POLYCYSTIC OVARIAN SYNDROME (PCOS)

Polycystic Ovary Syndrome (PCOS) is one of the common hormonal disorders in women, characterized by enlargement of the ovaries and the formation of numerous benign follicles. In women with PCOS, the ovaries do not function properly and produce an excessive amount of androgens. PCOS is a widely prevalent condition, affecting approximately 8% to 12% of women.

What Are the Symptoms of Polycystic Ovary Syndrome?

The main symptoms of polycystic ovary syndrome include:

• Irregular menstruation: Frequent, infrequent, or heavy menstrual bleeding
• Infertility: The inability to conceive after more than one year of regular unprotected intercourse. PCOS is one of the causes of infertility in women.
• Increased hair growth (hirsutism): Male-pattern hair growth on areas such as the upper lip, chin, chest, abdomen, inner thighs, etc.
• Hair loss
• Obesity: Defined as a body mass index (BMI) above 30. About 80% of women with PCOS are obese.
• Acne: Severe acne that develops after puberty and does not respond to treatment is common in PCOS.
• Acanthosis nigricans: Thickened, velvety, darkened patches of skin in the groin, armpits, and other skin folds.

What Causes Polycystic Ovary Syndrome?

The exact cause of PCOS is not known, but it is believed to result from multiple interconnected factors. Insulin resistance and excess androgens are among the leading factors. Insulin is a major hormone that regulates blood sugar in the body. When cells develop resistance to this hormone, despite sufficient insulin production, insulin cannot be effectively utilized, leading to increased blood sugar levels, which can result in diabetes. Androgen, on the other hand, is a hormone found in both men and women, playing a major role in the development of the male reproductive system. Excess androgens lead to symptoms such as increased hair growth, hair loss, and irregular menstruation, which are major symptoms of PCOS.

What Other Health Issues Are Associated With Polycystic Ovary Syndrome?

Since PCOS is a hormonal disorder and hormones affect the entire body, PCOS not only affects the reproductive system but also impacts the entire body and metabolism, leading to certain health issues.

The main health issues seen in patients with PCOS include:

• Type 2 diabetes (high blood sugar)
• High cholesterol levels
• Cardiovascular diseases

Metabolic syndrome: Characterized by increased waist circumference, high blood pressure, elevated cholesterol levels, and high blood sugar levels. People with metabolic syndrome are at a 5-fold increased risk of developing diabetes and a 2-fold increased risk of developing cardiovascular diseases compared to those without metabolic syndrome.

Sleep apnea: A sleep disorder where individuals experience difficulty breathing and sudden interruptions in breathing while asleep.

Depression

Endometrial hyperplasia: Abnormal proliferation of the ‘endometrium’ tissue lining the uterus due to irregularly secreted hormones, leading to an increased risk of uterine cancer.

What Tests Should Be Done for Polycystic Ovary Syndrome?

The tests you need to undergo should be selected individually based on your age and symptoms. Possible tests include:

Blood tests: For measuring hormone levels, blood sugar, and cholesterol levels

Ultrasound: Can be performed vaginally or abdominally (pelvic). This imaging allows examination of the ovaries. Women with PCOS are expected to have numerous small benign follicles in their ovaries.

Is Treatment Possible for Polycystic Ovary Syndrome?

There are some treatment options available for the problems caused by PCOS. The most important point in treatment is that it should be individualized. The most appropriate treatment should be selected based on the patient’s symptoms, desire for pregnancy, and accompanying findings.

Lifestyle changes are the first-line treatment for all types of complaints. Losing weight in overweight or obese patients will alleviate most complaints. Even losing only 5% of body weight leads to positive developments in the course of the disease.

In addition to lifestyle changes, there are some medical treatment options available. These treatments include:

• Birth control pills: These pills are the main treatment for PCOS. They contain both progesterone and estrogen hormones. While these pills do not cure the disease, they help alleviate symptoms such as irregular menstruation, heavy menstrual bleeding, acne, and increased hair growth (hirsutism) caused by this condition. They also reduce the risk of uterine cancer.
• Anti-androgens: Since excess androgens, which are the main hormones causing PCOS, are also responsible for symptoms such as acne and increased hair growth, medications that reduce the effect of the androgen hormone are used in treatment. These medications can reduce symptoms such as acne and increased hair growth.
• Progestin: This hormone can regulate periods. It also reduces the risk of uterine cancer.
• Metformin: This medication is effective in reducing insulin resistance associated with PCOS. In diabetic women, the use of metformin helps to keep blood sugar levels within normal range.
• Additionally, medication with topical lotion or antibiotics for acne treatment, and laser therapy or mechanical (waxing) methods for hair removal are used.

Which Treatment Method Should Be Chosen for a Patient With Polycystic Ovary Syndrome Who Wants to Get Pregnant?

Weight loss contributes to regular ovulation in women with PCOS. If you are overweight, shedding excess weight can help regulate your menstrual cycles and increase your chances of getting pregnant. If despite weight loss, your periods remain irregular, medications that assist ovulation can be utilized to enhance your chances of conceiving. Occasionally, ovarian surgery is attempted, although the long-term success of these treatments is uncertain.