Polycystic Ovarian Syndrome (PCOS) affects almost 5% of women. It is an ovulatory dysfunction caused by a hormonal imbalance that can affect women in different ways, interfering with their reproductive function.
Many hormones are affected by this pathology: estrogens, progestogens, androgens, follicle-stimulating hormone (FSH), luteinizing hormone (LH), etc. These hormonal alterations result in the appearance of small cysts in the ovaries (which can be easily visualized by transvaginal ultrasound) and an increase in the levels of androgens (male hormones) in the blood, which results in some clinical manifestations.
These alterations involve the main manifestation of polycystic ovary syndrome, which is anovulation, i.e. the absence of ovulatory cycles. For this reason, patients present amenorrhea (absence of periods) or opsomenorrhea (very irregular periods).
As a consequence of these ovulatory alterations, there is greater difficulty in achieving pregnancy.
Other pathologies characteristic of patients with polycystic ovary syndrome may also be associated, such as insulin resistance, obesity, diabetes, arterial hypertension or hypercholesterolemia.
Polycystic Ovary Syndrome Symptoms
Among the most frequent symptoms of PCOS are:
- Irregular cycles or amenorrhea (absence of menstruation).
- Acne, even in adulthood.
- Hirsutism: excess hair growth on areas of the face, abdomen, chest or around the nipples.
- Overweight/obesity
- Difficulty in getting pregnant.
- Acanthosis nigricans, which is the appearance of dark marks in the skin folds (armpits, groin, under the breasts…).
- Reduced density of the scalp and male pattern baldness (hair loss especially in the frontal area).
Diagnosis of Polycystic Ovarian Syndrome
The diagnosis of Polycystic Ovarian Syndrome has 3 components:
- Clinical component, associated with the symptoms described.
- The ultrasound component, in which enlarged ovaries with microcysts in their periphery are observed. There is a 20% of the population that can present this ultrasound pattern without having PCOS.
- The hormonal component, which is verified with a blood test.
Associated with PCOS, there is an increased risk of developing a metabolic syndrome, which consists of obesity, cholesterol alterations, insulin resistance, arterial hypertension. This can lead to the development of type 2 diabetes and cardiovascular pathology.
Polycystic Ovary Syndrome Treatment
The purpose of the treatment of Polycystic Ovary Syndrome is based on two fundamental pillars: the regularization of the menstrual cycle and the reinstatement of ovulatory cycles.
The first thing to do is to consult with our doctor or gynecologist, who will perform several tests prior to treatment: a study of ovarian function, an examination to detect the possible presence of ovarian cysts, different tests to detect hormone levels, insulin resistance tests and thyroid function tests.
Depending on the results of the analyses, the treatment to be carried out will be decided. In some cases, normalization of the menstrual cycle can be achieved by using oral contraceptives alone, although it is often necessary to combine them with other methods.
If our doctor has detected that we have a high insulin resistance, for example, he may opt for a treatment with metmorphine associated with diet and moderate physical exercise. In this way, insulin resistance is reduced, as well as the probability of developing type 2 diabetes.
Clomiphene citrate is one of the most widely used treatments to restore ovulatory cycles. It acts by blocking estrogen receptors, and this leads to the production of a greater amount of follicle stimulating hormone (FSH) and luteinizing hormone (LH), which normalize ovulation. In cases in which ovulatory cycles are not achieved in spite of clomiphene citrate, gonadotropins, hormones that facilitate correct maturation of the ovum, can be administered.
As a last resort, the doctor can resort to laparoscopic surgery to perform “ovarian drilling”. This consists of making different perforations in the ovarian cortex in order to reduce the number of cysts and normalize hormonal levels and the menstrual cycle.
Within the treatment of PCOS there are multiple alternatives, which will depend on the patient’s symptoms and whether pregnancy is desired or not. Among them are lifestyle changes (weight loss may be enough to regulate ovulation and improve symptoms), medical treatment (especially the use of oral contraceptives), etc.