Polycystic Ovary Syndrome (PCOS), which is a common disease especially in women under the age of 30, is the formation of many benign cysts within the thick egg tissue in the ovary.
As a result of the disease caused by the abnormal production of LH and FSH hormones secreted from the pituitary gland in the brain. , ovaries do not ovulate regularly every month. The causes of Polycystic Ovary Syndrome, which causes the secretion of male hormones from the ovaries, are not fully known, like many hormonal diseases.
How does PCOS occur?
The emergence of the disease resembles a vicious circle. . The increase in the LH hormone increases the production of male hormones in the ovaries. As a result, the secreted male hormones (androgens) turn into estrogen in the fat tissue. In the final stage, estrogen increases LH production again upon return. This vicious circle can be broken by factors such as weight loss or ovarian suppression. Again, due to excess weight, resistance to insulin occurs and as a result, the hormonal balance is disrupted and this vicious circle is achieved.
When does it occur?
Polycystic Ovary Syndrome ( PCOS) is first recognized by the onset of menstrual bleeding during adolescence and affects 3% – 5% of women of reproductive age. During this period, menstrual irregularities are the most important stimulus and are seen in almost 75% of patients. The most common irregularity is infrequent menstruation. From time to time, amenorrhea, that is, absence of menstruation, may occur. Bleeding following delay is usually excessive and prolonged. This irregularity is a sign of a disorder in ovulation.
Even if young girls who have just started menstruating do not have PCOS, such disorders can normally be seen during the first 2 years. The use of regulating drugs such as birth control pills may delay the diagnosis of PCOS.
Hormones called androgens are steroid hormones such as testosterone and are found in high amounts in men, but are secreted in much lower amounts in women. In PCOS patients, androgen hormones are found in higher amounts than they should be, and therefore male pattern hair growth, acne and even male pattern hair loss may occur.
What causes ovulation disorders and menstrual irregularities in PCOS syndrome? It is not surprising that infertility emerges as a problem. Infertility is not a 100% symptom in PCOS cases. Some patients can even ovulate regularly and get pregnant very easily despite their PCOS symptoms. However, PCOS is still an important factor that causes pregnancy delays and infertility. PCOS patients often need treatment to become pregnant. Approximately 40% of its patients have obesity problems. Obesity alone may trigger other symptoms in some patients. In such cases, the problems may disappear completely when weight loss is achieved.
Symptoms of Polycystic Ovary Syndrome
The symptoms generally seen in patients are menstrual irregularity, acne, oily skin, increased hair growth, infertility and weight gain. To diagnose PCOS, clinical findings, laboratory tests and ultrasound examination must be evaluated together.
How is PCOS diagnosed?
One of the most important diagnostic methods is vaginal ultrasonography examination. Ultrasonography reveals many small cysts on the edges of the ovary. These cysts are only a few millimeters in diameter and do not cause problems on their own. The source of cysts are follicles (egg-containing sacs) that develop but are not expelled with ovulation. Their number may increase over time.
Polycystic Ovary (PCO) is a definition that refers to the appearance of the ovaries on ultrasonography. It should not be confused with Polycystic Ovary Syndrome. Many women's ultrasonographic appearance may be polycystic, but hormonal values and clinical picture are completely normal. In the general population, 20% of women have polycystic-looking ovaries. Polycystic Ovary Syndrome (PCOS) is a group of symptoms. It represents disease, that is, pathology. PCO and
PCOS are two different definitions.
Blood hormone values are also important in the diagnosis of PCOS. Androgen levels, LH and FSH rates in the blood are of great importance. An LH/FSH ratio above 3 is a finding in favor of PCOS. Again, blood progesterone levels measured on the 21st day of menstruation provide information about whether ovulation has occurred.
Studies conducted in recent years have shown that there is a relationship between PCOS and the insulin hormone. Insulin is a hormone released from the pancreas and helps cells use glucose. provides the bee. In PCOS, there is resistance in the cells to insulin. Therefore, the pancreas secretes more insulin to cope with the situation. This high dose of insulin affects the ovaries, preventing ovulation, resulting in an increase in androgens. While insulin resistance is detected in 30% of thin women with PCOS, this rate reaches up to 75% in obese women.
Long-term risks
Long-term effects of PCOS Problems and risks depend on both insulin and androgen excess. High amounts of insulin carry the risk of Type 2 diabetes in the long term. This type of diabetes can usually be controlled with strict diet and oral medications. Type 2 diabetes develops in 25-35% of untreated PCOS patients with weight problems by the age of 30. Hormonal changes seen in PCOS also bring blood pressure problems. At the same time, high cholesterol also occurs in these patients. Both conditions are high risk factors for heart disease.
Long-term menstrual irregularities increase the risk of endometrium (tissue lining the uterus) cancer. Since there is no ovulation, there is no progestreon hormone support on the endometrium. Therefore, the endometrium is exposed only to estrogen for a long time. Thus, the risk of cancer increases.
PCOS treatment methods
Menstrual irregularity
As we mentioned before, ovulation in PCOS Irregular and heavy bleeding is frequently encountered due to problems. Therefore, the main goal of treatment is to restore ovulation. In addition, medications that stimulate ovulation can also be used. However, such drugs cannot be used for a long time due to possible side effects. Excess weight is one of the reasons that cause menstrual problems in both PCOS and non-PCOS patients. Ovulation disorders occur due to excessive production of estrogen in fatty tissue. In obese patients, a weight loss of around 5% is usually sufficient for ovulation to begin. Birth control pills are the most frequently preferred drug group to regulate menstrual periods in patients younger than 35 years of age and who do not want children. In second place are progestreon drugs used after the 15th day of menstruation. Both drug groups reduce menstruation. It stings you.
Infertility
In 70% of women who have infertility problems due to ovulation disorders, the problem is PCOS. This situation is more evident in obese patients. The first thing to do in PCOS patients who want to have children is to lose weight. The most effective drug that stimulates ovulation in PCOS patients is clomiphene citrate. This drug is used under physician control.
In case clomifene fails, there are two main approaches. The first of these is to stimulate the ovaries with injectable hormones. Then, insemination is done. Success rates of up to 62% have been reported with this treatment. The most important complications of this treatment are ovarian hyperstimulation syndrome and multiple pregnancies. The treatment should be carried out under extremely meticulous close control and by physicians who are knowledgeable about the subject.
The second alternative is laparoscopic diathermy (LOD). Here, the abdominal cavity is entered via laparoscopy. The ovaries are burned with cautery or laser and small holes are made on them. Although the mechanism of the treatment is unknown, it was observed that it provided regular ovulation and improved the response to clomiphene. Spontaneous pregnancy rates within 12 months after LOD are between 60 and 80%. The success of LOD is better in those whose infertility period is less than 3 years and whose LH levels are more than 10.
Hairing
It occurs due to the excess of male hormones called androgens. Hair growth (hirsutism) is a condition frequently seen in cases of PCOS. While some women do not worry about this, for some women it is the main reason to consult a physician. In some cases, hair growth is not due to hormonal imbalance and may be structural. Existing hair cannot be removed by treatment, so bleaching or epilation is necessary.
Because birth control pills reduce androgen levels in the blood, they can prevent new hair growth. The most commonly used drug for this purpose is a substance called cyproterone acetate. It can be used alone or in combination with some other medications. Hirsutism treatment is a long-term treatment. 8 – 18 months of treatment may be required for success. The reason for this is slow hair growth.
Since PCOS and insulin resistance often occur together, one of the new approaches in the treatment of PCOS is to increase insulin sensitivity. Use of aphrodisiac drugs. Although there are not enough studies on this subject, the first results indicate that the success rates are quite high.
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