Polycystic Ovary Syndrome (PCOS) was first described in the literature by Stein and Leventhal in 1935. PCOS is a hormonal disorder that is common in women of reproductive age. Although rare or prolonged menstrual periods are observed in women with Polycystic Ovary Syndrome, high levels of androgens (testosterone, dihydrotestosterone and androstendione hormones) can also be observed. Accordingly, follicles known as small fluid accumulations are formed in the ovaries. As a result, problems arise in healthy and regular ovulation.
The actual cause of Polycystic Ovary Syndrome is unknown. A notable study of evidence shows that both hereditary and non-hereditary factors, as well as intrauterine (life in the womb) and extrauterine (life after birth) factors, are associated with Polycystic Ovary Syndrome. It is also necessary to keep in mind that Polycystic Ovary Syndrome can be defined by multiple pathological explanations, given that it is not a "disease" but a "syndrome". Regular weight loss along with early diagnosis and treatment reduces the risk of developing long-term complications such as Type 2 diabetes and heart disease.
Factors thought to cause polycystic ovary syndrome are as follows:
- High insulin levels: insulin is the most important hormone responsible for the absorption of glucose into the cell, which is released from the pancreas and provides the main source of energy for cells in the body. If resistance to insulin develops at the receptors that will allow glucose to enter the cell on the cell surface, glucose that cannot enter the cell will rise in the blood. This increase can also lead to an increase in androgen levels, and as a result, the ovulation process becomes difficult.
- Low-grade inflammation: this term refers to the effects of certain substances that white blood cells (white blood cells) produce in the body to fight infections. Research shows that androgens produced in women with Polycystic Ovary Syndrome also trigger low-grade inflammation. This condition can cause cardiovascular pathologies.
- Hereditary factors
- High androgen levels
Signs and symptoms
Signs and symptoms usually develop with the first menstrual cycle at the entrance to puberty. Sometimes Polycystic Ovary Syndrome can develop due to rapid weight gain as age progresses. Although there are various signs and symptoms for Polycystic Ovary Syndrome, it will be significant to evaluate the existing clinic in terms of Polycystic Ovary Syndrome if there are at least two of the following substances:
- Irregular menstrual periods. Infrequent, irregular, or prolonged menstrual periods are the most common symptom for Polycystic Ovary Syndrome. For example, periods less than 9 per year, longer than 35 days between each period, and abnormally painful.
- Excessively increased androgen levels. Excessive elevated levels of androgen hormones can cause increased body and facial hair (hirsutism) , acne, and male pattern baldness (androgenic alopecia).
- Polycystic Ovaries. This condition, which can be noticed by ultrasound, is characterized by the formation of a large number of follicles around the mature egg, but also prevents the ovary from producing high-quality eggs.
Complications
- Infertility
- Gestational (formed during pregnancy) diabetes or high blood pressure levels triggered by pregnancy
- Miscarriage or premature birth
- Non-alcoholic steatohepatitis, severe liver inflammation due to fat accumulation in the liver
- Clinical picture characterized by metabolic syndrome, high blood pressure, high blood sugar levels, and abnormal cholesterol or triglyceride levels, increasing the risk of cardiovascular disease
- Type 2 or early diabetes
Obesity is associated with Polycystic Ovary Syndrome and is the most important parameter in increasing the severity and risk of complications.
Diagnostic Methods
There is no definitive test for the diagnosis of Polycystic Ovary Syndrome. Doctors begin diagnostic evaluation by receiving information from patients about their health history, weight change, and menstrual period patterns. A physical examination is performed to cover the signs of increased hair growth, insulin resistance and acne.
- Pelvic examination: inspection (by observation) and manual (by hand) examination. The presence of any structural disorder, growth or other abnormalities in the reproductive organs is evaluated.
- Blood test: performed to determine hormone levels. It is useful to exclude possible menstrual irregularities or high androgen levels and to measure glucose tolerance, cholesterol and triglyceride levels in hunger.
- Transvaginal ultrasound: provides an assessment of the condition of the ovary and the thickness of the line of the uterus (the part in the uterus where the embryo develops and grows). The working principle of this imaging method is based on transferring sound waves sent by an apparatus to all surrounding tissues inside the vagina through a transducer (transducer) to a computer screen.
It is recommended that patients who receive a diagnosis be examined by specialists for depression, anxiety and sleep apnea along with regular monitoring for blood glucose, cholesterol, triglyceride levels and blood pressure.
Treatments or administration methods
Treatment of Polycystic Ovary Syndrome is based on the patient's complaints such as infertility, hair growth or increased acne, obesity. Lifestyle changes and medications are specific treatment options.
Lifestyle changes; low-calorie diet and regular exercise and weight loss contribute greatly to the decline of the current disease, as well as increase the contribution of medications recommended by doctors and help treat infertility.
Drug therapy, three of which are recommended for the main purpose.
- Regularizing the menstrual cycle: a combination of drugs used for birth control purposes (estrogen and progestin) reduces androgen production and also regulates estrogen levels. Hormone regulation reduces the risk of endometrial cancer and prevents abnormal bleeding, excessive hair growth and acne. Vaginal rings and patches containing a combination of estrogen and progestin are also available, as is the use of medicaston in pill form. Progestin therapy can regulate menstrual periods and protect against endometrium cancer when administered for 10 to 14 days every 1-2 months. This method of treatment does not reduce androgen levels and does not provide birth control. If you want to avoid pregnancy, it is recommended to use only a progestin-containing minipill or progesterone-released intrauterine device.
- Help ovulation: Clomiphene is an oral anti-estrogen therapy and should be taken in the first half of the menstrual period. Letrozole, this drug used to treat breast cancer, increases egg production. Metformin corrects insulin resistance in Type 2 diabetes and reduces the amount of insulin in the blood. In women who use clomiphene for pregnancy treatment, metformin is sometimes combined. These drugs, which are derived from gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH), are used by injection.
- Reducing the increase in abnormal hair growth: birth control pills reduce the increase in androgen, which causes excessive hair growth. Spiranolactone (Aldactone) limits the effects of androgens on the skin. Only this drug can cause congenital anomalies. For this reason, it is recommended not to be used during pregnancy or during the desired periods of pregnancy. Eflornithine is used as a cream to reduce regional hair growth. Electrolysis is the destruction of each hair follicle using an electric current with the help of a thin needle. For the last two methods of treatment, Obstetricians and Gynecologists refer patients to a dermatology clinic.
Incidence and distribution (Epidemiology)
Although the distribution of polycystic ovary syndrome varies due to different diagnostic criteria, a meta-analysis conducted in 2016 evaluated the diagnostic criteria used in Europe, Australia, Asia and the Americas, and found a ratio of about 6% in terms of diagnosis.
30% of women diagnosed with Polycystic Ovary Syndrome have a normal menstrual cycle, while about 85-90% of women who complain of oligomenorrhea (menstrual periods last longer than 35 days) and 35-40% of women who complain of amenorrhea (never having menstruation) have Polycystic Ovary Syndrome.
Prevention Methods
The following methods are recommended to prevent Polycystic Ovary Syndrome:
- Continue to remain at a healthy weight. In this way, insulin and androgen levels will remain within regular limits and the necessary conditions for ovulation will be easier to form. Doctors and dietitians constitute the appropriate nutrition program for their clients.
- Consuming a limited amount of carbohydrates. Low-fat and high-carbohydrate diets increase insulin levels.
- Having an active, active life supported by regular exercises. It is critical for lowering blood sugar to normal values and treating insulin resistance.