Polycystic ovary syndrome is manifested by a wide range of clinical symptoms and endocrine and metabolic abnormalities. PCOS is defined as higher levels of androgens (male sex hormones) in combination with irregular menstrual cycle (longer cycles, missing menstrual bleeding). The certainty of PCOS diagnosis can be supported by typical morphologic symptoms of ovaries (many small ovarian cysts) found by ultrasonography; however, normal appearance of ovaries does not exclude PCOS diagnosis. This syndrome occurs in about 5 – 10% of all women. It is important to not confuse PCOS syndrome with the condition of normal polycystic ovaries (PCO), which is a normal condition without hormonal swings diagnosed using ultrasound examination in up to 30% of women of reproductive age. The finding of PCOS alone without other fulfilled criteria does not mean a clinical PCOS diagnosis.
The cause is yet to be determined. The main factor includes lower sensitivity of body cells to insulin, which then leads to an increase in androgen production via complex chemical processes. Genetic and some other factors also contribute to PCOS.
Symptoms (usually occur individually or in small groups):
1. Irregular or missing menstruation
2. Missing ovulation (releasing of the egg from the ovary)
3. Obesity
4. Hirsutism (excessive hairiness)
5. Resistance to insulin
6. Acne
7. Numerous small cysts on ovaries
8. Enlarged ovaries – up to three times bigger than normal size
9. Infertility – inability to become pregnant after more than 12 months of unprotected sexual intercourse
10. Chronic pelvic pain – more than 6 months
11. Dyslipidemia – abnormalities of lipid levels in blood
12. High blood pressure – more than 140/90
Diagnostic Criteria
– a chronic pattern of missed ovulation or menstrual cycle disorders (menstrual bleeding occurs late or not at all) followed by higher androgen levels after excluding other possibilities of increased androgen levels
– supportive criteria: ultrasound finding of polycystic ovaries, the ratio of Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels ratio – LH at least two times greater than FSH
Diagnosis is based on physical examination, presence of the above mentioned symptoms, ultrasound examination and endocrine examination.
Treatment
Medications and surgical procedures are both used.
1. Weight reduction – Higher weight is associated with a more frequent occurrence of sterility and menstrual cycle disorders. Weight reduction also helps increase cell sensitivity to insulin.
2. Hormonal treatment – Taking medications that decrease androgen levels or their effect on the tissue (antiandrogens or androgen antagonists). Cyproteronacetate is the most frequently used medication. It is used, for example, in a form of a contraceptive pill (DIANE 35, MINERVA, CHLOE) or as ANDROCUR preparation. Some other medications can be applied with a great antiandrogen effect – for example, spironolakton (VEROSPIRON), flutamid (ANDRAXAN) or finasterid (PROSCAR, PENESTER).
3. Insulin sensitizers – Preparations that enhance tissue sensitivity to insulin – metformin/METFORMIN, GLUKOPHAGE, SIOFORF
4. Ovulation induction – Can be combined with additional assisted reproduction methods
5. Surgical treatment – Thin layer on the surface of the ovaries is very lightly laparoscopically drilled (ovarian drilling), which improves their ovulation functions and hormone production.