What is PCOS?
Polycystic ovarian syndrome (PCOS) is a process characterised by an abnormal production of gonadotropins, elevated androgens and, in many cases, it is associated with insulin resistance. It is the most common endocrine disorder among women of childbearing age (incidence of 4-10%).
The most common clinical signs include irregular menstrual cycles, hirsutism, acne and obesity.
Long term complications can include increased cardiovascular risk (metabolic syndrome, diabetes mellitus or hypertension), and endometrial abnormalities.
What are the causes of PCOS?
Because there’s no one, single factor responsible for PCOS, even today we are unable to identify a specific root cause. Some theories point to genetic causes, as a certain genetic predisposition has been proven and many genes are associated with PCOS. Other theories attribute PCOS to environmental factors that several members of the family, especially females, could be exposed to.
Several years ago, the importance of so-called “fetal programing” started to receive attention: this theory suggests that certain stimuli during fetal development could have an impact on adult life.
Treatment
Treatment will depend on the patient’s symptoms and their desire to have children, so it must be personalised. The four pillars of treatment are focused on:
- Controlling the symptoms caused by hyper¬ androgenism (acne, hirsutism, alopecia and seborrhoea).
- Preventing long-term endometrial complications.
- Improving the patient’s metabolic status.
- Fertility treatment.
Lifestyle changes are fundamental in the majority of PCOS cases, together with the use of contraceptives to treat the disease, but they are not the only tools that we have at our disposal.
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Frequently asked questions about PCOS
Because this condition is diagnosed by identifying several different issues, PCOS is diagnosed through a combination of physical exams, medical history, ultrasounds (sonograms), and blood tests.
Upon examination, women with PCOS usually complain of irregular cycles, late menstrual periods or long periods of time between menstrual cycles.
They may also be overweight, have increased hair growth (hirsutism), acne, or be unable to get pregnant.
On an ultrasound, many women with PCOS have enlarged ovaries with many small cysts. Blood tests may show elevated blood sugar, high cholesterol levels or high levels of male hormones.
The most frequent cause is anovulation: in a high percentage of patients, ovulation does not properly occur half way through the cycle, meaning that a pregnancy cannot take place. These patients are also at a higher risk of miscarriage during the first trimester, especially those with insulin resistance and/or obesity.
Some of the risks are related to irregular ovulation. When ovulation doesn’t occur, the normal hormone cycle is interrupted and oestrogen levels are affected, thus causing the lining of the uterus (endometrium) to thicken and lead to abnormal bleeding.
Symptoms include weight gain, high cholesterol, elevated blood pressure, insulin resistance and diabetes.
Different options exist for treating PCOS related infertility.
One way to treat infertility is to induce ovulation using medicine that has been prescribed and controlled/monitored by a specialist. Women with PCOS must be monitored very closely to make sure their ovaries don’t react excessively to treatment, as this increases the risk of multiple gestations.
If a woman is overweight, losing weight and maintaining a healthy lifestyle can help improve ovulation patterns and, as a result, fertility. Medications such as Metformin can help some patients with PCOS to use insulin more effectively and thus improve ovulation. This medication may also lower the risk of developing diabetes or metabolic syndrome.
Assisted Reproduction Treatment may also help women with PCOS to get pregnant if other treatments do not work.
If a woman is overweight, the recommendation is to lose between 5 10% of her bodyweight and to maintain a healthy lifestyle such as following a Mediterranean diet, reducing the intake of simple carbohydrates and increasing intake of antioxidants such as Inositol, melatonin or alpha lipoic acid. These are treatments that may alleviate symptoms and prevent PCOS related complications.