoni mu amayi

Polycystic ovary ndi matenda wamba a endocrine. Pafupifupi wachisanu mwa akazi amisinkhu yobadwa nawo amakumana ndi izi.

Polycystic imakhudza mwachindunji kuchuluka kwa mahomoni achikazi. Pankhaniyi, ndi estrogen ndi progesterone.

Matendawa amatha chifukwa cha matenda ashuga, osabereka ndi a oncology, motero, chithandizo chake chovuta ndichofunika kwambiri. Pambuyo pakupita maphunziro ambiri azachipatala, mankhwalawa Siofor amagwiritsidwa ntchito mwachangu pa polycystic ovary.

Zinthu zosiyanasiyana zimatha kupangitsa ovary ya polycystic. Chimodzi mwazinthu zopanga insulin ndi thupi. Izi zimabweretsa kulephera kwa ovulation komanso kuchuluka kwa androgens (kapena mahomoni achimuna) opangidwa ndi thumba losunga mazira.

Ndipo izi zimasokoneza kukula kwachilendo kwa masamba. Umu ndi momwe m'mimba mwake mumachitika mungu wambiri. Matenda a shuga amadziwikanso ndi kuphwanya mayamwidwe a glucose zimakhala ndi maselo (insulin kukana).

Tizilombo tambiri tambiri tambiri timene timatulutsa:

• kuphwanya lamulo lokhudza kusamba,
• ma androjeni okwera kwambiri mthupi la mkazi,
• polycystosis imatsimikiziridwa ndi ultrasound.

Nthawi yomweyo, theka la azimayi omwe ali ndi polycystic ovary syndrome (PCOS) amakumana ndi insulin, monga matenda a shuga. Izi zapangitsa asayansi azachipatala kuti azikhulupirira kuti mankhwala a shuga monga Siofor amatha kuyambitsa matenda ofanana ndi a pathogene.

Poyamba, mankhwala a Siofor (chinthu chogwiritsidwa ntchito ndi metformin) adapangidwa ngati njira yochizira matenda amtundu wa 2, omwe amadziwika ndi insulin (maselo samayankha insulin). Amapezeka mumitundu yosiyanasiyana 500, 800 kapena 1000 mg. Metformin mu kapangidwe ka mankhwala amachepetsa onse shuga wamagazi ndi miyezo ya testosterone.

Siofor mu gynecology imagwiritsidwa ntchito mokangalika: imathandizira pochiza matenda obwera ndi mahomoni m'thupi la PCOS, ngakhale kuti palibe zomwe zikuwonetsa.

Imasinthasintha kuzungulira kwa ovulation ndipo siziwonjezera zochita za hypoglycemic. Chifukwa chake, mankhwalawa amalimbikitsidwa onse chifukwa cha kuvuta kwa kubereka komanso kupopera mazira a polycystic.

Kusatetezeka kwa maselo mu glucose komwe kumachitika mu polycystic ovary syndrome kumawoneka mosiyana ndi shuga, komwe kunenepa kwambiri ndiye chizindikiro chachikulu.Ndi PCOS izi sizimawonedwa. Ndiye kuti, kukana insulini ndikofanana kwa akazi onenepa komanso owonda. Insulin imalimbikitsa kupanga ma androgens, kuchuluka kwawo kumawonjezeka. Ndipo ichi ndi chizindikiro cha polycystic syndrome. Chifukwa chake, chithandizo ndi Siofor pankhaniyi ndizoyenera.

Njira yamachitidwe

Kafukufuku wazomwe zimachitika chifukwa cha mankhwalawa zakhala zikuchitika kwanthawi yayitali. Koma chiwembu chomaliza cha thupi lake wamkazi sichinakhazikitsidwebe.

Mphamvu zopindulitsa za Siofor zimawonekera mu:

• kutsika kwa kuchuluka kwa shuga m'magazi a chiwindi,
• maselo amatumbo samayamwa magazi,
• ma cell receptors nthawi zambiri amamanga insulin,
• lipid kagayidwe wa magawo kunja.

Mukalandira mankhwalawa, kusintha kwabwino kwa mahomoni kumachitika m'thupi, ndipo kagayidwe kazinthu zimayenda bwino. Kuphatikiza apo, Siofor imathandizira kukulitsa chidwi cha maselo a minofu kulowa insulin. Mwa mphamvu iyi, mankhwalawa amatchedwa "insulin sensitizer."

Kudzichitira nokha ndi Siofor popanda mankhwala omwe mumalandira kumabweretsa zovuta zazikulu!

Mankhwalawa ali ndi zabwino zambiri. Uku ndi kuchepa kwa njala, chifukwa chake kulemera kwa wodwalayo, androgen yocheperako imapangidwa, ziphuphu zimatha, kuthamanga kwa magazi kumatulutsa. Kuphatikiza apo, msambo umabweranso mwakale, zomwe zimatanthawuza kuti mwayi wa kubereka kolondola kwa mwana wosabadwayo.

Kwa mafuta ndi chakudya chamafuta

Siofor amadziwika ndi achire ambiri zotsatira mafuta ndi chakudya metabolic zimachitika mu thupi wamkazi.

Mankhwala amathandizanso kukakamiza kuthamanga kwa shuga ndi matumbo am'mimba ndipo, motero, amachepetsa kuyamwa kwa shuga m'chiwindi.

Ndi polycystosis, monga matenda ashuga, kapangidwe ka shuga m'magazi a chiwindi chimasokonekera. Ndiye kuti, chiwindi, ngakhale kuchuluka kwa shuga m'magazi, akupitilizabe kupanga shuga. Ichi ndi chiwonetsero cha kukana insulin. Izi zimachitika: zomwe zili mu insulin mthupi ndizokwera, ndipo ma cell amayenera kugwira glucose, koma izi sizichitika - maselo "amafa ndi njala".

Siofor amapulumutsa. Zimathandizira kuwonjezera chidwi cha lipid ndi maselo amitsempha kuti apange insulin. Izi zimakhudza kuchepa kwa shuga wa plasma. Maselo amathera amanjenje ndi minyewa yam'mimba amapeza chakudya choyenera. Ndipo minofu ya adipose imachepetsa kupanga mafuta kuchokera ku glucose. Chifukwa chake wodwala akuchepa.

Kuchepa kwa insulini kumabweretsa vuto komanso kuchepa kwa kupanga kwa androjeni, ndipo izi zimachepetsa masculinization m'thupi la mkazi.

Pa akazi ndi akazi dongosolo

Polycystic ovary imasokoneza magwiridwe antchito amtundu wa kubereka, popeza pali kuchuluka kwa kuchuluka kwa mahomoni achimuna ndi achikazi.

Zosokoneza pamatumbo am'mimba zimadziwika ndi zovuta zotsatirazi:

• kupweteka mwezi ndi kusakhazikika,
• kulephera kwa dongosolo la ovulation,
• mimba sizichitika.

Kuphatikiza kwakukulu kwa Siofor ndikuti chiyambi cha kudya kwake sichimatengera tsiku la msambo komanso kuchepa kwa mazira.

Mankhwala amakhazikika kusintha kwa mahomoni. Koma sangachiritse kwathunthu dongosolo la endocrine. Komabe, kutenga Siofor kuphatikiza mankhwala ena kumathandizira magwiridwe antchito a kubereka - msambo umakhala wokhazikika, mwayi wokhala ndi pakati umachulukirachulukira.

Osati ndemanga zokha za Siofor 850 okhala ndi ovary ya polycystic ndizabwino, koma kafukufuku wazachipatala adawonetsa kuti mwa azimayi azaka 30 mkombowu udachira pafupifupi kwathunthu (97%).

Mapiritsi a Siofor 850

Kuti muwonjezere mphamvu ya mankhwala, tikulimbikitsidwa kuchita izi:

• zolimbitsa thupi zolimbitsa thupi (pazifukwa zaumoyo),
• kupatula fodya ndi mowa,
• imwani mankhwala a antiandrogenic.

Contraindication

Kuphwanya kwapakati pa mankhwala ndi Siofor ndi tsankho kwa chinthu chilichonse cha mankhwalawa.

Chithandizo sichabwino kwa atsikana osakwana zaka 15.

Palibe chifukwa chomwe muyenera kugwiritsa ntchito mankhwalawa mankhwalawa PCOS, ngati pali matenda opatsirana, kutentha thupi kosafunikira, uchidakwa.

Kuphatikiza pa zotsutsana zotsatirazi:

• matenda a impso ndi chiwindi,
• nthawi yantchito
• zigawenga
• lactic acidosis,
• kuchuluka kwa zaka - kwa akazi opitirira zaka 60, mankhwalawa sagwiritsidwa ntchito.

Pa nthawi yoyembekezera, mankhwalawa amayenera kumwedwa pokhapokha ngati adokotala akuwuzani.

Mu PCOS, njira yotsatira ya mankhwalawa imalimbikitsidwa: 500 mg patsiku ndi zakudya zitatu patsiku.

Piritsi liyenera kumeza popanda kutafuna, ndikutsukidwa ndi madzi. Ndikofunikira kukumbukira muyeso yovomerezeka ya tsiku lililonse - osati oposa 1700 mg.

Matenda a Polycystic amathandizidwa kwakanthawi, ndipo Siofor amayenera kutengedwa kuchokera miyezi isanu ndi umodzi kapena kupitirira.

Ndikofunika kuyang'anira kayendedwe ka mazira ndi msambo. Nthawi zambiri pambuyo pa miyezi 6, kuvunda kwam'mimba ndikwabwinobwino. Kenako mankhwalawo amasiya. Ngati pakufunika kubwereza maphunzirowo, adzayikidwa ndi adokotala.

Siofor itha kugulidwa pa pharmacy kokha ndi mankhwala. Izi zikutanthauza kuti kudzichitira nokha sikumaphatikizidwa! Ndi dokotala yekhayo amene angatchule njira yoyenera komanso mlingo wa mankhwalawa.

Zimatenga nthawi yayitali bwanji kuchiza PCOS

Cholinga chamankhwala chothandizira kupangira ovary ndikubwezeretsa kusamba komanso kuthandiza mzimayi kukhala ndi pakati. Chithandizo chimachitika mu magawo angapo:

• Matenda a kulemera
• Kubwezeretsa kusamba,
• Kukondoweza kwa ovulation.

Kutalika kwa gawo loyamba kumasinthika ndipo zimatengera kulemera koyambirira komanso kupezeka kwama metabolic. Nthawi zambiri zimakhala zokwanira kuchepetsa kulemera kwa thupi ndi 5-10% kuti mukwaniritse nthawi yayitali ya msambo. Nthawi zambiri pakadutsa izi, ovulation amayamba pawokha, ndipo mankhwala ena samachitika. Izi sizitanthauza kuti polycystosis adachiritsidwa. Matendawa amakhalapo ndipo nthawi zina amatha kudzimva bwino.

Gawo loyamba polimbana ndi ovary ya polycystic liyenera kukhala lachulukidwe la wodwala.

Mankhwala akhoza kutumikiridwa pambuyo pokhazikika kapena moyenera ndi gawo ili la chithandizo. Mahomoni omwe amabwezeretsa ovulation amagwiritsidwa ntchito. Msambo mutha kusamba pafupipafupi. Kuyamba kwa kubereka kwamadzulo ndi kubereka kwa mwana.

Simatha kuchedwetsa kukonzekera kwa nthawi yayitali. M'pofunika kuganizira za mwana atangobwezeretsedwanso m'mimba mwa mayi. Mphamvu ya mankhwalawa imasungidwa kwa chaka chimodzi, pambuyo pake mwayi wa kubereka umachepa.

Ngati mankhwala osankhidwa samakulolani kuti azitha kusamba komanso kubereka, chizolowezi cholimbikitsidwa ndi kukula kwa follicular chimachitika. Mankhwala a Hormonal omwe amalimbikitsa kusinthasintha kwa dzira amagwiritsidwa ntchito. Ndi bwino kutenga pakati kwa mwana, zochizira zimatha apa. Palibe kuchitapo kanthu, opaleshoni ikuwonetsedwa. Umuna wa in vitro ndikotheka. Pambuyo kukondoweza kwa ovulation, follicles amasonkhanitsidwa ndipo mimba imagwiridwa mu vitro ndi kukhazikikanso kwina kwa mazira mu chiberekero cha patsekeke.

Ngati, atalandira chithandizo, mayiyo akulephera kukhala ndi pakati payekha, ndiye kuti adzapatsidwa umuna wa in vitro.

Kutalika kwa chithandizo cha polycystic ovary syndrome kumadalira zinthu zambiri. Pafupifupi, kuyambira pa chiyambi cha mankhwala mpaka kutenga pakati kwa mwana kumadutsa zaka 1 mpaka 3. Ndikosatheka kuchiritsa PCOS kwathunthu komanso kwamuyaya, koma mutha kukwaniritsa chikhululukiro chokhazikika komanso kuwongolera kwakukulu mu thanzi la kubereka kwa amayi.

Kulemera kwachulukidwe

Ngakhale ndi chithandizo chokwanira, munthu sayenera kuyembekeza kuti matendawa atha msanga. Kutenga nthawi yayitali mankhwala a polycystic ovary makamaka chifukwa chakuti kuti mwana athe kutenga pakati mokwanira ndikofunika kuti azitha kusamba. Izi ndizosatheka ndizovuta zamtundu wa metabolic zomwe zimatsogolera ku kukula kwakanthawi.Njira zotsatirazi zimathandizira kuthana ndi ma pathological omwe amachititsa kuti matendawa atukuke:

• Zakudya Pazakudya za mayi yemwe ali ndi vuto la ovary la polycystic ayenera kukhala zinthu zomwe zili ndi kalozera wamagulu ochepa owonjezera. Zinthu zotere zimadutsa pang'onopang'ono kudzera m'mimba ndipo sizipangitsa kuti magazi azikhala ndi shuga. Zotsatira zake zimadziwika pambuyo pa miyezi 1-2. Monga lamulo, ndi kuchepa kwa 5-10%, kuzungulira kumabwezeretsedwa, kusamba kumakhala kokhazikika ndipo ovulation imayamba,
• Zochita zolimbitsa thupi. Ndi PCOS, kuphunzitsa zolimbitsa thupi ndi masewera olimbitsa thupi kumapindulitsa, koma pokhapokha ngati pali contraindication. Potengera maziko amakono a mtima ndi mitsempha yamagazi, mutha kuchita masewera olimbitsa thupi, yoga ndi ma Pilates pamagulu apadera achire. Lolola kusambira, kuthamanga chete, kuyenda,

Kuchita masewera olimbitsa thupi kumathandizira kuchepetsa thupi, mwakutero kumawonjezera mwayi wamayi wogonjetsa polycystic.

• Kukonza mankhwala. Hypoglycemic wothandizira amathandizidwa kuti athandize kuchepetsa magazi m'magazi ndikuchepetsa thupi. Zimakhudzanso zakumaso kwa mahomoni ndipo zimatsogolera kukhazikitsidwa kwa ovulation. Kwa izi, Metformin ndi fanizo zake (Siofor, Glucofage) amagwiritsidwa ntchito. Mankhwalawa amachepetsa kuyamwa kwa shuga m'matumbo ndi kapangidwe kake m'chiwindi, komanso kumakulitsa chidwi cha maselo kuti apange insulin. Kulemera kwa mzimayi kumakhazikika, chiwopsezo cha zovuta zimachepa.

Kafukufuku wasonyeza kuti kugwiritsa ntchito Metformin kumachepetsa kuchuluka kwa androjeni m'magazi, kumathetsa mawonetseredwe a hirsutism, kumakupatsani mwayi wobwezeretsa masiku osamba ndikuyamba ovulation. Komabe, maphunziro ena adawonetsera kuti zakudya zomwe zimaphatikizidwa ndi zochitika zolimbitsa thupi zimabweretsa zotsatira zofananira ndipo sikuti nthawi zonse pakufunika kogwiritsa ntchito mankhwala a hypoglycemic.

Hypoglycemic mankhwala omwe amachepetsa shuga m'magazi ndikuchepetsa thupi.

Kuwongolera zamavuto amthupi

Ndikotheka kuchitira thumba losunga mazira ndi mahomoni ena:

• Kuphatikiza kulera kwamlomo. Mapiritsi othandizira kubereka ndi maziko a chithandizo cha mahomoni cha PCOS. Mankhwalawa amalepheretsa kupanga mahomoni a luteinizing, omwe amachititsa kuchepa kwa kapangidwe ka androgens m'mimba mwake. Ma COC amathanso kusinthasintha kwa msambo komanso amachepetsa chiopsezo chokhala ndi endometrial hyperplastic process, yomwe nthawi zambiri imalumikizidwa ndi polycystic. Mankhwala osokoneza bongo omwe ali ndi gestagens a mibadwo yatsopano potengera drospirenone (Yarina ndi Yarina kuphatikiza, Jess ndi Jess kuphatikiza, Model Pro, Midiana), komanso mankhwala ena (Jeanine, Belara, Silhouette, Regulon, Marvelon, ndi ena otero). Amayenera kuledzera mogwirizana ndi njira zakulera,
• Kukonzekera kwa Progesterone. Amagwiritsidwa ntchito pazovuta za luteal gawo kuyambira 16th mpaka 25th tsiku lazungulira. Limbikitsani kukhazikitsidwa kwa msambo pamsika pochedwa. Mankhwalawa onse omwe amachokera pa progesterone yachilengedwe (Utrozhestan) ndi ma analogu opanga (Dufaston, Norkolut) amagwiritsidwa ntchito. Kugwiritsa bwino ntchito kwa progestogens koyera kumakhala kotsika kuposa kuphatikiza ndi estrogens, komabe, zovuta zochepa zomwe zingagwiritsidwe ntchito pochiza PCOS.
• Mankhwala a antiandrogenic. Amalembedwa kuwonjezera pa ma COC ngati othandizira omwe amachotsa mawonetseredwe a hyperandrogenism (hirsutism). Ali ndi mphamvu ya teratogenic, motero, malingaliro a mwana motsutsana ndi maziko awo saloledwa. Mu gynecology, kugwiritsa ntchito veroshpiron, spironolactone, flutamide kumachitika. Deandamethasone, methylprednisolone (Metipred) ndi ena ali ndi mphamvu ya antiandrogenic,
• Mankhwala osokoneza bongo kuti alimbikitse ovulation. Clomiphene amagwiritsidwa ntchito pofuna kuthamangitsa kusasitsa kwa masamba ndi kumasulidwa kwa dzira kuchokera m'mimba. Ndondomeko ya mankhwalawa imasankhidwa payekhapayekha, kuyambira pa Mlingo wochepa wa mankhwalawa.

Mankhwalawa PCOS, clomiphene amagwiritsidwa ntchito polimbikitsa ovulation.

Chithandizo cha ovary ya polycystic popanda mahomoni ndizosatheka.Zimachitika kuti kubwezeretsanso kwa mazira kumachitika pambuyo pakusintha kwamoyo (zakudya kuphatikiza zolimbitsa thupi), koma kawirikawiri kuwonjezeredwa kwa mankhwala kumafunika.

Kuphatikiza pa chithandizo cha mahomoni, mankhwala ena amadziwika:

• Mavitamini ndi michere. Ndi PCOS, mankhwala a Vitamini samangogwiritsidwa ntchito kuwonjezera mphamvu yamtundu komanso kulimbikitsa chitetezo cha mthupi. Kudya pafupipafupi zinthu zopindulitsa kumathandizira kusintha matenthedwe am'magazi komanso kumathandizanso kudwala kwa matendawa. Kukhazikika kwa mavitamini B6, B9 (folic acid), D12, C, D, E,
• Zotupa zapakhomo ndi mankhwala azitsamba. Anapatsidwa ngati mankhwala obwezeretsa. Thandizani ku normalization wamagulu am'magulu, kukonza bwino zinthu, kukulitsa mphamvu. Zogwiritsidwa ntchito ndi Phytohormone (Cyclodinone, Dysmenorm, zitsamba zowonjezera ndi helba, ndi zina), mankhwala osokoneza bongo a homeopathic dilution (Ovariamin, Remens, Inofert ndi ena) amagwiritsidwa ntchito,
• Kukonzekera kwa enzyme (mwachitsanzo Wobenzym). Amakhala ndi mphamvu zolimbitsa ndi immunomodulatory kwenikweni.

Wobenzym adalembera chithandizo chovuta cha PCOS kuti chiziwongolera chitetezo chokwanira komanso chamderalo. Mankhwala amapereka mphamvu ya mankhwala othandizira.

Center Family Planning Center ku Moscow idachita kafukufuku pa ubale womwe ulipo pakati pa mavitamini D ndi PCOS. Phunziroli linakhudza azimayi 58 omwe ali ndi polycystic ndi amayi 28 athanzi. Zinapezeka kuti kuchuluka kwa mavitamini D mthupi la magulu omwe adawerengedwa sikunasiyane kwambiri, chifukwa chake sikungatheke kuyankhula momveka bwino za momwe izi zimathandizira pakukula kwa matendawa. Phunziroli lidasindikizidwa mu magazine a "Mavuto a Kubala," mu 2015.

Njira Zina Zothandizira

Mankhwala ovuta a PCOS, laser chithandizo imachitidwa. Amachitika motsutsana ndi maziko a kumwa mankhwala ndipo akuphatikiza njira ziwiri:

• Mitsempha yamitsempha yamagazi yopaka magazi,
• Kuwonetsera kwakunja kwa laser kutengera kwa ziwalo.

Njira ya mankhwala kumatenga masiku 10-12. Maphunziro awiri akuwonetsedwa ndikupuma pamwezi. Potengera maziko a laser mankhwala, kusintha kwa msambo kumadziwika.

Njira za physiotherapy zimagwiritsidwa ntchito pochiza PCOS. Zotsatira Zoyembekezeredwa:

• Kuchepetsa kapu yamkaka yayitali kwambiri,
• Kupititsa patsogolo kufalikira kwa magazi ndi zamitsempha.
• Matenda a metabolism.

Physiotherapy imachepetsa nthawi yobwezeretsa ziwalo zoberekera komanso zimathandizira kudwala kwa matendawa. Njira zotsatirazi zimagwiritsidwa ntchito:

• Electrophoresis yokhala ndi Vitamini B1 ndi Lidase
• Magnetotherapy pogwiritsa ntchito maginito ochezeka kwambiri,
• Hydrotherapy (Nyanja ndi malo osambira),
• Mankhwala othandizira matope ndi mankhwala a parafini pamalo a zowonjezera.

Mankhwala a Mud ndi paraffin nthawi zina amagwiritsidwa ntchito ngati njira zowonjezerapo pa chithandizo chovuta cha polycystic.

Hirudotherapy ndi njira inanso yochizira ovary polycystic. Mchitidwe wokhazikitsa leeches mu nyini ndi pamimba yotsikira. Ichitidwa magawo atatu mpaka 6. Amakhulupirira kuti hirudotherapy imathandizira kuti magazi azituluka m'chigawo cha m'chiwalo cha ziwalo za m'magazi komanso kuwonda kwa kapisozi kachiberekero.

Zithandizo za anthu amitundu ina zimagwiritsidwa ntchito popanga zida za chomera. Kunyumba, mutha kupanga decoctions ndi infusions kutengera "zitsamba" zachikazi, monga nkhalango ya payini, celandine, burashi wofiira, yarrow, yarrow, licorice. Mbewu za fulakesi, uchi, phula zimagwiritsidwa ntchito. Njira ya mankhwala ndi yayitali - mpaka miyezi 3-6 ndi zosokoneza.

Njira zochiritsira zosagwiritsidwa ntchito masiku onse sizitha kusintha njira zachikhalidwe ndipo siziyenera kugwiritsidwa ntchito povulaza madokotala omwe amapezeka.

Kukonzekera kwam'mimba ndi zapamwamba

Mutha kukonzekera kutenga pakati kwa mwana atangomaliza kugwiritsa ntchito mankhwala a mahomoni kapena kumaliza ntchito yopanda chithandizo cha mahomoni. Pambuyo pa opareshoni, ndikofunikira kuti kudikirira pafupifupi miyezi itatu kuti thupi likhale ndi nthawi yochira. Nthawi yomweyo, kutenga pakati sikuyenera kuchedwetsedwa kwa miyezi yopitilira 6-12.Patatha chaka atamaliza kulandira chithandizo, mphamvu yake imachepa, ndipo kubereka kwa mwana kumakhala kovuta.

Kukula kwa matendawo kumatengera zinthu zosiyanasiyana:

• Zaka za mkazi. Pambuyo pa zaka 30 mpaka 35, mwayi wazotsatira zamankhwala ndi kubereka kwa mwana zimachepa. Ndi nthawi yayitali ya matendawa, ovulation ndizovuta kwambiri kuzikwaniritsa. Amayi ambiri amakhala ndi kukana kwa clomiphene, mankhwala omwe amagwiritsidwa ntchito polimbikitsa kusasira kwa dzira,
• Pamaso pa concomitant matenda a ziwalo za m'chiuno. Kusamalira kwakanthawi matenda oyambitsidwa bwino kumathandizira matendawa ndipo kumawonjezera mwayi wokhala ndi pakati wopambana,
• Kukhalapo kwa kubereka kwapakati. Matendawa amakhala bwino ngati mayiyo anali ndi pakati posakhalitsa asanazindikire kapena ali ndi timadzi tambiri timene timayambitsa mazira.

Polycystic ovary si chiganizo. Matendawa amatengedwa kuti ndi osachiritsika, komabe, motsutsana ndi chiyambi chokwanira chamankhwala, mutha kuchotsa mawonekedwe ake osakhala bwino. Malinga ndi kuwunika kochita ma gynecologists, azimayi ambiri, atalandira chithandizo chovuta, msambo umabwezeretsedwa ndipo ovulation imayamba. Koma kutenga pakati kwa mwana sizitanthauza kubereka bwino kwake, chifukwa chake, mutatsimikizira kuti muli ndi pakati, muyenera kulembetsa ndi dokotala wazachipatala kuti muwoneke musanabadwe. Njirayi imachepetsa chiopsezo cha zovuta komanso imathandizira kuti kubereka kubereka.

Physiotherapy ndi olimba pochiza PCOS

Kupambana kwamankhwala kwa PCOS sikungotengera kokha kwa dokotala komanso mankhwala omwe adalandira, komanso moyo wa wodwalayo. Monga tanena kale, kukonza masikelo ndikofunikira kwambiri pochiza ovary polycystic. Kuti muchepetse kunenepa, tikulimbikitsidwa kuti muchepetse zakudya zamafuta - shuga, chokoleti, mbatata, mkate, pasitala, mbewu monga chimanga. Ngati ndi kotheka, kudya mchere kumayenera kuchepetsedwa. Kuphatikiza pa zakudya, ndikofunikira kuchita masewera olimbitsa thupi osachepera 2-3 pa sabata. Malinga ndi mayesero azachipatala - maola 2,5 a zochita zolimbitsa thupi pa sabata limodzi ndi zakudya - odwala ena omwe ali ndi PCOS ali ndi zotsatira zofanana ndi kugwiritsa ntchito mankhwala! Izi ndichifukwa choti minofu ya adipose imapezekanso gwero la androgens, ndikuchotsa mapaundi owonjezera sikungangongolera chiwonetserocho, komanso kuchepetsa kwambiri ma androgens a "owonjezera" ngati polycystosis.

Njira zamagulu olimbitsa thupi zimasonyezedwanso PCOS. Lidase galvanophoresis imagwiritsidwa ntchito kukhazikitsa dongosolo la ovarian enzymatic. Ma electrodes aikidwa mu suprapubic dera. Njira ya chithandizo ndi masiku 15 tsiku lililonse.

Tsoka ilo, zithandizo zochizira zikhalidwe yolimbana ndi PCOS sizothandiza, chifukwa chake, monga lamulo, iwo samalimbikitsidwa pa polycystosis.

Chithandizo cha ovary ya polycystic ndi yayitali, ndipo imafuna kuwunikidwa mosamala ndi dokotala wazamankhwala. Ndikulimbikitsidwa kuti azimayi onse omwe ali ndi PCOS, posachedwa, akhale ndi pakati ndikubereka, chifukwa Zizindikiro za nthendayi, tsoka, nthawi zambiri zimapita patsogolo ndi ukalamba.

Mavuto a PCOS:

- osabereka, osavulaza,
- matenda a shuga ndi matenda oopsa, chiwopsezo cha matenda a mtima ndi stroko ku PCOS chikuwonjezeka kangapo,
- khansa ya endometrial imatha kupezeka ndi polycystic chifukwa cha kukanika kwa thumba losunga mazira,
- amayi oyembekezera omwe ali ndi PCOS nthawi zambiri kuposa amayi oyembekezera omwe ali ndi thanzi labwino amakhala ndi pathupi pang'onopang'ono, kubadwa pasanakwane, matenda ashuga azimayi oyembekezera komanso preeclampsia.

Mafunso ndi mayankho a obstetrician-gynecologist pa mutu wa PCOS:

1. Ndili ndi kunenepa kwambiri komanso PCOS. Ma mahomoni opatsidwa, ma COC, omwe ndinapezanso zochulukirapo. Zoyenera kuchita
Ndikofunikira kudutsa mayeso a mahomoni ndikuwakambirana ndi a gynecologist-endocrinologist, mulimonse, yesani kudzichepetsera thupi (zakudya, masewera olimbitsa thupi).

2. Pakhoza kukhala PCOS chifukwa cha kugonana koyambirira?
Ayi, sizingatero.

3. Masharubu anga akukura kumaso kwanga. Kodi izi zikutanthauza kuti ndili ndi ovary ya polycystic?
Osati izi, izi zitha kukhala zosiyananso ndi zomwe mwazolowera. Lumikizanani ndi dokotala wazachipatala komanso ayese mayeso a mahomoni.

4. Ndili ndi PCOS. Analandira chithandizo - palibe. Posachedwa, tsitsi lakula thupi lonse. Gynecologist adalimbikitsa kuyambiranso. Kodi opaleshoniyo ithandizanso kuchotsa tsitsi?
Zithandiza, koma zotsatira zake zimakhala zosakhalitsa. Kutaya tsitsi kwathunthu ndikotheka pokhapokha kukonza kwa mahomoni.

5. Kodi ndikofunikira kumwa ma antiandrogens chifukwa cha zotsatira zabwino za laparoscopy, musanayambe kuchita opaleshoni?
Ayi, izi sizofunikira.

6. Ndinkachedwa kusamba. Dokotala adapanga diagnostic ya PCOS ya PCOS ndi mahomoni opatsidwa. Koma sindinakulitse tsitsi, kapena kunenepa kwambiri. Kodi ndiyenera kumwa mahomoni konse?
PCOS sidziwikiratu pokhapokha ngati pali ma ultrasound komanso, chithandizo sichimayikidwa popanda kuyang'ana kuchuluka kwa mahomoni. Ndikupangira kulumikizana mobwerezabwereza ndi gynecologist-endocrinologist ndikuyesa kwathunthu.

7. Kodi ndingathe kupita ku sauna ndi PCOS?
Inde mutha kutero.

Mavuto pa phwando

Mankhwala a Siofor nthawi zambiri amakhala ndi nthawi yayitali (pafupifupi chaka). Chifukwa chake, chiopsezo cha mavuto ndi chambiri.

Nthawi zambiri, mavuto am'mimba amawonedwa.

Izi zitha kukhala zizindikiro zazing'ono - nseru, kukhumudwa m'mimba, kusowa chilimbikitso.

Koma kutsegula m'mimba pafupipafupi ndi kusanza kumatha kuchitika, komwe kumayambitsa kufooka kwa thupi. Poyerekeza izi, kuperewera kwa vitamini B12 kumayamba. Koma kuletsa Siofor nthawi yomweyo sikofunika. Ndikokwanira kutenga maphunziro a Cyanocobalamin.

Vuto loopsa kwambiri pa mankhwala a Siofor ndi lactic acidosis. Matendawa nthawi zambiri amapezeka ndi polycystic ovary. Chofunikira chake ndichakuti minofu ya chiwindi singathe kulanda maselo a lactic acid. Kuchuluka kwa asidi m'magazi kumabweretsa asidi. Potere, ubongo, mtima ndi impso zimavutika.

Siofor ndi polycystic ovary: madokotala amawunika

Magulu a immunology ndi kubereka amagwiritsa ntchito makamaka kubwezeretsa mazira. Madokotala amadziwa zabwino zomwe zimachitika Siofor pakukhudzana ndi mahomoni ndi zizindikiro zamankhwala mwa odwala.

Kafukufuku adawonetsa kuti chithandizo sichimangochepetsa thupi, komanso zimachepetsa insulin yolimbitsa thupi pambuyo pochita masewera olimbitsa thupi. Ndemanga za Siofor 500 zokhala ndi thumba losunga mazira kwambiri.

Zimatsimikiziridwa kuti mankhwala omwe ali ndi Mlingo wa 500 ml katatu patsiku (kuphatikiza ndi mankhwala ena omwe amalimbikitsa mphamvu ya insulin) amatha kuchepetsa kupanga insulin ndikubwezeretsa ovulation.

Zonsezi zikulankhula za maubwino amwa mankhwala osokoneza bongo pankhani ya PCOS. Komanso, amachepetsa chiopsezo cha mtundu wachiwiri wa matenda a shuga ndi matenda a mtima ndi mitsempha ya mtima mwa odwala.

Makanema okhudzana nawo

Pazinthu zovuta kuzitenga Metformin za PCOS mu kanema:

Mosasamala za matenda, kaya ndi matenda a shuga kapena polycystic, kukana insulini kumachitika nthawi zonse. Amadziwonetsa mu mawonekedwe a lipids yapamwamba kwambiri m'magazi kapena matenda oopsa. Siofor amateteza izi ma pathologies ndipo amachepetsa chiopsezo cha zovuta za mtima ndi minyewa.

Metformin (Siofor) pochiza PCOS (polycystic ovary syndrome). | Gynecologist kuphatikiza ndi ultrasound

Metformin ndi mankhwala a gulu lalikuluuanide omwe amagwiritsidwa ntchito pochiza matenda a shuga a 2.

Ku Western Europe ndi ku United States, amagwiritsidwa ntchito ngati "pokhapokha" pofufuza matenda ovomerezeka a polycystic ovary syndrome (PCOS, sclerocystic ovary, Stein-Leventhal syndrome).

Ngati pali PCOS, payenera kukhala insulini. Ndi kukana kwa insulin, kuthekera kwa maselo poyankha insulin ndikulowerera kwa glucose mu cell kumachepetsedwa kwambiri. Metformin imathandizira kuyankha kwa insulini, ndipo imathandizira shuga kulowa cell. Zotsatira zake, kuchuluka kwa insulini kutsikira kwachilengedwe.

PCOS (sclerocystic ovary, Stein-Leventhal syndrome) imawonetsedwa ndi zizindikiro: ziphuphu zakumaso, hirsutism, alopecia (kutayika kwa tsitsi kumutu), kusokoneza ntchito ya kubereka (kusamba kwa msambo. Zizindikirozi zimakhudzana mwachindunji ndi hyperinsulinemia komanso kukana kwa insulin. Popanda kuteteza matenda a insulin, munthu sayenera kudikirira kusintha kwa PCOS (Stein-Leventhal syndrome).

Malinga ndi anzawo aku Europe ndi ku America, kutenga metformin imathandizira kuzungulira, kumabwezeretsa ovulation, kumachepetsa kwambiri mawonetseredwe a PCOS (polycystic ovary syndrome, ovarian sclerocystosis, Stein-Leventhal syndrome. Komabe, munthu sayenera kuyiwala za kadyedwe, kuphatikizidwa kwa chakudya chamafuta othamangitsa chakudya, komanso masewera olimbitsa thupi.

Metformin - Zotsatira zoyipa

Amayi ambiri amadwala matenda otsegula m'mimba, kusanza, kusanza, komanso kusanza poyankha Metformin (Siofor). Metformin mu 10-30% ya anthu omwe amalandila chithandizo chamanthawi yayitali amachititsa kuti ma B12 malabsorption, omwe angayambitse magazi m'thupi.

Chithandizo cha Metformin chitha kuwonjezera milingo ya homocysteine ​​(amino acid), yomwe imakhala pachiwopsezo cha atherosulinosis.

Zotsatira zake pakugwiritsa ntchito siofor:

Kulephera kwa chiwindi, kuledzera, kuwonongeka kwaimpso.

Pakati pa mankhwala, palibe mankhwala ena monga siofor (metformin), omwe angathandize kwambiri ndi polycystic ovary syndrome (PCOS, ovarian scleropolicystosis). Chowonadi ndi chakuti njira yokhayo ya pathogenetic yochizira PCOS ndikulimbana ndi insulin kukana ndikusintha zomwe tafotokozazi.

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Momwe ZOTHANDIZA ZA LH ​​ZINASINTHIRA MU POLYCYSTOSIS

Amayi omwe ali ndi PCOS nthawi zambiri amakhala ndi mahomoni ambiri a luteinizing ndi FSH yaying'ono, yomwe chifukwa cha izi imabweretsa zovuta mu msambo. Kuchulukitsa kwa LH kumabweretsa kuchuluka kwamahomoni achimuna (androgens) ndi estrogen m'thupi la mkazi. Kuchuluka kwa androgens nawonso kumathandizira kukulitsa shuga, matenda a mtima, kupezeka kwa ziphuphu ndi hirsutism. Ndipo kuchuluka kwa estrogen komanso kuchepa kwa progesterone (komwe kumapangitsa kuti ovulation) asokoneze njira ya ovulation, kumayambitsa endometriosis, amenorrhea (kusowa kwa msambo) kapena, mosiyanasiyana, magazi aku chiberekero. Mwambiri, PCOS imayendera limodzi ndi kunenepa kwambiri.

Zomwe zimawonetsa kuti ndi LH komanso polycystic ovary yapamwamba

Mu kusabereka kwa akazi komwe kumachitika chifukwa cha mavuto a mahomoni, kuwonjezeka kwa LH ndi FSH nthawi zambiri kumakhala kophatikizana ndi kuchuluka kwa mahomoni ogonana. Steady high LH ikuwonetsa kuphwanya mayankho pakati pa gonads ndi hypothalamus, zomwe zimakwiyitsa kupanga kolakwika kwa LH ndi FSH. Izi ndizabwinobwino ndi kusamba, koma uku ndikuthekera kwa azimayi amsinkhu wobereka. Izi zitha kuwonetsa kuphwanya lamulo monga:

• kusamba koyamba
• Shereshevsky-Turner syndrome,
• Seyer Syndrome
• Mitundu ina ya kobadwa nako kwa adrenal hyperplasia,
• yafupika ntchito yamchiberekero.

POLYCYSTOSIS WA OVARIES NDI CHIPEMBEDZO CHA LH / FSH

Nthawi zambiri, kuchuluka kwa LH kupita kwa FSH mwa atsikana ndi 1-1.5 patatha chaka chimodzi kuchokera pamene mayi akuyamba kusamba ndikuchoka kwa 1.5 mpaka 2 patatha masiku awiri atapita kusamba komanso kusamba.

LH ndi FSH zimayambitsa kupatsirana kwa mazira ndipo zimabisidwa ndi ma pituitary gland mu ubongo. Kumayambiriro kwa mkombero, misinkhu ya mahomoni awa nthawi zambiri amakhala osiyanasiyana 5 mpaka 20 mIU / ml. Amayi ambiri amakhala ndi pafupifupi LH ndi FSH kumayambiriro kwa kuzungulira kwa mkombowu. Kuwonjezeka kowopsa kwa LH, momwe kuchuluka kwa mahomoni kumakwera mpaka 25-40 mIU / ml, kumawonedwa maola 24 asanafike mazira.Dzira likangotulutsidwa ndi mazira, LH imachepa.

Mwa azimayi ambiri omwe ali ndi PCOS, LH ndi FSH nthawi zambiri amakhala opanda malire - kuyambira 5 mpaka 20 mIU / ml. Koma panthawi imodzimodzi, kuchuluka kwa mahomoni kumaphwanyidwa: LH ndi yotalika 2-3 kuposa FSH.

Mwachitsanzo, msungwana yemwe ali ndi PCOS akhoza kukhala ndi luteinizing timadzi tokwana 18 mIU / ml ndi FSH pafupifupi 6 mIU / ml (onsewa azikhala mkati mwazonse za 520 mIU / ml). Izi zimatchedwa kuchuluka kwa LH kupita ku FSH, kapena 3: 1 chiŵerengero. Kuwerengeka kwa mahomoni kumeneku ndikokwanira kusokoneza ovulation. M'mbuyomu, izi zimawerengedwa kuti ndizofunika paziwonetsero za ovary ya polycystic. Pakadali pano, kuwunikira uku komanso kuchuluka kwake sizofunikira kwambiri pakuwonetsetsa PCOS, koma ndizothandiza pakuwunika chithunzi chonse.

Kuphatikiza apo, palinso kuphatikiza pakati pa chiyezo cha LH / FSH ndi kukana kwa insulin. Pophwanya chiwopsezo cha LH ku FSH, kukana insulini kumadziwika nthawi zambiri.

MUNGATANI KUTI MUZINTHA BWINO KWA LH MU POLYCYSTOSIS YA OVARIES YOPHUNZITSA ZINTHU ZABWINO

1. Kuwongolera kwa insulin

Asayansi amati pali mgwirizano pakati pa insulin ndi LH. Kafukufuku wokhala ndi akazi 10 omwe ali ndi PCOS komanso kunenepa kwambiri awonetsa kuti azimayi akamachepera thupi ndipo matupi awo amayamba kukhudzana ndi insulin, milingo ya LH imasintha. Kukana kwa insulini pakuyesa uku kunalumikizidwa ndi kuchuluka kwambiri kwa LH.

Kafukufuku wina adati insulin yayikulu imagwira pa gonadotropin-releasing hormone (GnRH, GnRH), yomwe imawonjezera kupanga kwa LH. Chifukwa chake, akukhulupirira kuti mwa kuwongolera insulin, mahomoni a luteinizing amathanso kuchepetsedwa.

Pseudovitamin myo-inositol imathandizira kukulitsa chidwi cha insulin, imachepetsa kulemera ndi ziphuphu mu PCOS, imachepetsa LH ndi testosterone, imayang'anira ovulation ndikuwongolera mawonekedwe a dzira popanda kuyambitsa zovuta.

Omega-3 ndi chakudya chofunikira kwa akazi omwe ali ndi PCOS. Mafuta awa amathandizira kuchepetsa kutupa kwathunthu mthupi komanso kuchepetsa testosterone. Omega amathanso kutsitsa LH.

Kuchita masewera olimbitsa thupi pafupipafupi kumachepetsa zizindikiro za polycystic ovary zviratidzo. Amathandiza:

• kukhala ndi phindu la insulin
• onjezerani kuchuluka kwa mazira m'mimba,
• cholesterol yotsika
• Kuchepetsa thupi.

Malinga ndikuwona komanso kuyesa kwa magazi a mahomoni, ngakhale masabata 6 ophunzitsidwa pafupipafupi amatha kusokoneza ntchito ya pituitary gland ndi kupanga mahomoni: masukulu atatha, LH ndi prolactin kuchepa ndipo FSH ikukwera.

Momwe MUNGAPANGIRE BWANJI KUGWIRITSANSO KWA LH NDI FSH MU POLYCYSTOSIS USING MEDICINES

• Metformin (Glucophage)

Mankhwala osokoneza bongo omwe ali ndi metformin (Glucofage ndi Siofor) amalembedwa mtundu wa shuga 2, komanso kukana kwa insulin, kuphatikiza azimayi omwe ali ndi PCOS. Ngati LH yayikulu imalumikizidwa ndi insulin yowonjezereka, mapiritsi okhala ndi metformin amatha kukhazikitsa msambo, kusinthitsa kuchuluka kwa mahomoni a amuna, ndikuchepetsa zizindikiro za polycystic.

Mankhwala akuluakulu omwe amateteza kuphatikiza kwama mahomoni achimuna kwambiri ndi monga flutamide, finasteride, spironolactone, cyproterone acetate. Mapiritsi ena oteteza kubala (chabwino, COC) amakhalanso ndi zotsatira za antiandrogenic.