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Polycystic ovary syndrome, also known as polycystic ovary syndrome, from the English translation of Policystic Ovary Syndrome (PCOS), despite its increasing prevalence / diagnosis, with an estimated frequency of around 5-10%, remains unclear. The problems begin with determining the causes of the syndrome and, unfortunately, they don’t end there. Controversies still concern the definition, diagnosis criteria, treatment and prognosis. If there are so many contradictions, what do you know?
When is the anxiety?
Symptoms that women, often young women, report to the gynecologist are most often menstrual disorders, such as rare or amenorrhea. Unfortunately, there may be difficulties in getting pregnant or reporting it. Other disturbing and aesthetically bothersome symptoms are the appearance of acne, seborrhea and excessive hair growth, i.e. hirsutism or alopecia. Hirsutism may affect the face areas of varying severity: upper lip and chin, abdominal area, chest area, back, thighs, groin area. The symptoms result from a disruption of the male sex hormones or androgens. It should be emphasized, however, that not all women with excessive levels of androgens have hirsutism, just as women with hirsutism do not always have excess androgens.
What else is threatening?
Polycystic ovary syndrome is not only aesthetic reasons, but above all fertility disorders resulting from the lack of ovulation. Unfortunately, the list of threats does not end there. Abnormal menstrual bleeding and hormonal disorders increase the risk of developing endometrial cancer. Long-term metabolic disturbances mainly concern the risk of developing glucose intolerance and diabetes mellitus, which develops in approximately 10% of patients with PCO syndrome by the 4th decade of their life. It is most likely related to a faster progression of carbohydrate disorders and resistance, both in adipose tissue cells and in skeletal muscles, to insulin, which is the main hormone responsible for the proper level of glucose in the blood. Some develop arterial hypertension. Blood tests often show an abnormal lipid profile in the form of increased total cholesterol, LDL cholesterol, and triglycerides, and decreased HDL cholesterol levels. Further, the function of blood vessels, and more precisely one of their layers – the endothelium, may be disturbed, which in turn leads to a disturbance of the compliance and elasticity of the artery walls, as is the case with atherosclerosis. Coronary atherosclerosis is much more common in obese women with PCOS, which is responsible for ischemic heart disease and myocardial infarction.
Why is there an increased risk of cardiovascular disease in patients with PCO syndrome? If we take a closer look at the risk factors for cardiovascular disorders and the conditions commonly seen in polycystic ovary syndrome, many of them overlap. They include: obesity, diabetes, arterial hypertension, lipid metabolism disorders, and insulin resistance. It is still unknown why obesity affects, according to various sources, from 30 to 75% of women with PCO. On the other hand, in the United States of America, a parallel increase in the frequency of PCOS diagnosis was observed with the increase in obesity in women.
Diagnostics not only by symptoms
In the criteria for identifying an international organization dealing with the issue of androgen disorders (AES) of 2006, there is a diagnostic “wicket” in the form of the word “or”. It may happen that a patient presents, for example, because of irregular periods without excessive hair, or vice versa, i.e. with hirsutism and normal menstrual bleeding, and yet she can be diagnosed with PCO syndrome. How does it happend? The gynecologist, who performs basic examinations, apart from a thorough interview with the patient and gynecological examination, performs an ultrasound examination, assessing the appearance and size of the ovaries. It is important whether they meet the criteria for polycystic ovaries. An additional element is the marking of sex hormones, incl. free testosterone levels, total testosterone levels or Free Androgen Index. To sum up: the definition of AES refers to hyperandrogenism (obviously after excluding other causes, e.g. thyroid disease) in the form of hirsutism and / or hyperandrogenemia and ovarian dysfunction: absent or rare menstruation and / or polycystic ovaries. Other criteria from 2003. (Rotterdam) require 2 out of 3 for diagnosis: 1. ovulation disorders and / or anovulation, 2. hyperandrogenism, 3. polycystic ovaries. As you can see, it is not easy to reach a consensus. In addition to the diagnosis, diagnosis should be performed for glucose intolerance, lipid disorders and other possible causes of clinical symptoms suggesting the diagnosis of PCO syndrome.
What and how to treat?
Treatment is symptomatic and depends on the desired effect. In the case of infertility, the goal is to get the ovaries to cycle and ovulate. Pharmacological and surgical methods are available. Regardless of the disputes about the etiology and causes of the syndrome, it has been shown how important it is to modify the lifestyle of women with PCOS. A healthy low-calorie diet with a low glycemic index is essential for overweight or obese patients, but should be followed by all women with suspected or diagnosed PCOS. Physical activity is also important. Much has been said about the overall health effects of regular exercise, even in polycystic ovary syndrome. The reduction of excess body weight is crucial in further treatment. There are specific reasons and medical justification for all these methods, supported by numerous scientific studies, so you don’t have to take them on faith and use them calmly. Unfortunately, modification of the lifestyle to treat the symptoms of the syndrome most often needs to be supported by pharmacological treatment. Several classes of drugs are available with different mechanisms and with different effects. The choice of therapy and its scheme are selected by a specialist individually for each patient, depending on the clinical picture and the purpose of the action. One of the drugs improving insulin sensitivity of peripheral tissues is metformin, which additionally often restores regular menstruation and improves blood lipid results. It is necessary to describe in two words the action of contraceptives, i.e. another group of drugs in the PCO syndrome. They lower the concentration of androgens, reduce or eliminate acne and hirsutism, regulate menstruation, and also reduce the risk of endometrial cancer. At this point, it is worth recalling that contraceptive treatment, regardless of the reason for its inclusion, is determined and prescribed by the doctor based on the health of the woman, taking into account the limitations and possible contraindications to their use. Another group of drugs used in the treatment of PCO syndrome are antiandrogens, which reduce hirsutism, also lower androgen levels and lower LDL cholesterol and triglycerides without affecting HDL and insulin levels.
The most common method used by women in hirsutism is mechanical hair removal (shaving, plucking, waxing, using depilatory creams). The recommended method for removing unwanted hair is laser coagulation.
The issue of polycystic ovary syndrome will be of great interest for a long time to come, because not only is it one of the most common endocrine diseases in women, but it also concerns such important issues as fertility and appearance. May the mystery of PCOS be quickly clarified and, with the understanding of the mechanisms of its origin, be possible not only symptomatic but also causal treatment.
Text: Katarzyna Kuśmierczyk
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