Polycystic Ovary Syndrome (PCOS) was first described in 1935 by Irving F. Stein and Michael L. Leventhal. It’s a syndrome composed of several symptoms, with no single sign or test being diagnostic. The syndrome takes its name from the enlarged, polycystic-appearing ovaries.
What might be the signs that I have PCOS?
Women with PCOS who visit the gynecologist do so because of one of the following reasons:
- Irregular menstruation. As mentioned above, most patients with PCOS suffer from menstrual irregularities. Either menstruation stops completely (amenorrhea) or comes irregularly (oligomenorrhea).
- Unwanted hair growth, acne, male alopecia. These are symptoms caused by increased androgens circulating in the blood and exerting their effect on the hair roots.
- Infertility. Infertility is when couples pursue the desire to have children for more than one year with regular, unprotected sexual intercourse. In normal fertile couples, the probability of achieving pregnancy per cycle is around 20%. Getting pregnant is even more challenging for women with PCOS, who may have ovulation problems (at best, only in some of their cycles).
What are the most common findings in women with PCOS?
Increased androgens in the blood (Hyperandrogenemia). Testosterone is the most important androgen. Other androgens that may be elevated in women with PCOS include androstenedione, DHEA, and DHEA-S.
Ovulation and menstruation disorders. Normal cyclic menstruation is the result of regular ovulation. The typical menstrual interval is between 21 and 35 days. Fewer or more frequent menstrual periods are an indication of ovulatory dysfunction. Most women with PCOS have significant menstrual disorders.
The polycystic appearance of the ovaries. Describes a specific sonographic appearance. Multiple small follicles, enlarged ovaries, and a classic topographic.
What is required to make the diagnosis of PCOS?
The most used diagnostic criteria are the “Rotterdam criteria.” According to these, the diagnosis should be based on at least two of the three main criteria:
- Disruption of ovulation,
- Clinical or biochemical evidence of elevated androgens in the blood and
- Polycystic appearing ovaries on ultrasound.
In addition to the previously mentioned criteria, women with PCOS often experience specific physiological changes not included in the diagnostic criteria.
These include:
Abnormalities of glucose metabolism, dyslipidemia, chronic inflammation, and metabolic syndrome.
What else does the reproductive physician need to think about before making a diagnosis of PCOS?
PCOS is a diagnosis of exclusion. Other causes of chronic failure to ovulate and excess androgens must be ruled out.
Thyroid disorders
Are often the cause of menstrual disorders. They are not only causative of ovulation but can also have serious adverse effects on the pregnancy’s outcome and the embryo’s development. The TSH serum test is the gold standard for determining primary thyroid disorders.
Hyperprolactinemia
Hyperprolactinemia is closely related to menstrual irregularities and is one of the most common causes of menses failure.
(Rarer) Cushing’s syndrome, adrenal hyperplasia, idiopathic hirsutism, severe insulin resistance syndromes
What could be the long-term consequences of PCOS?
- Increased risk of endometrial hyperplasia and endometrial cancer. The excess estrogens continuously stimulate the uterus’s mucous membrane without progesterone’s counteraction could lead to abnormal growth of the endometrium.
- Increased risk of type 2 diabetes. The hormone-related disturbances of the glucose balance and the insulin resistance often observed in overweight women with PCOS can lead to type 2 diabetes without appropriate treatment. Early adjustment and control of glucose levels are significant.
- Increased risk of cardiovascular disease.
- Increased risk of infertility.
How should PCOS be treated?
The treatment approach must be individualized and tailored. Prevention strategies are fundamental to minimize long-term clinical consequences.
Lifestyle Modification
It’s the First- Line Approach. At least 50% of women with PCOS are obese. Even a slight weight reduction can result in significant improvements and, in some cases, can restore the normal cycle and ovulation.
Menstrual Abnormalities and Risk for Developing Endometrial Cancer
Combined oral contraceptives are the most utilized treatment for the menstrual abnormalities associated with chronic anovulation.
Metabolic abnormalities and associated Health risks
All women with PCOS should be screened with an oral glucose tolerance Test (OGTT) at the time of presentation and at least every two years after that.
Unwanted hair growth, acne, male alopecia
Mild hirsutism can be managed effectively with cosmetic measures. Medical management options include a combination of estrogen-progestin contraceptives, topical agents, and antiandrogens.
Loss of scalp hair (alopecia) can cause a significant psychosocial burden. Unfortunately, effective and reliable therapies are limited.
Infertility
When anovulation is determined as the mechanism for infertility, strategies to achieve ovulation should be considered as the first line- approach. For some, weight loss can be decisive in restoring ovulation. For other patients, short-term drug treatment is necessary with the same goal.
Would you like to have more information?
Christos Roukoudis, M.D. is a gynecology and obstetrics specialist specializing in gynecological endocrinology and reproductive medicine. He possesses the highest level of expertise in treating disorders of gynecologic endocrinology, including PCOS syndrome. Request an appointment now for more information.
