Polycystic ovary syndrome

Content

Introduction

Polycystic ovary syndrome (PCOS, Poly-Cystic Ovary Syndrome) is also known as ovarian polycystosis or Stein-Leventhal syndrome, named after the two American doctors who described it in 1935. PCOS is a hormonal disorder common in women in the period between the onset of the first menstruation and the menopause ( reproductive age). It is characterized by an alteration of the menstrual cycle, an excessive presence of male hormones (hyperandrogenism) and the absence of ovulation. It affects between 8% and 20% of women and represents one of the most common causes of infertility.

The women at greatest risk for PCOS are those who have first-degree family members, i.e. a mother or sister, who suffer from this condition. The syndrome may be associated with changes in metabolism, such as insulin resistance resulting in high levels of insulin in the blood (hyperinsulinemia). Rapid detection and treatment coupled with weight loss can reduce the risk of complications over the long term. term such as type 2 diabetes and cardiovascular disease.

Symptoms

The signs and disorders (symptoms) of polycystic ovary syndrome (PCOS) often occur during the period of sexual development (puberty) during the first menstrual periods. Sometimes, the condition may present itself later; in some cases, it may appear following a considerable increase in body weight.The syndrome presents with a variety of signs and symptoms that make it difficult to define specific criteria for identifying it. In most cases, it is discovered when at least two of the following three disorders occur:

  • changes in the menstrual cycle, which can be infrequent, irregular, or prolonged. You can have fewer than 9 periods in a year or an interval of more than 35 days between one flow and the next and, sometimes, particularly heavy periods
  • excess of androgens, which can lead to physical signs such as an overabundance of hair in typically male areas (hirsutism) and, sometimes, severe forms of acne and hair loss
  • polycystic ovary, characterized by an increase in the volume of the ovaries that contain multiple follicles (small cysts that enclose egg cells) and may be associated with a lack of ovulation

In obese women, the signs and symptoms of PCOS are usually more severe. It is good to consult a doctor in case of persistent irregularities in the menstrual cycle, if you are unable to become pregnant or in case of signs indicative of an excess of androgens such as hirsutism, oily skin, unresponsive acne to cure, and a major hair loss.

Causes

The causes of polycystic ovary syndrome (PCOS) are still unknown and it seems to be linked to a malfunction of the reproductive system caused by metabolic imbalances, genetic mutations and environmental factors that give life to the so-called "perpetual cycle of the" polycystic ovary ". Factors that could be involved in the onset of PCOS include:

  • hormonal imbalance, which involves the ovaries and the glands that control their activity (pituitary and hypothalamus), is characterized by an excessive production of androgens responsible for acne and abnormal hair growth (hirsutism)
  • metabolic syndrome, linked to an "excessive action of" insulin on the ovary.Insulin is a hormone produced by the pancreas that controls the transport of glucose from the blood into cells, where it is used for energy production. When cells develop insulin resistance, blood glucose levels rise, stimulating the pancreas to produce a more insulin. Too much insulin can increase androgen production, causing difficulty ovulating
  • low-grade inflammation, which could stimulate the polycystic ovary to produce androgen hormones which, in turn, in the long term, could also be responsible for cardiovascular problems
  • family type cause, some research suggests that PCOS may be linked to the presence of specific genes
  • overweight or obesity, these conditions seem decisive for the onset of the syndrome. Resumption of ovulation has been observed in people who lose weight

Diagnosis

There is no test to ascertain (diagnose) the polycystic ovary syndrome (PCOS). After excluding other conditions that may be responsible for the present disorders, the gynecologist inquires about the state of health of the person over time (anamnesis), about the history of the menstrual cycle, on a possible infertility and on the presence of family members with PCOS. He performs a complete gynecological examination to identify any enlargement of the ovaries and checks for excessive hair (hirsutism), acne and other signs of excess androgen hormones (hyperandrogenism). Measure blood pressure, waist circumference and calculate body mass index to see if the person is overweight. The doctor may order blood tests to check androgen, cholesterol and blood sugar levels and, where appropriate, l "insulinemia. By means of a transvaginal pelvic ultrasound (common examination which consists in the introduction of an ultrasound probe into the vaginal canal) the doctor studies the appearance of the ovaries, verifies the presence of follicular cysts and checks the thickness of the mucosa that lines the uterus (endometrium). ).

The presence of a single disorder (symptom) is not enough to hypothesize PCOS which is often diagnosed only after ruling out other conditions that cause similar symptoms. PCOS can occasionally be associated with a number of other hormonal changes that cause hyperandrogenism. It is important to pay attention to the progression of hyperandrogenism symptoms which can occur more or less rapidly. If the symptoms worsen quickly, it is advisable to proceed with the necessary clinical tests to confirm or exclude a hyperandrogenism of a different origin.

Therapy

To reduce circulating androgen hormones and menstrual irregularities, women with polycystic ovary syndrome (PCOS) who are not planning to become pregnant are routinely prescribed hormone therapy that contains estrogen and progestogen which blocks the production of hormones by the women. ovaries. Combination therapies with estrogen / progestogen plus an antiandrogen (eg, spironolactone, cyproterone acetate) are effective in reducing androgens and related symptoms such as hirsutism and acne. There are different drugs, both by type of hormones contained and for their dosage, which allow the doctor to prescribe the most appropriate therapy for each individual case. In fact, there is no hormone therapy suitable for all women with PCOS. In most cases, hormone therapy is administered orally, alternatively, a patch or vaginal device that also contains a combination of estrogen can be used and progestogens with the same therapeutic effect.

To facilitate ovulation in women with PCOS who want to plan a pregnancy, the doctor may prescribe drugs such as clomiphene (anti-estrogen to be taken in the first part of the menstrual cycle), medicines that directly inhibit the release of insulin from the pancreas ( diazoxide and octreotide) or drugs, such as metformin, which indirectly reduce insulin secretion.

Prevention

The prevention of polycystic ovary syndrome (PCOS) is based on a healthy and correct lifestyle from an early age.

From early childhood, it is important to take care of nutrition and lifestyle to facilitate the maintenance of an adequate weight, prevent any insulin resistance and the overproduction of androgens.

Even in reproductive age, the adoption of a correct and balanced diet and adequate physical and sporting activity can favor the reduction of insulin sensitivity and limit the altered production of androgens characteristic of PCOS.

Bibliography

Azziz, R. et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. Journal of Clinical Endocrinology and Metabolism. 2004; 89:2745–2749

Rotterdam ESHRE / ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility. 2004;81:19-25

In-depth link

NIH. Eunice Kennedy Shriver National Institute of Child Health and Human Development. About Polycystic Ovary Syndrome (PCOS) (English)

NHS. Polycystic ovary syndrome (English)

Mayo Clinic. Polycystic ovary syndrome (PCOS) (English)

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