Inflammation of the right ovary in women: symptoms and treatment

Right-sided oorphitis or inflammation of the right ovary in women has symptoms similar to appendicitis, peritonitis, and acute endometriosis. Therefore, sometimes diagnosing the disease can be difficult. The development of inflammatory processes in the right ovary is associated with the anatomical feature of the organ. Delayed diagnosis and treatment can cause severe complications, including complete loss of female reproductive function. At the Healthy Family multidisciplinary clinic, every woman in need of professional medical care can undergo the comprehensive diagnostics necessary to make an accurate diagnosis. If necessary, our specialists, taking into account the course of right-sided oorphitis, will prescribe effective treatment that will help you quickly recover and prevent the development of negative consequences.

Causes of inflammation of the ovary on the right side

Inflammation of the ovary on the right develops due to the penetration of pathogenic microflora from organs located nearby, such as:

appendix;
intestines.

When the appendix or rectum becomes inflamed, the infection spreads to adjacent tissues, affecting the ovaries. The right ovary is more susceptible to diseases than the left due to the anatomical features of the organ. The fact is that the gland located on the right is slightly larger in size than the left one. Also, the right ovary is more actively supplied with blood flow, and in the presence of a focus of infection, pathogenic microorganisms most often spread through the hematogenous route throughout all internal organs, affecting healthy tissue.

The causative agents of oorphitis can be:

Opportunistic microflora that constantly lives in the body and is activated when the immune system is dysfunctional: staphylococci, streptococci, fungi.
Infections that are sexually transmitted: gonococci, mycoplasmas, trichomonas, chlamydia.

The danger of right-sided inflammation is that after the infection penetrates the right ovary, it quickly spreads and spreads to the left, causing bilateral oorphitis, which often leads to disruption of the functioning of the female reproductive glands and the development of infertility.

Factors that can serve as a trigger for the occurrence of inflammatory processes in female paired glands:

recurrent inflammatory diseases of organs located in the abdominal cavity;
abortion, surgical interventions that injure the tissues of the reproductive system;
systematic hypothermia, which reduces the body’s protective functions;
promiscuous unprotected sexual intercourse;
uncontrolled use of hormone-containing drugs;
Exceeding the period of use of the intrauterine device.

Right-sided orphitis can occur as a result of the progression of distant infections that spread throughout the body along with lymph and blood. In this case, the causes of inflammation of the right ovary:

advanced dental caries;
chronic tonsillitis;
appendicitis;
cystitis, pyelonephritis.

Polycystic ovary syndrome or multifollicular ovaries

Doctors often see a fairly typical picture on ultrasound, which is called multifollicular ovaries. For some patients, multifollicular ovaries are synonymous with polycystic disease, in which there are also many follicles. Meanwhile, these are completely different concepts.

Causes of PCOS
Symptoms of PCOS
Diagnosis of PCOS
PCOS treatment
Conservative treatment of PCOS
Stimulation of ovulation in PCOS
Surgical treatment of PCOS
Physiotherapy and fitness for the treatment of PCOS

First, let's describe the ultrasound picture of the ovaries with polycystic disease:

the volume of the ovaries is almost doubled (7-9 cm3 or more with the usual size of 4-7 cm3);
thickening of the ovarian capsule, which is clearly visible as a more pronounced line along the periphery of the entire ovary (the thickness of the capsule can reach a quarter of the visible diameter of the ovary);
along the periphery, under the capsule in a specific “necklace” there are 10 or more follicles with a diameter of about 10 mm.

However, the described picture is sometimes only mistakenly similar to polycystic ovaries. For example, a very similar picture can be seen in phase 1 of the cycle (on days 5-7) due to purely physiological changes that naturally occur in a woman’s reproductive system. In addition, similar changes occur in women during long-term use of oral contraceptives, as part of hypogonadotropic amenorrhea, and, finally, in girls during puberty.

Multifollicular ovaries are characterized by slightly different signs on ultrasound. The main difference is the normal volume of the ovary. In addition, there are rarely more than 7-8 follicles, and their diameter is 4-10 mm3. The classic definition of multifollicular ovaries was given by M.V. Medvedev, B.I. Zykin (1997): these are transient changes in the structure of the ovaries in the form of many echo-negative inclusions with a diameter of 5-10 mm, which develop reversely in the absence of a clinical picture and echo structure of polycystic ovaries.

Thus, multifollicular ovaries are only an ultrasound symptom of the menstrual cycle within the normal range. However, given that the picture may be unclear, that there are certain variants of the course of polycystic ovary syndrome, when identifying the picture of multifollicular ovaries, it is necessary to carry out a differential diagnosis. To do this, the blood levels of LH and FSH, testosterone, and insulin are examined. With multifollicular ovaries, the level of these hormones is within normal limits. And with polycystic ovary syndrome, the LH/FSH ratio is greater than 2.5-3, the level of total and free testosterone, as well as insulin, is increased. In addition, the presence of polycystic ovaries is also indicated by the clinical picture of the disease.

The same applies to girls during puberty, in whom the condition is also called “emerging polycystic ovary syndrome.” Their specific ultrasound picture is accompanied by specific hormonal and external changes.

Thus, multifollicular ovaries are a diagnosis not of a disease, but of a certain condition, which in itself is not the cause of infertility, menstrual irregularities, etc. But it is still necessary to carry out a differential diagnosis with more severe conditions.

For the differential diagnosis of multifollicular and polycystic ovaries, the following signs can be used:

Multifollicular ovaries are often mistaken for polycystic ovaries, but multifollicular ovaries should be considered as a normal variant, and polycystic ovaries as a disease.

The female genital organs - ovaries, fallopian tubes, uterus - are subject to changes depending on the phase of the menstrual cycle. At the beginning of the menstrual cycle, 5-7 follicles begin to mature in the ovaries, but only one of them matures. With the picture of multifollicular ovaries, more than 7 follicles mature simultaneously. Multifollicular ovaries often occur at the beginning of puberty, when menstrual function is just established, in women who take oral contraceptives for a long time, as well as on days 5-7 of the normal menstrual cycle. Sometimes multifollicular ovarian syndrome can be accompanied by menstrual irregularities, most often due to a deficiency of luteinizing hormone, which can be caused by sudden weight loss, or vice versa, weight gain. In this case, amenorrhea or oligomenorrhea may occur. Menstrual irregularities accompanying multifollicular ovaries may indicate the initial stage of polycystic ovary syndrome.

Often, based on ultrasound data alone, it can be difficult to differentiate multifollicular ovarian syndrome from polycystic ovary syndrome. In such cases, dynamic observation by a gynecologist and determination of hormonal levels is necessary. However, there are a number of ultrasound signs that distinguish multifollicular ovaries from polycystic ovaries. The main distinguishing feature is the size of the ovary; with multifollicular ovary syndrome it is normal, with polycystic ovaries it is enlarged. The number of follicles in multifollicular ovarian syndrome is 8-10, follicle diameter is 4-8 mm, polycystic syndrome is more than 10, follicle diameter is more than 10 mm. Multifollicular ovaries are not accompanied by hormonal disorders, unlike polycystic ovaries.

Most often, multifollicular ovaries do not require treatment; they are accompanied by normal ovulation and do not interfere with pregnancy. Treatment is only necessary if multifollicular ovarian syndrome is accompanied by anovulatory cycles. Treatment consists of normalizing hormonal levels.

PCOS - polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an endocrine (hormonal) disease characterized by pathological changes in the structure and function of the ovaries. Frequently used synonyms for PCOS are polycystic ovarian syndrome or sclerocystic ovarian syndrome.

Causes of PCOS

PCOS is a common hormonal disorder among women of reproductive age, leading to permanent infertility. Despite the urgency of the problem, the exact causes of PCOS are still unknown.

It is a known fact that almost all women with polycystic ovary syndrome have insulin resistance, that is, the body’s sensitivity to insulin, a pancreatic hormone that regulates blood sugar levels, is reduced. All this leads to insulin circulating in the blood in large quantities. According to studies, it can be assumed that increased insulin stimulates the ovaries to excessive production of male sex hormones - androgens, which disrupt the structure and function of the ovaries.

First of all, androgens have a detrimental effect on the ovulation process, without which pregnancy is impossible, preventing eggs from growing normally. The outer membrane of the ovaries thickens under the influence of male hormones and the mature follicle cannot “tear” it so that the egg can be released and take part in the fertilization process. An unruptured follicle fills with fluid and turns into a cyst. The same thing happens with other follicles - they mature and stop working, becoming cysts. Thus, the ovaries of a woman with polycystic disease are a cluster of many small cysts. Because of this, the ovaries in PCOS are larger in size than normal ones.

In addition to hormonal causes, predisposing factors leading to the development of PCOS include:

hereditary predisposition occupies almost the main place in the causes of PCOS;
obesity or overweight;
diabetes.

Symptoms of PCOS

The symptoms of PCOS are varied. The first thing a woman usually notices is irregular periods. Delays in menstruation with PCOS can be months or even six months. Since disruption of the hormonal function of the ovaries begins with puberty, cycle disturbances begin with menarche and do not tend to normalize. It should be noted that the age of menarche corresponds to that in the population - 12-13 years (in contrast to adrenal hyperandrogenism in adrenogenital syndrome, when menarche is delayed). In approximately 10-15% of patients, menstrual irregularities are characterized by dysfunctional uterine bleeding against the background of endometrial hyperplastic processes. Therefore, women with PCOS are at risk of developing endometrial adenocarcinoma, fibrocystic mastopathy and breast cancer.

The mammary glands are developed correctly, every third woman has fibrocystic mastopathy, which develops against the background of chronic anovulation and hyperestrogenism.

In addition to menstrual irregularities, increased levels of male hormones cause increased hair growth throughout the body (hirsutism). The skin becomes oily, pimples and blackheads appear on the face, back, and chest. Characteristic is the appearance of dark brown spots on the skin on the inner thighs, elbows, and armpits. The hair on the head quickly becomes oily due to impaired function of the sebaceous glands. Hirsutism, of varying severity, develops gradually from the period of menarche, in contrast to adrenogenital syndrome, when hirsutism develops before menarche, from the moment of activation of the hormonal function of the adrenal glands during the period of adrenarche.

Almost all patients with PCOS have increased body weight. In this case, excess fat is deposited, as a rule, on the abdomen (“central” type of obesity). Since insulin levels are elevated in PCOS, the disease is often combined with type 2 diabetes. PCOS contributes to the early development of vascular diseases such as hypertension and atherosclerosis.

And finally, one of the main and unpleasant symptoms of PCOS is infertility due to lack of ovulation. Most often, infertility is primary (in 85% of cases), i.e. There have never been any pregnancies. Sometimes infertility is the only symptom of polycystic ovary syndrome. Infertility is primary in nature, in contrast to adrenal hyperandrogenism, in which pregnancy is possible and is characterized by miscarriage.

Since there are many symptoms of the disease, PCOS can easily be confused with any dyshormonal disorder. At a young age, oily skin, acne and pimples are mistaken for natural age-related features, while increased hairiness and excess weight problems are often perceived as genetic features. Therefore, if the menstrual cycle is not disrupted and the woman has not yet tried to become pregnant, then such patients rarely turn to a gynecologist. It is important to know that any such manifestations are not the norm and if you discover similar symptoms, you should consult a gynecologist-endocrinologist in person.

Diagnosis of PCOS

Structural changes in the ovaries in PCOS are characterized by:

stromal hyperplasia;
hyperplasia of theca cells with areas of luteinization;
the presence of many cystic atretic follicles with a diameter of 5-8 mm, located under the capsule in the form of a “necklace”;
thickening of the ovarian capsule.

Diagnosis of PCOS includes:

detailed survey and examination by a gynecologist-endocrinologist. Upon examination, the doctor notes an enlargement of both ovaries and external signs of PCOS;
Ultrasound of the pelvic organs with a vaginal sensor. When examining the periphery of the ovaries, many unovulated follicles up to 10 mm are revealed, the volume of the ovaries is greatly increased;
clear criteria for the echoscopic picture of PCOS: ovarian volume more than 9 cm3, hyperplastic stroma makes up 25% of the volume, more than ten atretic follicles with a diameter of up to 10 mm, located along the periphery under a thickened capsule. The volume of the ovaries is determined by the formula: V = 0.523 (L x Sx N) cm3, where V, L, S, H are the volume, length, width and thickness of the ovary, respectively; 0.523 is a constant coefficient. The increase in ovarian volume due to hyperplastic stroma and the characteristic location of the follicles help differentiate polycystic ovaries from normal (on the 5-7th day of the cycle) or multifollicular. The latter are characteristic of early puberty, hypogonadotropic amenorrhea, and long-term use of COCs. Multifollicular ovaries are characterized by ultrasound by a small number of follicles with a diameter of 4-10 mm located throughout the ovary, a normal pattern of stroma and, most importantly, a normal volume of the ovaries (4-8 cm3); study of blood plasma hormones (LH, FSH, prolactin, free testosterone, DHEA-c, 17-OH progesterone). Hormones must be taken on certain days of the menstrual cycle, otherwise the study will not be informative. LH, FSH and prolactin are given on days 3-5, free testosterone and DHEA-c on days 8-10, and 17-OH progesterone on days 21-22 of the cycle. As a rule, with polycystic disease, the levels of LH are increased (an increase in the LH/FSH ratio of more than 2.5), prolactin, testosterone and DHEA-c; and FSH and 17-OH progesterone are reduced;
biochemical blood test (with PCOS, the levels of cholesterol, triglycerides and glucose may be increased);
an oral glucose tolerance test is performed to determine insulin sensitivity;
diagnostic laparoscopy with ovarian biopsy - a piece of ovarian tissue is taken for histological examination. Endometrial biopsy is indicated for women with acyclic bleeding due to the high incidence of endometrial hyperplastic processes.

After a test with dexamethasone, the androgen content decreases slightly, by about 25% (due to the adrenal fraction).

The ACTH test is negative, which excludes adrenal hyperandrogenism, characteristic of adrenogenital syndrome. An increase in insulin levels and a decrease in PSSG in the blood were also noted.

In clinical practice, a simple and accessible method for determining impaired glucose tolerance to insulin is the sugar curve. Blood sugar is determined first on an empty stomach, then within 2 hours after taking 75 g of glucose. If after 2 hours the blood sugar level does not return to the original values, this indicates impaired glucose tolerance, i.e. insulin resistance, which requires appropriate treatment.

The criteria for diagnosing PCOS are:

timely age of menarche;
disturbance of the menstrual cycle from the period of menarche in the vast majority of cases as oligomenorrhea;
hirsutism and obesity since menarche in more than 50% of women;
primary infertility;
chronic anovulation;
increase in ovarian volume due to stroma according to transvaginal echography;
increased T levels;
increase in LH and LH/FSH ratio > 2.5.

PCOS treatment

Treatment for PCOS is determined by the severity of symptoms and the woman’s desire to become pregnant. Usually they start with conservative treatment methods; if ineffective, surgical treatment is indicated.

If a woman is obese, then treatment should begin with correction of body weight. Otherwise, conservative treatment in such patients does not always give the desired result.

In the presence of obesity, the following are carried out:

The first stage of treatment is normalization of body weight. Reducing body weight against the background of a reduction diet leads to normalization of carbohydrate and fat metabolism. The diet involves reducing the total calorie content of food to 2000 kcal per day, of which 52% comes from carbohydrates, 16% from proteins and 32% from fats, and saturated fats should make up no more than 1/3 of the total amount of fat. An important component of the diet is limiting spicy and salty foods and liquids. A very good effect is observed when using fasting days; fasting is not recommended due to protein consumption in the process of gluconeogenesis. Increasing physical activity is an important component not only for normalizing body weight, but also for increasing the sensitivity of muscle tissue to insulin. The most difficult thing is to convince the patient of the need to normalize body weight as the first stage in the treatment of PCOS;
the second stage of treatment is drug treatment of hormonal disorders;
the third stage of treatment is stimulation of ovulation after normalization of body weight and in PCOS with normal body weight. Stimulation of ovulation is carried out after excluding tubal and male factors of infertility.

Conservative treatment of PCOS

The goals of conservative treatment of PCOS are to stimulate the ovulation process (if a woman is interested in pregnancy), restore the normal menstrual cycle, reduce the external manifestations of hyperandrogenism (increased hairiness, acne, etc.), and correct disorders of carbohydrate and lipid metabolism.

In case of impaired carbohydrate metabolism, infertility treatment begins with the prescription of hypoglycemic drugs from the biguanide group (Metformin). The drugs correct blood glucose levels, the course of treatment is 3-6 months, doses are selected individually.

To stimulate ovulation, the hormonal antiestrogen drug Clomiphene Citrate is used, which stimulates the release of an egg from the ovary. The drug is used on days 5-10 of the menstrual cycle. On average, after using Clomiphene, ovulation is restored in 60% of patients, pregnancy occurs in 35%.

If Clomiphene has no effect, gonadotropic hormones such as Pergonal, Humegon are used to stimulate ovulation. Hormone stimulation should be carried out under the strict supervision of a gynecologist. The effectiveness of treatment is assessed using ultrasound and basal body temperature. If a woman is not planning a pregnancy, for the treatment of PCOS, combined oral contraceives (COCs) with antiandrogenic properties are prescribed to restore the menstrual cycle. COCs Yarina, Diane-35, Zhanine, Jess have these properties. If the antiandrogenic effect of COCs is insufficient, it is possible to combine drugs with antiandrogens (Androcur) from the 5th to the 15th day of the cycle. Treatment is carried out with dynamic monitoring of hormone levels in the blood. The course of treatment averages from 6 months to a year.

The potassium-sparing diuretic Veroshpiron, which is also used for polycystic ovary syndrome, has a high antiandrogenic property. The drug reduces the synthesis of androgens and blocks their effect on the body. The drug is prescribed for at least 6 months.

Stimulation of ovulation in PCOS

Clomiphene

Clomiphene is a non-steroidal synthetic estrogens. Its mechanism of action is based on blockade of estradiol receptors. After discontinuation of clomiphene, the secretion of GnRH increases through a feedback mechanism, which normalizes the release of LH and FSH and, accordingly, the growth and maturation of follicles in the ovary. Thus, clomiphene does not stimulate the ovaries directly, but has an effect through the hypothalamic-pituitary system. Stimulation of ovulation with clomiphene begins from the 5th to the 9th day of the menstrual cycle, 50 mg per day. With this regimen, the increase in gonadrtropin levels induced by clomiphene occurs at a time when the selection of the dominant follicle has already been completed. Earlier use of clomiphene may stimulate the development of multiple follicles and increases the risk of multiple pregnancies. In the absence of ovulation according to ultrasound and basal temperature, the dose of clomiphene can be increased in each subsequent cycle by 50 mg, reaching 200 mg per day. However, many clinicians believe that if there is no effect when prescribing 100-150 mg of clomiphene, then further increasing the dose is inappropriate. If there is no ovulation at the maximum dose for 3 months, the patient can be considered resistant to clomiphene.

The criteria for the effectiveness of ovulation stimulation are:

restoration of regular menstrual cycles with hyperthermic basal temperature for 12-14 days;
progesterone level in the middle of the second phase of the cycle is 5 ng/ml. and more, preovulatory LH peak;
Ultrasound signs of ovulation on the 13-15th day of the cycle;
the presence of a dominant follicle with a diameter of at least 18 mm;
endometrial thickness is at least 8-10 mm.

If these indicators are present, it is recommended to administer an ovulatory dose of 7500-10000 IU of human chorionic gonadotropin - hCG (prophasy, choragon, pregnyl), after which ovulation is noted after 36-48 hours. When treating with clomiphene, it should be taken into account that it has anti-estrogenic properties, reduces the amount of cervical mucus (“dry neck”), which prevents the penetration of sperm and inhibits the proliferation of the endometrium and leads to implantation failure in the event of fertilization of the egg. In order to eliminate these undesirable effects of the drug, it is recommended to take natural estrogens in a dose of 1-2 mg after stopping taking clomiphene. or their synthetic analogues (microfollin) from the 10th to the 14th day of the cycle to increase the permeability of cervical mucus and endometrial proliferation.

If the luteal phase is insufficient, it is recommended to prescribe gestagens in the second phase of the cycle from the 16th to the 25th day. In this case, progesterone preparations (duphaston, utrozhestan) are preferable.

The frequency of ovulation induction during treatment with clomiphene is approximately 60-65%, pregnancy occurs in 32-35% of cases, the frequency of multiple pregnancies, mainly twins, is 5-6%, the risk of ectopic pregnancy and spontaneous miscarriages is not higher than in the population. In the absence of pregnancy against the background of ovulatory cycles, it is necessary to exclude peritoneal factors of infertility during laparoscopy.

In case of resistance to clomiphene, gonadotropic drugs are prescribed - direct ovulation stimulants. Human menopausal gonadotropin (hMG), prepared from the urine of postmenopausal women, is used. HMG preparations contain LH and FSH, 75 IU each (pergonal, menogon, menopur, etc.). When prescribing gonadotropins, the patient should be informed about the risk of multiple pregnancy, the possible development of ovarian hyperstimulation syndrome , as well as the high cost of treatment. Treatment should be carried out only after excluding pathology of the uterus and tubes, as well as male factor infertility. During the treatment process, transvaginal ultrasound monitoring of folliculogenesis and the condition of the endometrium is mandatory. Ovulation is initiated by a single injection of hCG at a dose of 7500-10000 IU, when there is at least one follicle with a diameter of 17 mm. If more than 2 follicles with a diameter of more than 16 mm are detected. or 4 follicles with a diameter of more than 14 mm. administration of hCG is undesirable due to the risk of multiple pregnancies.

When ovulation is stimulated by gonadotropins, the pregnancy rate increases to 60%, the risk of multiple pregnancies is 10-25%, ectopic - 2.5-6%, spontaneous miscarriages in cycles ending in pregnancy reach 12-30%, ovarian hyperstimulation syndrome is observed in 5 -6% of cases.

Surgical treatment of PCOS

Surgical treatment is also used for PCOS, most often to treat infertility. The operation is performed laparoscopically, with small incisions made under general anesthesia. There are two main surgical methods for the treatment of PCOS - wedge resection of the ovaries (remove ovarian tissue that synthesizes androgens in excess) and electrocautery of the ovaries (spot destruction of androgen-producing ovarian tissue, the operation is less traumatic and less time-consuming compared to wedge resection). The advantage of laparoscopic resection is the possibility of eliminating the often concomitant peritoneal factor of infertility (adhesions, obstruction of the fallopian tubes).

As a result of surgery, ovulation is restored and within 6-12 months the woman can conceive a child. In most cases, in the postoperative period, a menstrual-like reaction is observed after 3-5 days, and ovulation is observed after 2 weeks, which is tested by basal temperature. Lack of ovulation for 2-3 cycles requires additional administration of clomiphene. As a rule, pregnancy occurs within 6-12 months, then the frequency of pregnancy decreases. If even after the operation the long-awaited pregnancy does not occur within a year, further waiting makes no sense and the woman is recommended to resort to IVF (in vitro fertilization).

Despite the fairly high effect in stimulating ovulation and pregnancy, most doctors note a relapse of the clinical symptoms of PCOS after about 5 years. Therefore, after pregnancy and childbirth, prevention of relapse of PCOS is necessary, which is important given the risk of developing endometrial hyperplastic processes. For this purpose, it is most advisable to prescribe COCs, preferably monophasic ones (Marvelon, Femoden, Diane, Mercilon, etc.). If COCs are poorly tolerated, which happens with excess body weight, gestagens can be recommended in the second phase of the cycle: duphaston at a dose of 20 mg. from the 16th to the 25th day of the cycle.

For women who are not planning a pregnancy, after the first stage of stimulation of ovulation with clomiphene, aimed at identifying the reserve capabilities of the reproductive system, it is also recommended to prescribe COCs or gestagens to regulate the cycle, reduce hirsutism and prevent hyperplastic processes.

Physiotherapy and fitness for the treatment of PCOS

The success of PCOS treatment depends not only on the doctor and the prescribed medications, but also on the patient’s lifestyle. As already mentioned, weight management is very important for the treatment of polycystic ovary syndrome. To lose weight, it is recommended to limit the consumption of carbohydrates - sugar, chocolate, potatoes, bread, pasta, cereals. If possible, you should reduce your salt intake. In addition to diet, it is advisable to exercise at least 2-3 times a week. According to clinical trials, 2.5 hours of physical activity per week in combination with diet has the same positive effect in some patients with PCOS as the use of medications! This is explained by the fact that adipose tissue is also an additional source of androgens, and by getting rid of extra pounds, you can not only correct your figure, but also significantly reduce the amount of “extra” androgens in polycystic disease.

Physiotherapeutic procedures are also indicated for PCOS. Lidase galvanophoresis is used to activate the ovarian enzymatic system. Electrodes are installed in the suprapubic region. The course of treatment is 15 days daily.

Treatment of polycystic ovary syndrome is long-term and requires careful monitoring by a gynecologist-endocrinologist. All women with PCOS are recommended to get pregnant and give birth as early as possible, since the symptoms of the disease, unfortunately, quite often progress with age.

Complications of PCOS:

infertility that cannot be treated;
diabetes mellitus and hypertension, the risk of developing heart attacks and strokes with PCOS increases several times;
Endometrial cancer can develop with polycystic disease due to long-term dysfunction of the ovaries;
Pregnant women with PCOS are more likely than healthy pregnant women to experience early miscarriages, premature births, gestational diabetes and preeclampsia.

All information is for informational purposes only. If you have any health problems, you need to consult a specialist.

Symptoms of right-sided pathology

Signs and symptoms of inflammation of the right ovary in women are nonspecific, which significantly complicates timely diagnosis. Acute right-sided oorphitis is accompanied by the following symptoms:

temperature increase to 38 – 39 °C;
sharp pain localized on the right;
spread of pain to the groin, lower back, inner thighs;
pathological vaginal discharge with purulent and mucous inclusions.

Pain with oorphitis intensifies during movement and physical activity. Most women complain of chills, weakness, lethargy, and dizziness. In a chronic course, the signs of ovarian inflammation in women on the right are blurred:

discomfort during intimacy;
profuse vaginal discharge with an unpleasant odor;
violation of the monthly cycle;
changes in the nature and volume of menstrual bleeding;
frequent urination, accompanied by discomfort.

In the chronic course of oorphitis, it is very difficult to determine the correct diagnosis and create an effective treatment regimen. In this case, the infection spreads to the left ovary, uterine tissue, and fallopian tubes, causing their deformation and disrupting normal functioning. Therefore, if disturbing symptoms raise suspicion of inflammation of the right ovary, it is better not to self-medicate, but to visit a gynecologist as soon as possible in order to begin adequate treatment as soon as possible and prevent the development of irreversible consequences.

What changes with age?

A woman's ovaries contain a limited number of follicles, and over time these follicles are used up. At first, most cycles become anovulatory, that is, ovulation and the formation of the corpus luteum do not occur, which means there is little progesterone hormone. A woman’s menstrual cycle begins to change - it becomes longer or shorter, the intensity of menstruation changes, and the menstruation itself comes irregularly. When there are very few follicles left, the ovary stops secreting estrogens. At first, menstruation becomes rare and irregular, then stops. The last menstruation is called “menopause”. Climacteric syndrome begins to develop.

The likelihood of pregnancy with inflammation of the right ovary

If the disease is diagnosed in a timely manner and treatment is prescribed adequately, the probability of successfully conceiving, carrying and giving birth to a healthy child is 70–80%. When right-sided orphitis has passed into a chronic stage, accompanied by frequent exacerbations, the probability of pregnancy does not exceed 20 - 25%.

Therefore, if a woman has not yet realized her reproductive function or is planning another pregnancy, she should closely monitor women’s health, and if there are any suspicious signs, seek professional medical help, and not self-medicate.

When should you see a doctor?

As soon as the first clinical signs of menopausal syndrome appeared. An irregular menstrual cycle is dangerous not only because of the inability to predict the date of the next period, but also because of the development of endometrial pathology. Without the influence of progesterone, the endometrium begins to grow excessively, and any excess growth is the basis for oncological changes. Bleeding and prolonged menstruation are reasons for a quick visit to the doctor or calling an ambulance. Hot flashes, sweating, changes in emotional background and other disturbances - all these symptoms change the quality of your life, and therefore also require correction. The sooner the necessary treatment is prescribed, the more complete and favorable its effect will be.

A gynecologist treats menopausal syndrome. If you have concomitant diseases, the doctor will recommend that you consult other specialists - an endocrinologist or a therapist.

Diagnosis of right-sided ovarian inflammation

In order for the treatment of inflammation of the right ovary in women to be adequate and effective, first the doctor must find out an accurate diagnosis, find out the causes of the pathology and identify the causative agent. First, the doctor will ask about disturbing symptoms, collect all the necessary data, conduct a gynecological examination, then give a referral for a comprehensive diagnostic examination, including the following procedures:

General clinical blood and urine tests, which confirm the progression of inflammatory processes in the body.
Bacterial inoculation on a nutrient medium to identify the pathogen and select an antibiotic.
PCR analysis to determine the viral pathogen.
Ultrasound examination of the organs of the reproductive system, which will help the doctor assess the degree of physiological changes in the gland.

If necessary, the doctor may prescribe additional diagnostics - laparoscopy, hysterosalpingoscopy. After confirming the diagnosis and identifying the pathogen, the socialist will prescribe a comprehensive treatment for inflammation of the right ovary.

How is the disease diagnosed?

Diagnosis of the syndrome consists of several elements:

gynecological examination, during which the doctor may detect enlargement and hardening of the ovaries. In addition, the doctor takes into account the characteristics of the menstrual cycle, hereditary diseases, past infections, type of hair growth, condition of the skin, and the woman’s weight;
laboratory tests. Studies may be ordered to determine the level of hormones produced by the anterior pituitary gland, thyroid gland, and testosterone. Tests are also carried out to determine the level of protein, glucose, and cholesterol in the blood;
instrumental methods of research. One of the most informative diagnostic methods is ultrasound. Ultrasound signs of pathology include an increase in the size of the ovaries, thickening of their capsule, dense stroma with increased blood flow, and the presence of 12 or more follicles with a diameter of 2–9 mm in at least one of the ovaries.

Treatment of right-sided inflammation of the ovary

Treatment of right-sided oorphitis can be carried out on an outpatient basis or in a hospital setting. It all depends on the nature and complexity of the pathology. If the woman’s general condition is stable and there is no threat to her health, she can be treated at home under the strict supervision of a doctor. If the inflammatory process progresses and complications develop, the patient is hospitalized in order to constantly monitor her and promptly adjust the treatment regimen.

In addition to medications, physiotherapeutic techniques are often used to treat right-sided oorphitis, which enhance the effect of medications and speed up recovery. After relief of acute processes, it is advisable to resort to the following physiotherapy procedures:

magnetic therapy;
electrophoresis;
acupuncture;
paraffin applications;
mud baths;
Charcot shower;
sanitation with mineral waters.

If the oorphitis is advanced, an adhesive process and irreversible deformations are observed in the ovary, surgical treatment is prescribed. Among the surgical methods, the laparoscopy procedure has proven itself, during which the surgeon cuts adhesions through small punctures in the abdominal cavity and removes deformed tissues. After surgery, prevention of relapse is necessary.

Prescribed drugs for inflammation of the right ovary

To stop an acute inflammatory process of a bacterial nature, antibiotics are prescribed. To eliminate pathological symptoms and strengthen the body, the following groups of drugs are additionally used:

Nonsteroidal anti-inflammatory drugs. Relieves inflammation, swelling, pain.
Painkillers. Relieves acute pain syndrome.
Antipyretic. Used at high temperatures.
Antihistamines. Relieve swelling with histamine blockers.
Immunomodulators. Stimulate protective functions, increase the body's resistance to pathogenic infections.
Biostimulants. Improve trophism and restoration of damaged tissues.
Lactobacilli. Restore the balance of beneficial microflora, which suffers after taking antibiotics.

Treatment methods

Treatment of the disease is as follows:

for the treatment of endocrine disorders, hormonal drugs are prescribed that help regulate the menstrual cycle and suppress the effect of androgens;
to restore normal ovulation, non-steroidal anti-estrogenic drugs based on clomiphene are used;
if the level of glucose in the blood is high, hypoglycemic agents are used;
To normalize weight, a low-calorie diet and split meals (5-6 times a day) are prescribed. Fast carbohydrates and fatty foods are excluded from the menu. Proteins and fiber products become the basis of the diet. Food is boiled, baked or steamed. In addition, women are recommended to exercise moderately.

If conservative treatment does not produce results, then surgery is indicated. Surgical treatment can be carried out:

by excision of the sclerotic membrane of the ovaries. This stimulates the growth of normal follicles, which will subsequently release a viable egg;
by wedge resection of the ovaries. During the operation, damaged ovarian tissue is partially excised. This allows the formed eggs to be released from the ovary;
using endothermocoagulation - cauterization of ovarian tissue in places with a large accumulation of follicles containing fluid.

Possible complications of inflammation of the ovary on the right

Complications of right-sided oorphitis arise as a result of the lack of timely and adequate treatment. If a woman ignores disturbing symptoms and self-medicates, the risk of developing the following dangerous consequences increases:

Structural changes in the tissues of the right ovary. Inflammatory processes localized in the gland lead to irreversible structural changes that negatively affect the functioning and ability of the ovary to produce hormones and female germ cells.
Spread of the infectious process to adjacent tissues. Inflammation of the uterus and fallopian tubes often causes the formation of adhesions and scars on the surface of the organs. Such deformations interfere with normal fertilization and often cause infertility.
Inflammation of organs located in the peritoneum. Advanced oorphitis leads to dangerous complications such as cystitis and pyelonephritis.
Disruptions in the menstrual cycle. The ovary affected by the infection ceases to synthesize sex hormones in sufficient quantities, and the process of maturation of the egg in the gland is disrupted, which leads to disruptions in the menstrual cycle.
Infertility. If the inflammatory process has spread to the left ovary, causing bilateral oorphitis, infertility develops. When both ovaries become inflamed, the menstrual cycle is disrupted, ovulation does not occur, which makes conception impossible.

How do the ovaries work?

The ovaries produce sex hormones: estrogens, progesterone and small amounts of androgens (male sex hormones). If the reproductive system works correctly, then the follicle matures in the ovary, ovulation occurs (follicle rupture) and the egg is released, and the corpus luteum is formed. These processes are accompanied by the production of hormones: in the first phase of follicle maturation, estrogens are secreted, and in the second phase, the phase of activity of the corpus luteum, progesterone predominates, which creates favorable conditions for pregnancy.

Preventive procedures

Simple and accessible rules of prevention will help to prevent orthitis and prevent relapses:

avoid hypothermia;
adhere to the rules of intimate hygiene;
lead a protected sex life using barrier methods of contraception;
treat genitourinary system infections in a timely manner;
maintain immunity at a high level;
take vitamins prescribed by your doctor;
Healthy food;
get rid of habits that are harmful to health;
lead an active, healthy lifestyle;
regularly undergo preventive gynecological examinations, which will help identify and treat pathology in the initial stages of development.

If there are suspicious symptoms and a rapid deterioration in general health, self-medication is prohibited. Incorrectly selected drugs can only complicate the course of the pathology, contribute to chronicity and irreversible deformations of the tissues of the ovaries and other organs of the reproductive system.

What is menopausal syndrome?

Menopausal syndrome is a whole complex of symptoms associated with a lack of estrogen in a woman’s body. The first to appear are so-called vasomotor disorders - hot flashes, sweating, palpitations, dizziness. emotional background also depends on hormones: anxiety, depression, tearfulness, irritability, decreased libido and insomnia - this is how the body reacts to menopause. The severity and duration of these symptoms varies from person to person - for some they do not bother them at all, but for other women they continue for years. Over time, urogenital disorders : vaginal dryness, itching, burning, pain during sexual intercourse. The tone of the perineal muscles decreases, urination disorders may appear, including urinary incontinence when laughing or coughing. metabolism changes —weight may increase, adipose tissue accumulates in the waist area, bones become brittle (osteoprosis develops), appearance changes—the skin loses its elasticity, wrinkles appear. Of all these symptoms, only vasomotor symptoms (hot flashes and sweating) are temporary. Psychoemotional, urogenital disorders and metabolic changes will progress over time if left untreated.

Cost of treatment for inflammation of the right ovary

The treatment regimen for inflammation of the right ovary in women is determined individually, taking into account the nature of the course, stage, presence of associated complications, etc. Our specialists will help you quickly determine the diagnosis and prescribe the most effective therapy, which will help you fully recover and prevent negative consequences.

To find out the cost of treatment for right-sided orthitis and make an appointment with a specialist at the Healthy Family clinic, call the number or request a call back. As soon as the managers see the request, they will immediately contact you, advise on all issues of interest and agree on a time convenient for you.

What is ovarian reserve?

If you have ever been to an appointment with a fertility specialist, you have probably heard this phrase, in an optimistic intonation: “well, your ovarian reserve is quite promising” or with a negative connotation: “the ovarian reserve is rather low”...

Ovarian reserve or functional ovarian reserve is the name given to the estimated number of eggs in a woman’s ovaries that can eventually lead to pregnancy.

This potential is laid in the ovaries of a girl in the womb; after her birth, about 400,000 cells remain in the ovaries. In the future, a sad fate awaits us, unlike the male reproductive reserve, which is periodically renewed throughout life, our female reserve is only spent during life, without the possibility of restoration. Every month we lose at least 20 cells, regardless of lifestyle, presence or absence of pregnancies, use of contraceptives, etc.

Thus, with age, the number of cells capable of giving birth to pregnancy normally decreases in all women.

In addition, throughout life, the ovaries are negatively affected by many factors that reduce the quality of these cells (inflammatory reactions, neoplasms, exposure to various toxic substances, etc.). Surgical interventions on the ovaries (removal of ovarian cysts, resection of the ovaries, etc.) can prematurely reduce the follicular reserve to 0 in young women.

What is hormone replacement therapy?

Hormone replacement therapy is estrogen preparations. Modern drugs meet the requirements of the International Menopause Society, which means that they:

contain natural estrogens, which are absolutely identical to those hormones produced in a woman’s body
taken daily to eliminate the possibility of recurrence of hot flashes during breaks
contain minimal doses of hormones
do not have a negative effect on metabolism, that is, they do not lead to weight gain
may have additional beneficial effects: removing excess fluid, helping stabilize blood pressure, reducing hirsutism (excessive facial hair growth).

The main component of HRT is estrogens. They are the ones who have a therapeutic effect and stop the manifestations of menopausal syndrome. But drugs that contain only estrogens are prescribed to those women who have had the uterus and cervix removed. Additional conditions are the absence of rapid growth of uterine fibroids and endometriosis before surgery.

All other women should receive combination therapy that includes estrogens and gestagens to protect the endometrium. Such therapy can be prescribed in the form of two regimens:

Cyclic, when in the first 14 days a woman receives only estrogens, and in the next 14 days - estrogens and gestagens. With this regimen, a woman will have menstrual-like discharge (similar to regular periods) once every 28 days.
Continuous, when both estrogens and gestagens are prescribed every day. In this case, there will be no menstrual-like discharge, but in the first months of use, spotting may appear - this is the body adjusting to a new hormonal background. After a few months of use, such discharge stops completely.

Hormone replacement therapy is prescribed as a tablet, skin gel, patch, or a combination of these. The type of HRT and dosage regimen are selected individually for each woman, and only a doctor can do this.

Are there any contraindications for HRT?

Yes, they exist, just like for any drug. These include:

Vaginal bleeding of unknown origin
Acute severe liver disease
Acute deep vein thrombosis
Acute thromboembolic disease, hereditary and acquired thrombophilias, previous thromboembolism or deep vein thrombosis.
Porphyria
Breast cancer and endometrial cancer.

In addition, there are a number of diseases for which the use of hormone replacement therapy is limited, therefore, before prescribing replacement therapy, a doctor’s consultation and examination are necessary.

When to start HRT and how long can you continue taking it?

It is better to start HRT at the first signs of depletion of ovarian function and the appearance of menopausal syndrome. The more time has passed since the last menstruation, the fewer estrogen receptors remain in the body, which means that hormonal drugs will not be as effective as possible. It is considered optimal to prescribe HRT no later than 6-8 years after the last menstruation. If therapy was started on time, the effect of the drugs persists throughout the duration of administration and does not depend on age.

In the absence of contraindications, the duration of hormone replacement therapy is not limited. There is no need to take breaks in treatment. It must be remembered that a woman taking such drugs should regularly visit a gynecologist and undergo an examination at least once a year (usually the same as before selecting HRT).

What examination is prescribed before selecting HRT?

This is an examination that allows a woman to exclude contraindications for HRT. The minimum examination includes:

Oncocytology of the cervix (screening for cervical cancer)
Ultrasound of the pelvic organs
Mammography (breast cancer screening)
Blood chemistry
Hormonal examination (usually an assessment of thyroid function).

This list can be expanded, especially if a woman suffers from chronic diseases.