多囊卵巢综合征（PCOS）

诊断

目前还没有哪个单项检查可以专门诊断多囊卵巢综合征（PCOS）。医务人员可能会首先讨论您的症状、药物和任何其他医疗状况。医务人员还可能询问您的月经期和体重变化。体检包括检查有无毛发过度生长、胰岛素抵抗和痤疮的体征。

之后，医务人员可能建议进行以下检查：

• 盆腔检查。在盆腔检查期间，医务人员可能检查您的生殖器官是否有肿块、生长物或其他变化。
• 血液检测。血液检测可以检测激素水平。此检查可以排除以下可能原因：体征类似于 PCOS 的月经问题或雄激素过多。您可能还需接受其他血液检查，例如检测空腹胆固醇和甘油三酯水平。葡萄糖耐量试验可以评估您的身体对葡萄糖的反应。
• 超声检查。超声检查可检查您的卵巢外观以及子宫内膜的厚度。将一个棒状设备（换能器）放在您的阴道中。换能器发射的声波会被转换成为计算机屏幕上的图像。

如果您已确诊为 PCOS，医务人员可能会建议您进行更多核查并发症的检查。这些检查可能包括：

• 血压、葡萄糖耐量以及胆固醇和甘油三酯水平的定期检查
• 抑郁症和焦虑症筛查
• 阻塞性睡眠呼吸暂停筛查

治疗

PCOS 治疗侧重于解决那些困扰您的问题，可能包括不孕不育症、多毛症、痤疮或肥胖症。具体的治疗可能包括改变生活方式或药物治疗。

生活方式改变

医务人员可能建议通过低热量食物和适度的运动来减重。即使体重略有减少（例如，体重减轻了 5%），也可能会改善您的病情。减重可以提高医务人员建议用于治疗 PCOS 的药物的有效性，并有助于治疗不孕不育症。医务人员和注册营养师会与您一起确定最佳的减重方案。

药物

为了调节经期，医务人员可能建议：

• 复方避孕药。含有雌激素和孕激素的药丸会减少雄激素的产生并调节雌激素。调节激素水平可以降低患子宫内膜癌的风险，并纠正异常出血、毛发过多和痤疮。
• 孕激素疗法。每 1-2 个月服用孕激素 10-14 天可以调节经期，并预防子宫内膜癌。这种孕激素疗法不会改善雄激素水平，不能避孕。如果您还想避孕，仅含孕激素的迷你药丸或含孕激素的宫内避孕器是更好的选择。

为了帮助您排卵以便怀孕，医务人员可能建议：

• 氯米芬。这种口服抗雌激素药物在月经周期的第一个阶段服用。
• 来曲唑（Femara）。这种乳腺癌治疗药物可以刺激卵巢。
• 二甲双胍。这种用于治疗 2 型糖尿病的口服药物可以改善胰岛素抵抗并降低胰岛素水平。如果您在服用氯米芬期间没有怀孕，医务人员可能建议添加二甲双胍以帮助排卵。如果您处在糖尿病前期，二甲双胍可以减缓 2 型糖尿病的进展，并帮助减重。
• 促性腺激素。这些激素药物通过注射给药。

如果需要，请与医务人员讨论可能有助于您怀孕的程序。例如，体外受精可能是可选方案。

为了减少毛发过度生长或改善痤疮，医务人员可能建议：

• 避孕药。这些药片能够减少分泌雄激素，过多的毛发生长以及痤疮正是雄激素所致。
• 螺内酯（Aldactone）。这种药物可以阻断雄激素对皮肤的影响，包括毛发过度生长和痤疮。螺内酯可能引起出生缺陷，因此在服用这种药物时需要采取有效的避孕措施。如果您已怀孕或计划怀孕，则不建议使用此药物。
• 依氟鸟氨酸（Vaniqa）。这种乳霜能减缓面部毛发的生长。
• 脱毛。电解和激光脱毛是脱毛的两种方案。电解法将细针插入每个毛囊。针头会发出电流脉冲，损伤并破坏毛囊。激光脱毛系使用集中光束去除多余毛发的医疗程序。您可能需要多次电解或激光脱毛治疗。其他方案可能包括剃毛、拔毛或使用可溶解多余毛发的药膏。但这些治疗方案的效果都是暂时性的，而重新长出的毛发可能更粗。
• 痤疮治疗。包括药丸和外用乳霜或凝胶在内的药物可能有助于改善痤疮。请与医务人员讨论适合方案。

Medicines to treat infertility

Not everyone with PMOS has difficulty getting pregnant. If you're trying to get pregnant and have irregular periods or have not become pregnant within 6 to 12 months, your healthcare professional may suggest medicines to help you ovulate, such as:

• Metformin (Glumetza, Fortamet). This medicine for type 2 diabetes improves insulin's ability to lower blood sugar. If you have prediabetes, metformin may delay or prevent type 2 diabetes and help with weight loss.
• GLP-1 medicines, such as Ozempic or Zepbound. For some people with PMOS, GLP-1 medicines may be used to help lower blood sugar and promote weight loss. GLP-1 medicines are usually given as a shot. They are stopped before pregnancy.
• Letrozole (Femara). This treatment helps the body make more of a hormone needed to trigger ovulation.
• Clomiphene. This medicine is a pill that's taken at the beginning of your menstrual cycle. If you don't become pregnant using clomiphene, your healthcare professional might recommend adding metformin to help you ovulate.
• Gonadotropins. These hormone medicines are given as shots.

If needed, talk with your healthcare professional about procedures that may help you become pregnant. For example, in vitro fertilization may be an option.

Medicines to treat male-pattern hair growth or acne

To reduce male-pattern hair growth or improve acne, your healthcare professional might recommend:

• Birth control pills. These pills lower the amount of androgens made or reduce the activity of those hormones, which can help clear acne and reduce male-pattern hair growth.
• Spironolactone (Aldactone). This medicine blocks the effects of androgens on the skin, which can help reduce male-pattern hair growth and acne. Spironolactone can cause birth defects, so effective birth control is needed while taking this medicine. This medicine isn't recommended if you're pregnant or planning to become pregnant.
• Eflornithine (Vaniqa). This cream can slow facial hair growth.
• Hair removal. Electrolysis and laser hair removal are two hair removal options. Electrolysis places a tiny needle in each hair follicle. The needle sends out a pulse of electricity. The electricity destroys the follicle. Laser hair removal uses light energy to remove unwanted hair. You might need many treatments of electrolysis or laser hair removal. Shaving, plucking or using creams that dissolve unwanted hair also may help, but the results are temporary. Often hair removal and medicines are used together.
• Acne treatments. Medicines, including pills and creams or gels, may help improve acne. Talk to your healthcare professional about options.

妥善处理与支持

Although there is no cure for polyendocrine metabolic ovarian syndrome (PMOS), lifestyle changes and treatments can improve symptoms and reduce long-term health effects. To cope, try these strategies:

• Connect with others. Finding support from other people with PMOS can be helpful. Whether it's an online community, PMOS support group, or trusted friend or family member, sharing experiences can make you feel understood and less alone.
• Learn as much as you can. Learning about PMOS and how it affects your body can help you feel more empowered. Turn to reliable sources such as your healthcare team to better understand your diagnosis, symptoms and treatment.
• Prioritize your mental health. Living with a chronic condition like PMOS can be stressful. Sometimes, this can lead to feelings such as anxiety or depression. Talk openly with your care team about how you're feeling and don't be afraid to ask for help.

Living with PMOS is challenging and different for everyone. Not all people with PMOS will have the same symptoms or face the same health issues. Although PMOS does increase your risk of complications such as infertility or diabetes, it doesn't always mean these will happen.

准备您的预约

要治疗 PCOS，您可能需要去女性生殖医学专家（妇科医生）、激素失调专家（内分泌科医生）或不孕不育症专家（生殖内分泌科医生）处就诊。

以下信息可以帮助您做好就诊准备。

您能做些什么

约诊前，请列出以下内容：

• 您出现的症状和症状的持续时间
• 您的月经相关信息，包括月经发生频率、持续时间和月经量
• 您服用的所有药物、维生素、草药和其他补充剂，包括剂量
• 关键个人和医疗信息，包括其他健康状况、近期生活变化和压力源
• 要向医务人员咨询的问题

需要咨询的一些基本问题包括：

• 您建议做哪些检查？
• PCOS 如何影响我怀孕的几率？
• 是否有任何药物可能有助于改善我的症状或怀孕的几率？
• 哪些生活方式改变可以改善症状？
• 从长期来看，PCOS 会如何影响我的健康？
• 我还有其他健康问题。如何以最佳方式同时进行管理？

如果想到其他问题，请随时提出。

医生可能做些什么

医务人员可能会向您询问一些问题，包括：

• 您有哪些症状？症状发生的频率如何？
• 您的症状有多严重？
• 症状是从什么时候开始的？
• 上一次月经是什么时候？
• 您自初潮以来体重是否增加？您的体重增加了多少，什么时候增加的？
• 是否有任何因素看似能改善您的症状？或加重您的症状？
• 您是否正在备孕，或打算怀孕？
• 是否有任何近亲（如您的母亲或姊妹）被诊断为患有 PCOS？