Polycystic ovarian syndrome (PCOS) is usually due to the fact that it is a hormonal disorder that is often overlooked or confused with other disorders because there is no single test to diagnose it. Confusion, misinformation and lack of medical communication about the symptoms of this condition also do not help patients to see the symptoms and see a professional for evaluation.
However, recent years have seen an increase in interest and research into the syndrome. Today we will explain all these developments and look at what PCOS is, what its symptoms are and how it can be treated. We will also see how polycystic ovary and pregnancy can be compatible.
What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS for short) is a hormonal disorder that affects both adolescent girls and women. It is, in fact, one of the most frequent endocrine disorders in women. The name ‘polycystic’ ovarian syndrome comes from the fact that the eggs are not released from the ovary, but instead a fluid is produced around the eggs. and are stored in vesicles. As a result, pockets called cysts form (hence polycystic ovaries, or ovaries with many cysts).
As mentioned above, it is not known exactly what causes the hormonal imbalance that leads to PCOS. Some theories point to an imbalance of sex hormones and insulin as the main problems. These alterations generate a defined group of symptoms (excess facial and body hair, weight gain, irregular menstrual cycles…) that are usually always present in PCOS.
The problem with this syndrome is that these are often mistaken or taken as normal signs of menstrual cycles. There is a popular misconception that it is ‘normal’ for periods to hurt, so women who feel this or other signs of possible PCOS do not go to the doctor because they think it is natural. It is very important to fight misinformation and lies about women’s diseases related to the reproductive organs.
PCOS is very difficult to recognise and diagnose. Some girls and women manifest only certain characteristics, which may also change in type and severity over time. In addition, the disease can develop at any age after puberty. All these particularities make it very complex to diagnose. In fact, there is no specific test.
Polycystic ovary syndrome symptoms
The symptoms of PCOS can be very different from patient to patient. Some girls or women may experience very mild symptoms. Others may suffer from a wide range of symptoms to a greater or lesser degree. Some of them are:
- Irregular or no menstrual periods (amenorrhoea) or abnormal uterine bleeding. This type of alteration occurs in 8 out of 10 women.
- Polycystic and large ovaries.
- Pelvic pain.
- Increased facial and body hair (hirsutism). It occurs in 70% of cases.
- Weight gain and obesity, especially with fat distribution in the centre of the body. Obesity occurs in 50-60% of cases. However, some women may have excess androgens and other symptoms of PCOS and have a weight that matches their body and characteristics.
- Acne. It affects one third of women. May be accompanied by darkening or thickening of the skin (patches or streaks around the neck and in the armpits).
- Hair loss on the top of the head.
- Deep voice (in very rare cases).
Diagnosis
The physician may diagnose PCOS when he/she finds at least 2 of the following characteristics in the patient:
- Excess male hormones (androgens). Practitioners should find elevated testosterone levels in the blood or confirm certain symptoms (acne (sometimes severe), excess hair on the face, stomach and/or back) that suggest the presence of PCOS.
- Ovulation problems, such as missed periods, irregular cycles or infertility.
- Ultrasound, which can show large ovaries with many small cyst-like follicles. If the patient has both of the above characteristics, ultrasound is not necessary.
The same criteria are not used in adolescent women as described above, since, due to their age, they tend to have irregular or no menstrual periods (amenorrhoea) during the first 2 years after the onset of menstruation. Ultrasound is of little use in detecting ovarian cysts. The doctor will first use hormone blood tests and look for signs and symptoms indicating an excess of male hormones.
Although symptoms may be observed, there is no single, specific test for PCOS. Its diagnosis is one of exclusion. The physician will perform a thorough evaluation of the clinical findings, including signs or symptoms, clinical and family history, and a physical examination. It visually and manually checks the patient’s reproductive organs for tumours, lumps or other abnormalities. It will also request appropriate laboratory tests to assist in the diagnosis, which may include:
- Testosterone. It is the main test to determine whether there is excess androgen production.
- Sex hormone binding globulin (SHBG). May be decreased in PCOS.
- Antimullerian hormone (AMH). There is usually an increase in their concentration.
Secondary evidence includes:
- Follitropin (FSH).
- Follitropin (FSH). It will have high levels.
- Oestrogen. They will be normal or elevated in case of PCOS.
- Dehydroepiandrosterone sulphate (DHEAS). It will be elevated.
- Androstenedione. It could be increased.
Treatment
Polycystic ovary syndrome (PCOS) cannot be cured and does not go away on its own. Therefore, the main goal of PCOS treatment is to alleviate symptoms and prevent possible future complications. Treatment depends on the severity of the symptoms and whether or not the patient intends to become pregnant. At AmbarLab always recommends speaking with a specialist to explain the options for each patient, as they depend on many factors.
Some of the indications for troubleshooting some PCOS symptoms may include:
- Diet, exercise and maintaining a healthy weight are the most important strategies to follow to treat PCOS and help manage symptoms. These lifestyle adjustments are highly recommended to help decrease insulin resistance. Regular exercise and a healthy diet will help lower blood pressure and cholesterol. This will also improve problems with sleep apnea.
- Decreasing or stopping the consumption of cigarettes or other tobacco products may decrease androgen concentrations.
- Medications such as metformin can help regulate menstrual cycles and promote ovulation.
- Antibiotics or retinoic acids can be used to treat acne.
- Oral contraceptives can be used to normalize menstrual periods.
- Other medications may also be prescribed to stabilize hormone concentrations, treat severe acne and/or excess hair, promote or induce ovulation, and decrease the risk of endometrial cancer.
If you do not want to take medication for facial or body hair, waxing, shaving, depilatory cream, electric hair removal or laser treatments can be used to remove it.
Polycystic ovary and pregnancy
Polycystic ovary and pregnancy are closely related, since one of the complications that PCOS can lead to is infertility. In the event that a woman suffers from polycystic ovaries and is able to conceive, pregnancy is associated with complications such as miscarriage, gestational diabetes and preeclampsia. Other serious complications that can result from polycystic ovary disease include:
- Diabetes or insulin resistance.
- Uterine cancer (endometrial cancer).
- High blood pressure.
- Metabolic syndrome.
- Sleep apnea.
- Mood disorders (depression, anxiety or eating disorders).
- Cardiovascular disease.
About 75% of women with PCOS have difficulty achieving pregnancy naturally, according to ORG Assisted Reproduction. The hormonal imbalance caused by this disease leads to long-term ovulation disturbances. These include oligoovulation (ovulation occurs infrequently or irregularly) and anovulation (no ovulation at all).
However, polycystic ovary and pregnancy are compatible. In most cases, fertility treatments such as in vitro fertilization (IVF) or artificial insemination (AI) are the best option to achieve pregnancy. It should be noted that these treatments in patients with polycystic ovaries carry risks of multiple pregnancy or ovarian hyperstimulation (OHSS). We recommend that, if you suffer from PCOS, you see a specialized doctor if you want to become pregnant. They will advise and guide you through the process.
If you need any laboratory test about PCOS or other hormonal disorders or diseases, AmbarLab is your laboratory of trust. Our clinical laboratory is a support to the maintenance of public health since through our work it is possible to confirm or not a diagnosis. Ambar Lab’s technicians and professionals analyze biological samples to study them in order to study, prevent, diagnose and treat diseases. You can get in touch with us for any questions or doubts, or continue browsing our blog to keep up to date in the world of medicine.