Polycystic Ovarian Syndrome: What is it and what should I do?
- Polycystic ovary syndrome is a complex chronic pathology that includes metabolic, reproductive and psychological disorders.
- It is therefore not a problem only for women who want to get pregnant, although it is associated with infertility in a high percentage.
- Treatment should focus on education, different psychological aspects and a notable change in lifestyle in combination with drug therapy if necessary.
September is the month dedicated to giving visibility to polycystic ovarian syndrome (PCOS), a very common ailment about which little is said. Therefore, we have asked dr. Juan Giles, gynecologist at IVI Valencia, who explains to us in this post what PCOS is, how to treat it, and how it is related to women’s fertility.
Polycystic ovary syndrome is a health problem that can affect women since adolescence and is considered the most common endocrine (hormonal) disorder in women of reproductive age. The estimate of its frequency is highly variable, ranging between 5% and 20%. These variations in frequency can be explained by differences in criteria in their diagnosis or diversity between races.
What Causes Polycystic Ovarian Syndrome?
Although its cause is unknown, it seems that the development of the syndrome is conditioned by the interaction between a certain genetic predisposition and exposure to different environmental factors. Some factors that could contribute to having PCOS are:
- Hereditary factors. We know that certain genes could be associated with its appearance, so if a member of your family has it, you would be more likely to present it. Not only at the level of hormonal or reproductive alterations, but also of metabolism such as insulin resistance that produces an excess of this hormone.
- Environmental factors. In women with susceptible genes, the presence of environmental factors or some infections trigger the onset of the syndromeIn addition to the influence exerted by the environment in which the fetus develops in the uterus and which is also associated with a greater risk of developing it.
- Androgen excess (hyperandrogenism). Women, like men, make sex hormones. In the case of these, the ovary produces estrogens, progesterone and androgens that regulate the menstrual cycle and ovulation.
In polycystic ovary syndrome, the woman manufactures amounts of androgens (also sometimes called “male hormones”) higher than normal.
- Hyperinsulinemia (excess insulin). Insulin is a hormone produced in the pancreas that allows your cells to use sugar. If your cells become resistant to the action of insulin, blood sugar levels can rise and the body will produce more insulin. If you have an excess of insulin can cause an increase in the production of androgens, which would cause difficulties in ovulation, increased hair (hirsutism) and acne.
What symptoms appear in polycystic ovary syndrome?
Symptoms can vary throughout the life of the affected woman; in adolescence it manifests itself from the gynecological and psychological point of view, while in adult life we find a infertility problem and metabolic complications.
Women may have:
- Alterations You can have irregular menstrual cycles, have intervals from one cycle to another of 36 to 90 days (oligoamenorrhea) and even have no periods (amenorrhea) or have heavy bleeding. The cause of these disorders is the higher amount of androgens, which interferes with the development of the ovum and its release during ovulation. Affecting 70-80% of women with this syndrome.
It can take up to two years for a woman to have regular periods from her first period, so this symptom can be difficult to recognize in adolescent girls.
- Associated with the absence of ovulation. In fact, it is the most common cause that you may have infertility due to not ovulating (anovulatory).
However, many women with this syndrome can get pregnant if they have sex, since they can ovulate occasionally. Therefore, if you do have sex, use a condom every time to avoid pregnancy and sexually transmitted diseases (ETS).
- Androgen excess. Excess androgens (“male hormone”) can cause physical signs, such as excess facial and body hair (hirsutism), and sometimes severe acne and male-pattern baldness. About 60% of you who have PCOS have hirsutism, but its frequency varies significantly with race and obesity.
- Metabolic disturbances. PCOS would put you at higher risk of developing glucose intolerance, Mellitus diabetes and gestational diabetes. Obesity is also common among those who suffer from PCOS, and may aggravate the other manifestations of the syndrome in those who suffer from it. If you are obese, you can also frequently present darkening and thickening of the skin around the neck, armpits or breasts, which is called acanthosis nigricans.
- Psychological affectations. Problems that arise as a consequence of changes in physical appearance associated with PCOS (acne, hirsutism or obesity) together with probable infertility and various long-term complications that affect quality of life can significantly alter the psychological health of those of you who are affected.
- Long-term complications. PCOS would make you have an increased risk of cardiovascular diseases such as hypertension or the alteration of fat levels in the blood (dyslipidemia) or the appearance of uterine cancer (endometrium) in case you do not have periods continuously.
How is polycystic ovary syndrome diagnosed?
There is no specific test for its diagnosis. In order to tell yourself that you have PCOS, you must present at least 2 of the 3 following conditions:
- Menstrual disturbances in the form of long intervals between periods or absence thereof, which means that you ovulate few times (oligoovulation) or you don’t ovulateanovulation).
The doctor, usually the gynecologist or the endocrinologist, will ask you in addition to the characteristics of your menstruation for questions about your health and the health of your family, which will allow him to take your medical history.
- The presence on physical examination of acne, male pattern alopecia and hirsutism would indicate that you have an increase in androgens (hyperandrogenism).
Usually it will also weigh you, take your blood pressure and perform a gynecological examination to rule out other possible causes of your symptoms. The doctor usually also requests a blood test to assess your hormones, or once the diagnosis is made to detect complications related to cholesterol, triglycerides and insulin resistance.
- To assess your ovaries, you must have a ultrasound at the beginning of your menstrual cycle. In the event that you have PCOS, it would be observed that the ovaries are enlarged and there is an increase in the number of small cysts called follicles (morphological characteristics of polycystic ovary).
Not all women with PCOS will have excess androgens, abnormal ovulation, and polycystic ovarian morphology on ultrasound. In fact, it is known that there may be up to 4 groups depending on the alterations they present.
How is polycystic ovary syndrome treated?
There is currently no treatment that can “cure” polycystic ovary syndrome, but there are several ways to treat and control it depending on the problems that you present and your needs may change over time. To simplify it, we are going to divide it into 2 sections: women with infertility and women who do not want to get pregnant.
- Women with gestational desire.
Infertility is an important problem in women with PCOS, as I mentioned before, since around 70% of them have problems getting pregnant.
In case you are obese or overweight, the first thing to do is diet and physical exercise (changes in lifestyle), since weight loss allows you to regulate ovulatory patterns and consequently fertility; in the same way that it improves the response to drugs used in reproductive treatments.
Medications to induce ovulation (ovulation induction) such as letrozole or clomiphene citrate can also be used. If you have not managed to get pregnant with these, injected drugs called gonadotropins can be administered to stimulate the growth of an egg. If you are given these medications, you have to watch yourself very carefully to make sure you are not responding too much, as this increases the risk of multiple births.
Some women are also given insulin-sensitizing drugs, such as metformin, as they can help the body use insulin more effectively to improve ovulation.
If the treatments discussed so far fail, surgery can be performed to reduce the number of small cysts in the ovary (follicles), but this technique may have some drawbacks.
Fertilization treatments in vitro (IVF) appear as the next treatment option or in the case that you have other factors that affect fertility.
- Women who do not want to get pregnant.
If fertility is not the goal, sometimes just losing weight can improve hormonal levels, which makes many of your symptoms disappear or lessen in severity. Physical exercise is very important to improve your body’s sensitivity to insulin and reduce the risk of diabetes.
Sometimes in addition to lifestyle changes, medications may be prescribed to treat polycystic ovary syndrome. Initially, unless it is contraindicated in your case, you can be prescribed contraceptive pills to regulate hormone levels and the menstrual cycle. Birth control pills can also help you control acne and excessive growth of body hair, decrease the risk of uterine (endometrial) cancer, and correct abnormal bleeding. Instead of birth control pills, you can use a skin patch or vaginal ring.
You could also take progesterone for ten to fourteen days every one to two months to regulate your periods and protect against endometrial (uterine) cancer. Treatment with progesterone, however, will not improve androgen levels, nor will it prevent pregnancy. The progesterone-only minipill or the progesterone intrauterine device would be the best options when you also don’t want to get pregnant.
Drugs that reduce “male hormones,” called antiandrogens, can help you treat skin problems and excessive growth of body hair.
To remove excess hair you can also resort to electrolysis and laser treatment. In electrolysis, a small needle that emits an electric current is inserted into each hair (hair follicle) that damages it until it is destroyed. You may need several treatment sessions.
Due to the effects of PCOS on your health, you could present psychological alterations that require treatment by a health professional.
Dr. Juan Giles
Gynecologist. Reproductive Medicine Specialist
IVI Valencia
