What is polycystic ovarian disease?

What is polycystic ovarian disease?

Polycystic ovarian disease (PCOS) is the most common hormonal disorder seen in women of reproductive age. It is transmitted under the influence of multiple genetic factors, and if there is a family history of PCOS, the risk increases. If first-degree relatives (mother, sister) have PCOS, PCOS will be seen in 20-40% of the person

Diagnosis

In diagnosis, the patient is examined, USG is performed and the degree of hair growth is measured by Ferriman-Gallwey. It is determined by . Male hormones are detected in the blood. (Total testosterone, free testosterone, SHBG, DHEA-S). Prolactin and TSH values ​​are requested.

According to the Rotterdam criteria:

• Delay in menstruation or absence of menstruation (rare or absent ovulation)
• Increased hair growth. (on the face, between the two breasts, around the navel, on the upper arms, on the back, on the upper leg) or high levels of male hormones in the laboratory
• Ultrasonography examination reveals 12 or more small cysts with a diameter of 2-9 mm in a single ovary

If at least 2 of these 3 items are present, PCOS is diagnosed.


Normal and polycystic ovaries are shown

 

Concomitant conditions

• Approximately of patients with polycystic ovarian disease Half of them are overweight.
• Tendency to gain weight, inability to lose weight
• Oily skin, acne, male pattern hair loss may be observed
• Increased hair growth
• Ovulation It may be the case that pregnancy does not occur because it is rare or absent.
• The risk of miscarriage is higher in those who become pregnant.
• It may be a risk factor for thickening of the uterus (endometrial hyperplasia) and intrauterine cancer
• Depression (26-40%), worry-anxiety disorder (11.6%), excessive desire to eat (23.3%), lack of enjoyment of life are observed more frequently
• Pregnancy poisoning (Preeclampsia), The risk of high blood pressure, gestational diabetes and premature labor triggered by pregnancy is increased.
• Babies of PCOS patients have a higher need for postnatal intensive care than normal babies. Perinatal morbidity is higher (even after the effect of multiple pregnancy is corrected).
• The rate of multiple pregnancy due to ovulation therapy is also high.
• Depends on weight. Unusually, 40% of PCOS patients have prediabetes. 10% have overt diabetes. The rate of hidden diabetes in overweight PCOS patients is 90%. In a recent study (common result of 35 studies), overt diabetes increased 4-fold and latent diabetes increased 2.5-fold in PCOS women. For this reason, when the diagnosis is made and every 2 years, it should be checked whether overt diabetes or latent diabetes has developed with a sugar loading test (75 grams of sugar loading).
• Blood fats are increased in 70% of PCOS patients. 24-40% are high in LDL fat, which is the artery-clogging fat known as bad fat. HDL fat, known as good fat, has decreased.
• Metabolic syndrome is seen in 33-47% of PCOS patients, and this rate is 2-3 times higher than normal.
• Cardiovascular diseases do not occur in PCOS patients. rate is higher. In a study we conducted, we found that a substance called CD40, which increases the risk of cardiovascular diseases, is higher in patients with PCOS.
• Even though there are studies indicating that the risk of ovarian cancer and breast cancer is high, it has not been fully demonstrated. Closer screening for breast cancer and ovarian cancer is not recommended at this time.

 

 

      Treatment

• Treatment based on complaints is more appropriate rather than a single treatment option.

  Vaginal bleeding without ovulation

  It develops secondary to excess estrogen due to non-ovulation. Due to the lack of progesterone hormone, the layer covering the inside of the uterus is thick and very fragile. Prolonged vaginal bleeding may occur. Since pathological thickening of the intrauterine layer may be observed in women over 35 years of age (endometrial hyperplasia with or without atypia has at least a 1% chance of turning into uterine cancer), it is necessary to perform intrauterine sampling. If hysteroscopy is possible, it should definitely be performed with hysteroscopy. In women under the age of 35, sampling is generally not necessary.

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