It is observed in approximately 4-8% of women of reproductive age. Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in society. The mechanism of this disease, on which many studies have been carried out, has still not been fully elucidated. Accompanying insulin resistance (hidden sugar), dyslipidemia (disorders in fat metabolism) and obesity (obesity) increase long-term health risks.
Diagnosis of the disease according to the latest criteria; It is diagnosed by excluding: 1) Clinical or high androgen levels in the blood, 2) Disorders in the functioning of the ovaries (little or no menstruation or structurally excessive cystic appearance of the ovaries), 3) Other causes of high androgen levels and ovulation disorders. The presence of two of these items is sufficient for diagnosis. Androgen excess in PCOS is detected by checking androgen hormone levels in the laboratory or by the presence of findings such as excess hair growth, acne on the skin, male pattern hair loss (alopecia). Polycystic ovaries are diagnosed by ultrasonography. In ultrasonography, the middle parts of the ovaries, called stroma, have increased, and 12 or more follicles (eggs) with a diameter of 2-9 mm are lined up around them. However, another issue that should not be forgotten is that polycystic ovaries can be seen in 20-30% of the population. These women are not diagnosed with PCOS unless there are other symptoms such as menstrual disorders and androgen elevation.
In PCOS, symptoms usually begin in adolescence. In PCOS, menstrual irregularities often manifest as long periods of menstruation (later than 35-40 days) or abnormal uterine bleeding. However, up to 40% of patients with PCOS have regular menstrual bleeding despite anovulation (inability to ovulate). Frequent menstruation (<21 days) is a very rare condition (1.5%). Patients with PCOS often apply to clinics due to infertility due to ovulation problems. If we look at the source of the ovulation problem in these patients, it can be considered as high LH hormone level, hyperinsulinemia (high insulin hormone level), which can be observed in 30-40% of thin patients and 80% of obese patients, and insufficiency in the functions of FSH. These patients spontaneously It is known that pregnancy losses are more common.
While patients with PCOS have normal fasting blood sugar levels, impaired glucose intolerance may be encountered after the sugar load test. This increases the risk of diabetes in the future. High insulin levels increase the release of androgen hormones from the ovaries.
In this disease, where we know that genetic and environmental factors are active, although we do not know the exact cause, the treatment is mostly aimed at eliminating the symptoms. In this sense, our main goal can be listed as correcting menstrual disorders, correcting androgen hormone levels, increasing insulin sensitivity and ensuring reproductive functions. Lifestyle changes for long-term health risks in PCOS are also extremely important.
While various medications are used in the treatment of androgen elevation, the patient should be informed that their effects may appear within six months at the earliest. Additionally, in order to increase the success of treatment, mechanical and cosmetic methods should be applied in addition to drug therapy. Combined oral contraceptives (birth control pills) regulate menstrual cycles, protect the uterine lining and reduce androgen hormone levels. Agents that increase insulin sensitivity are used to combat insulin resistance. The most commonly used drug is metformin. Metformin also lowers androgen hormone levels and may induce spontaneous ovulation. However, you should use all these medications with your doctor's recommendation. Weight loss through regular physical activity also improves insulin resistance.
PCOS has been associated with many diseases. A predisposition to type 2 diabetes, high cholesterol (hypercholesterolemia), hypertension, cardiovascular diseases, gestational diabetes and high blood pressure, and uterine wall, breast and ovarian cancers has been reported. For this reason, the diagnosis of PCOS should not be neglected, the fight should be started early and these patients should be under lifelong follow-up.
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