POLYCYSTIC OVARIAN SYNDROME

WHAT IS POLYCYSTIC OVARY SYNDROME (PCOS)?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women of reproductive age. Women with PCOS generally experience problems such as menstrual irregularity, amenorrhea, excessive hair growth, acne, excessive weight gain and the inability to have children in married couples. PCOS usually causes symptoms that begin with puberty. However, since these findings can also be seen in normal young girls during early adolescence, that is, the first few years, it is difficult to distinguish them. Therefore, diagnosis may be delayed. Young girls with complaints similar to adolescence should be followed more carefully in terms of the development of PCOS. In some patients, PCOS symptoms may occur at a later age due to weight gain, stress and malnutrition. Sometimes it may be necessary to perform some tests and evaluate with ultrasound to make a diagnosis. On ultrasound, the ovaries appear larger than normal. Tiny-lentil-sized cysts are seen inside. These are eggs at an early stage of development. There are 5-8 of these in normal ovaries. However, in patients with PCOS, a large number of these cysts (more than 10-12) are seen due to the arrest of egg development.

The exact cause of PCOS is not clear. However, there is generally a familial predisposition. In other words, there are girls in the family with similar findings. Different findings may be seen in different individuals. But the main reason is similar hormonal disorders. These problems may be exacerbated by weight gain.

HOW IS PCOS DIAGNOSED?

There are many intermediate forms of PCOS, patients may present with different complaints and symptoms. . However, to make a diagnosis, at least 2 findings must be present together. These are:

• • Ovulation disorders and menstrual irregularities: These are the most common problems. Some patients may experience late menstruation, amenorrhea, inability to become pregnant due to lack of ovulation, long-lasting bleeding, etc.

• Complaints due to excessive androgen levels: Androgens (such as testosterone) being high in blood tests or excessive hair growth on the body, acne, and excessive hair loss in some women.

• Ultrasound findings: Eggs on ultrasound. The cysts are larger than normal and many tiny cysts are seen inside them.

WHAT DOES PCOS HAPPEN?

The cause of PCOS is not exactly clear. The actual cause is not clearly known as it is caused by the combination of several hormonal problems. There are many hypotheses put forward. Some of these are: Familial-genetic factors: Some patients have a family history. So there are similar individuals in the family. In women, all or some of the problems such as hair growth, ovulation disorders, inability to become pregnant and menstrual irregularities may be present in different combinations. Diabetes, blood pressure diseases and obesity are more common in these families. Another cause of PCOS may be insulin excess. The amount of insulin increases, especially in overweight patients. Excess insulin can cause excessive androgen production from the ovaries, disrupting the entire hormonal balance and ovulation. In some patients, there is abnormal secretion of the GnRH hormone, which is secreted from the brain and controls the functioning of the ovaries. One or all of these may occur together.

WHAT RISKS ARE THERE IN WOMEN WITH PCOS?

In some women with PCOS, only ovulation occurs. There are no obvious symptoms other than menstrual disorders and mild menstrual irregularities. In some cases, in addition to these, some cosmetic problems such as excessive hair growth, excessive acne, and weight gain may be observed. These problems are problems that should be recognized and solved at that time. PCOS patients also have the risk of facing serious diseases that may occur in later ages due to existing hormonal imbalance and excessive weight gain, if not controlled. For example, insulin resistance and type 2 diabetes are more common in these women. The risk of high blood pressure, high cholesterol and blood fats, fatty liver, and obesity is higher in them. Sleep apnea and depression are more common. Abnormal uterine bleeding, thickening of the uterine wall due to lack of normal ovulation, and cancer development in the long term may occur. Because these patients ovulate infrequently, it may take them longer to become pregnant or they may need treatment to become pregnant. When they become pregnant, they are at risk for gestational diabetes and gestational hypertension.

WHAT CAN BE DONE TO DIAGNOSE PCOS?

There is no single test to be done to diagnose PCOS. Diagnosis is made by evaluating several tests or findings. First, the patient's complaints and findings are reviewed to see if there is another problem that could explain this. These are:

• Family history is taken. It is investigated to see if there are women in their family or relatives with similar problems.

• In the diagnosis of PCOS, the patient is first questioned about the menstrual pattern. Conditions such as menstrual irregularity, amenorrhea, late menstruation, inability to become pregnant, etc. are investigated.

• Cosmetic problems are emphasized. It is checked to see if there is excessive hair growth, acne, hair loss, epilation, color changes in certain parts of the body, etc.

• The patient's height and weight are measured, blood pressure is checked, and body mass index is calculated.

• For those who are married, a gynecological examination is performed and a smear test (cervical cancer screening test) is performed. It is examined whether there is a problem in the genital organs.

• Ultrasound is performed to evaluate the thickness of the uterine wall and the size and structure of the ovaries.

• Some blood tests are done. These tests may vary depending on the age of the patient. Hormone levels, blood sugar, blood fats and sugar loading tests are performed.

IS THERE A TREATMENT FOR PCOS?

There is no definitive treatment for PCOS in today's conditions. There are treatments only aimed at reducing or eliminating the symptoms of PCOS. Patients generally need to use these treatments for a long time. The treatment given varies depending on the patient's complaint. For example, menstrual regulating treatment is applied to a patient with menstrual irregularity, and ovulation treatment is applied to a childless patient. Similarly, treatment is applied to patients with hair growth and acne. Apart from these, these patients also need to be protected against risks that may occur in the future.

WHAT IS DONE IN PCOS TREATMENT?

In PCOS treatment, the patient's complaint, Planning is done by taking into consideration many factors such as age, cost of treatment, whether there is a desire for pregnancy or not. very few There are many forms of treatment. The most commonly used methods are:

• Lifestyle changes: The first thing PCOS patients should do is lifestyle changes. Healthy nutrition, weight loss, a regular lifestyle, stress reduction and sports form the basis of this style. When exercise is done regularly, it helps you lose weight and reduces insulin resistance and androgen levels by lowering blood sugar. Negative-bad habits (smoking, alcohol, sedentary life, cola drinks, ready-packaged foods) should be abandoned.Weight should be lost under the supervision of a doctor and dietitian and weight control should be achieved for life. Excess weight increases both insulin resistance and androgen levels in these patients, causing excessive hair growth, menstrual irregularities and ovulation problems. Even losing just 5-10 kilos provides a significant improvement in all these complaints.

• Treatment of menstrual irregularity: for this, birth control pills, menstrual regulating drugs, injections. Tapes, rings or hormonal spirals attached to the body can be used. Which medicine is preferred depends on the patient's age, complaints, whether he is married or not, and his desire for children. Generally, drugs containing both estrogen and progerterone are used. However, sometimes drugs containing only progesterone are used.

• Drugs that induce ovulation: Clomiphene citrate type drugs are generally used to induce ovulation. Clomiphene is a medicine taken as a pill. It is started in the first days of menstruation and used for 5-7 days. Clomiphene may not work for some patients, especially those who are overweight. These may include switching to different medications [letrozole (Femara), metformin (Glucophage)] or injection ovulation treatment. Treatments using injections, that is, gonadotropin, carry the risk of excessive egg development and multiple pregnancy in patients with PCOS. For this reason, doses should be adjusted very finely and increased in a controlled manner. However, if excessive eggs develop, the treatment should be canceled and treatment should be given at lower doses for a longer period of time the next month.

• Reduction and treatment of hair growth: The best way to reduce hair growth. frequent birth control pills and some drugs that reduce androgens three are used. Apart from this, there are also drugs used in the form of creams that reduce hair growth. However, these provide a temporary solution. In other words, during the period when the drug is used, it suppresses androgen hormones and reduces hair growth. When the drug is stopped, the hormones return to their previous state after a while, this period varies from person to person and the old complaints begin. Therefore, epilation is recommended to suitable patients as a permanent solution. Since epilation permanently damages the hair follicles, hair growth will no longer occur, regardless of hormone levels.

Can PCOS PATIENTS GET PREGNANCY?

The pregnancy status of PCOS patients depends on the ovulation status. If these patients ovulate, even if this is rare, they have a chance to become pregnant spontaneously. However, in some patients, ovulation does not occur or occurs very rarely. Some may also have other problems. Pregnancy can be achieved by applying treatment in these patients.

PREGNANCY AND BIRTH IN PCOS PATIENTS

Pregnancy and birth in women with PCOS are other It is more risky than women. The risk of miscarriage and premature birth is higher for these women. Sugar and blood pressure problems are more common during pregnancy. Due to these, growth problems in the baby and cesarean delivery rate are more common. To reduce all these risks, proper nutrition and weight control are very important during and even before pregnancy. If necessary, drug treatment can be started in these patients.

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