Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women of reproductive age. It is not only a problem of periods and pregnancy – it directly affects metabolism as well.
What is PCOS?
Polycystic ovary syndrome is linked to abnormal secretion of LH and FSH, hormones released by the pituitary gland. The exact mechanism of the disease is not fully known, but a disturbed hormonal balance in the ovaries, excess production of male sex hormones (androgens) and genetic factors all play a role.
Normally a follicle matures and ruptures every month. In PCOS it develops only partially and turns into a small 3–10 millimetre sac inside the ovarian tissue. These sacs make the ovaries larger. The release of the egg from the ovary into the tubes is disrupted – this is called anovulation. That is why PCOS is one of the most common causes of infertility in women.
Which signs may point to PCOS?
The disease sometimes causes no complaints at all. In most cases, however, the following signs related to raised androgens are seen:
- irregular or absent periods;
- increased hair growth (hirsutism);
- oily skin, acne, seborrhoea;
- hair loss;
- weight gain, especially fat around the abdomen;
- dragging pain in the lower abdomen;
- difficulty getting pregnant.
How is it diagnosed?
At least two of the following three criteria are enough for a diagnosis of PCOS:
- clinical signs – irregular periods, excess hair, acne, weight gain, etc.;
- raised androgen hormones on laboratory tests;
- multiple small sacs in the ovaries on ultrasound.
Because thyroid or prolactin disorders can cause similar signs, these causes are also checked before the diagnosis is made.
How is it related to insulin resistance?
Most women with PCOS have insulin resistance. Insulin is the main hormone that lets sugar in the blood enter the cells. In insulin resistance the cells lose their sensitivity to it, and the body has to release more insulin to keep blood sugar normal.
Long-lasting high insulin increases fat around the abdomen, boosts androgen production and disrupts the ovaries even further. In this way excess weight, insulin resistance and hormonal imbalance form a vicious circle that keeps feeding itself.
What happens if it is not treated?
The sacs seen in PCOS are not harmful in themselves – they do not need surgery and do not cause ovarian cancer. What is dangerous are the hormonal and metabolic disturbances behind the disease. Left untreated for a long time, PCOS can lead to:
- diabetes and impaired glucose tolerance;
- cholesterol disorders and high blood pressure;
- cardiovascular disease and metabolic syndrome;
- fatty liver;
- a higher risk of uterine cancer;
- depression, anxiety and sleep apnoea.
Patients with PCOS must be treated, because as the disease progresses getting pregnant becomes a serious problem.
Dr. Samir Shukurov
How does an endocrinologist help?
Treatment aims to restore hormonal, menstrual and reproductive function. The first step is losing weight and a healthy lifestyle: diet and physical activity ease the symptoms. Losing even 5–7% of body weight can regulate periods and improve the chances of pregnancy.
To restore ovulation, insulin resistance has to be reduced first. In some women this is achieved with tablets, and drug treatment takes about six months. When this is not enough, assisted reproductive methods are used together with a gynaecologist.
The endocrinologist also regularly monitors blood sugar, insulin and cholesterol so that diabetes and cardiovascular complications are prevented in time. After appropriate treatment the problem with pregnancy resolves in most cases.
This article is for general information only and does not replace a medical examination.