Polycystic ovary syndrome (PCOS); It is one of the most common endocrine (hormonal) disorders in women of reproductive age. PCOS; It can affect a woman's menstrual pattern, ability to have children (fertility), hormones, heart, vessels and even her appearance.
How to Diagnose Polycystic Ovary Syndrome (PCOS)?
Diagnosis of PCOS At least two of the following findings should be observed;
- Polycystic ovary (PCO) image on ultrasound; Presence of multiple cysts that do not exceed 8-10 mm in size on ultrasound and are located around the ovaries.
- No ovulation (anovulation); The menstrual period of a woman with PCOS may be irregular or the woman may not have a period at all.
- Chronic hyperandogenism; Excessive production of andogen hormone.
There is no specific test to diagnose PCOS.
The diagnosis of PCOS is the patient's history (age of the first menstrual period, menstrual period, bleeding duration, etc.), complaints, physical examination, ultrasound and blood tests. can be placed with At the same time, the patient's blood pressure and blood sugar level should be checked.
What are the Causes of Polycystic Ovary Syndrome (PCOS)?
The cause of PCOS, which can be observed in 15-20% of women, is not known exactly. . However, studies show that there are multiple factors affecting the emergence of PCOS. One of these factors is genetic predisposition. It is known that the risk of PCOS is higher in women who have PCOS in their family (mother or sister). However, there is no evidence that PCOS is inherited.
The symptoms of PCOS are triggered by imbalances in hormones that control the menstrual period. The main androgen male hormone; is testosterone. This hormone is produced by the ovaries in all women and is converted to estrogen, the main female hormone. In women with PCOS, testosterone is produced in excess of normal. If androgen levels are above normal; It causes acne, hair growth, weight gain and ovulation problems.
Insulin hormone is another hormone that plays a role in triggering PCOS symptoms. Ins� It is a hormone produced by the pancreas that regulates the level of glucose in the blood. Many women with PCOS have a condition called "insulin resistance".
In insulin resistance; body tissues resist the action of insulin and as a result the body has to produce more insulin. Insulin hormone, which is found at very high levels in the body; It also affects the ovaries and causes hormonal imbalance. Excess insulin increases androgen production. This disorder in insulin metabolism is the reason why women with PCOS tend to gain weight and lose weight difficult.
What are the Symptoms and Complaints of Polycystic Ovary Syndrome (PCOS)?
- Absence of menstruation or delayed-irregular menstruation as a result of irregular ovulation or absence of ovulation
- Infertility (infertility), recurrent miscarriages
- Increase in unwanted hair (increase in hair on the arms, legs, abdomen and back, coloration) darkening and thickening) male pattern hair loss is observed
- Oiling and acne on the skin in the face, chest and back area
- Weight problems; overweight, rapid weight gain and difficulty losing weight
- Depression and mood changes
- Sleep apnea, snoring
- High blood pressure (high blood pressure)
Irregular menstrual periods (menstrual cycle) and the absence of ovulation increase estrogen production in women, while stopping progesterone production. Progesterone is the hormone that causes the uterine lining (endometrium) to shed periodically every month. In the absence of progesterone, the lining of the uterus thickens, resulting in heavy bleeding or irregular bleeding. Over time, this can lead to hyperplasia (growth of tissue) and cancer.
Cysts that can be observed in PCOS are not harmful. There is no need for surgical intervention for these cysts and the cysts do not cause ovarian cancer.
However, hormonal irregularities observed in PCOS increase the risk of heart diseases, diabetes and uterine cancer later in life. woman with PCOS Diabetes or impaired glucose tolerance can be observed before the age of 40 in more than 50% of women.
Women with PCOS have high LDL (bad cholesterol) levels, low HDL (good cholesterol) levels, and have a higher risk of high blood pressure (high blood pressure). and women with PCOS have a 4-7 times higher risk of heart attack than other women of the same age.
How is Polycystic Ovary Syndrome (PCOS) Treated?
The standard for PCOS is certain there is no treatment. The treatment method differs according to the complaints observed in the person. Some of the treatment methods applied are as follows:
1) Lifestyle change: Weight loss, nutrition and exercise
The first step in the treatment of PCOS; It is to stay at the ideal weight with a healthy diet and exercise. It is observed that many women with PCOS are overweight or obese. Positive changes in eating habits; avoiding processed foods and sugar-added foods, consuming grain products, fruits, vegetables and lean meats help keep blood sugar low, regulate insulin use and hormone levels. Losing excess weight generally contributes to the increase of fertility (reproductive potential) without the need for medical treatment by regulating the menstrual cycle.
Daily exercise regulates the use of insulin in the body and helps to correct many complaints/symptoms of PCOS. Many of the symptoms and health risks can be eliminated with good nutrition, exercise and a healthy lifestyle without using medical treatment methods.
2) Use of drugs that increase insulin sensitivity
Recent studies show that drugs used in the treatment of type II diabetes can also be effective in the treatment of PCOS.
Metformin is the most promising of the drugs used for this purpose. metformin; Insulin affects blood sugar level control and decreases testosterone production. In addition, it has been observed that it slows down abnormal hair growth and can regulate ovulation a few months after use. Recent studies also show that metformin has other positive effects such as reduction in body mass and improvement in cholesterol levels.
3) regulation
Birth control pills enable the formation of regular periods in women with PCOS and the improvement of complaints such as acne, hirsutism (hair growth).
4) Coping with skin and hair problems
Low dose anti-androgen in women with acne and hair growth problems The use of birth control pills (oral contraceptives) together with medications may be recommended. Higher doses of anti-androgen can be used in resistant cases. Anti-androgens can improve excessive hair growth (hirsutism) and male pattern baldness. However, these drugs do not have any effect on fertility. These drugs cannot provide definitive treatment. Therefore, symptoms/complaints may reoccur when they stop taking the drugs.
5) To increase fertility (reproductive potential)
Before starting assisted reproductive treatments, other possible causes of infertility in men and women should be investigated. The problem in PCOS observed in women is usually the absence of ovulation. This problem can be solved with treatment methods that provide ovulation.
Clomiphene citrate is the most commonly used drug in the treatment of ovulation, and it can provide ovulation in 80% of cases and pregnancy in 60-70% of them. In women for whom the use of clomiphene citrate does not benefit; Medicines called "gonadotropins" are used. Pregnancy rates that can be achieved with this drug are between 50-70% and several treatment cycles may be required to see the effect.
Another way to achieve ovulation is the surgical method called "laparoscopic ovarian drilling". In this method, which is applied to women with PCOS for whom drug treatment does not work, male hormones can be reduced and ovulation can be achieved. The pregnancy rates that can be achieved with this surgical method called "laparoscopic ovarian drilling" are between 50-70%. This method is low cost.
If pregnancy does not occur with all these drug treatment and surgical treatment methods, the in vitro fertilization method can be applied. IVF; It is more costly than other methods but has the best places to conceive.
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