Polycystic ovarian syndrome
Polycystic Ovarian Syndrome (PCOS) occurs in 6-7% of the female population, it can be manifested from puberty, and it may coexist with the long-term development of diabetes mellitus and cardiovascular disease.
Do we know the cause of PCOS?
PCOS is a “mysterious” combination of hormonal anomalies. Although there seems to be a hereditary predisposition, the primary cause of PCOS has not been known. It is considered, however, that one of the fundamental disorders is in the secretion and function of insulin and this is a reason that PCOS often coexists with obesity and weight loss is hard. Another hormonal disorder observed is oversecretion of androgens from the ovary.
When should a woman be tested for PCOS?
A woman should seek medical help when she is presenting:
- Abnormalities in menstruation (usually delays)
- The unwanted hair on the face, mainly on the upper lip and jaw, between the breasts, the lower abdomen and the inside the thighs.
- Acne, oiliness and less common temporal alopecia (hair loss at the scalp).
- Acanthosis nigricans (thickened and dark skin on the neck and armpits)
What are the long-term consequences of PCOS?
- Infertility due to lack of ovulation
- Increased risk for diabetes and hypertension during pregnancy
- Diabetes mellitus
- High cholesterol and triglycerides in the blood
- High blood pressure
- Cardiovascular disease
- Endometrial cancer
How can PCOS be diagnosed?
Diagnosis is based on medical history, physical examination and laboratory tests. Other pathological conditions giving similar symptoms such as congenital adrenal hyperplasia, Cushing’s syndrome, ovarian tumours, prolactinoma, thyroiditis should be excluded. The doctor will ask about the features of the menstrual cycle. During the examination, he/she will find out if there is unwanted hair on the body or acne, he/she will measure the blood pressure, height and weight of the patient. He/she will finally ask for blood tests to evaluate blood levels of androgens, cholesterol and triglycerides and possible signs of diabetes mellitus. Finally, an ultrasound will be performed to determine if the ovaries are larger in volume and carry scattered multiple small cysts, the follicles, an image typical of polycystic ovaries, from which the syndrome has been named.
How is a woman with PCOS treated?
The type of treatment depends on the symptoms and on the woman’s desire to become pregnant.
Daily exercise of at least 30 minutes a day and weight loss for obese patients improves carbohydrate metabolism and may lead to symptom suppression and restoration of ovulation.
If the primary symptom is menstrual abnormalities, your doctor may prescribe progesterone or oral contraceptives. Women who do not have ovulation and want to become pregnant receive ovulatory formulations such as clomiphene citrate or gonadotropins. Other women with PCOS will be given hypoglycemic agents to improve insulin resistance. Inositol or otherwise known as vitamin B8 is a substance that we take with our food but is also produced in our body and involved in many functions. It appears that it can help women with PCOS. It is not toxic, it does not have serious side effects and taking it in doses of 2000-4000 mg daily shows:
- Increase pregnancy rates in patients with PCOS.
- Reduce blood levels of androgens and therefore improved related symptoms such as acne and hirsutism.
- Reduce the resistance to insulin that coexists with the syndrome.
For the treatment of hirsutism and acne, oral contraceptives and antiandrogens are administered, with effects noticeable after many months. Various depilation methods will remove existing hair growth. If the patient has diabetes, arterial hypertension or hypercholesterolemia, she will receive appropriate treatment.
Until when does a woman with PCOS is followed-up?
The PCOS patient after being subjected to an individualised treatment based on the presence and extent of PCOS features will continue the follow-up to minimise the risk of the long-term consequences of the syndrome.
