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Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS), also known as Stein–Leventhal syndrome, is a hormonal disorder accompanied by a constellation of characteristic symptoms.
The signs of polycystic ovaries consist of ovarian enlargement and the presence of pathological cysts visualized on ultrasound, during surgery, or on pelvic laparoscopy. These cysts are also visible on pelvic CT or MRI.
Symptoms of Polycystic Ovary Syndrome
Polycystic ovaries warrant consultation with a gynecologist, as the symptoms often cause concern. The main symptoms include:
• Absence of menstruation. It may occur that menarche never happens (primary amenorrhea) and must be induced by treatment. In other cases, menarche occurs and then disappears (secondary amenorrhea). Treatment is also required in this case.
• Irregular duration of menstrual cycles: cycles that are too short, too long, or of unpredictable length.
• Abnormal and irregular bleeding, including intermenstrual bleeding.
• Menstrual pain (dysmenorrhea) as well as pain during ovulation.
PCOS symptoms may appear at different periods of a woman’s life:
• As a rule, the clinical picture may be observed from menarche (the first menstrual period).
• Sometimes PCOS manifests in cases where menstruation appears at a very early age, for example at 8 or 9 years (early menarche).
• In other cases, due to polycystic ovaries, the first menstruation does not occur until 16 or 18 years (late menarche).
• In the first three years after the onset of menses and in early reproductive age, disorders of fertility (infertility) arise.
• Later (in perimenopause), excess insulin exacerbates endocrine disturbances, causing metabolic disorders such as obesity and type 2 diabetes.
There are also several symptoms that may seem unrelated to the disease:
• Excess hair growth on the face, chest, abdomen, or thighs—hirsutism.
• Late-onset or persistent acne that responds poorly to standard treatments.
• Obesity, weight gain, or difficulty losing weight, especially in the waist area.
• Pelvic pain.
• Oily skin.
Throughout life, women with polycystic ovaries are exposed to excess estrogen production, which leads to an increased risk of endometrial (uterine) cancer.
Pain in Polycystic Ovaries
In women with polycystic ovaries, pain may vary in location and intensity.
• Mild pain. Many women develop ovarian cysts at some point in life that cause only slight pain or mild discomfort. However, it should be noted that such sensations are not specific to PCOS, as they may also be caused by many other diseases.
• Sharp pain. Women with ovarian cysts suffer from intense pelvic or abdominal pain. These pains may be sudden or acute, and in other cases more persistent and prolonged, even chronic in nature. Such pain requires treatment.
• Pain between periods coinciding with ovulation. In women with polycystic ovaries this is common and is referred to as periovulatory pain. It is caused by abnormal growth, stretching, or enlargement of the ovarian follicle, which is very difficult or impossible to rupture. In other cases, the follicle ruptures very abruptly, causing severe pelvic and/or abdominal pain, which is a reason for urgent gynecologic consultation.
The types of pain described are common but not exclusive to polycystic ovaries. They may also occur if you have one of the following conditions:
• Peritoneal endometriosis or pelvic endometriosis.
• Pelvic inflammatory disease (PID), which includes infection and inflammation of the ovary and tube, called adnexitis.
• Some benign ovarian tumors, such as functional ovarian cysts, ovarian dermoid cysts, or ovarian teratomas.
• Malignant ovarian tumor (ovarian cancer).
• Ectopic pregnancy.
Thus, there is difficulty in specifically identifying pain due to polycystic ovaries, so it is important to consult your gynecologist when pain appears in the ovaries, abdomen, or pelvic area to determine the cause.
Causes
Although the primary cause of polycystic ovaries is unknown, several aspects may contribute to its development:
• Environmental factors: of particular interest to researchers are female obesity and intrauterine conditions caused by maternal overweight, gestational diabetes, hyperandrogenemia, etc.
• Genetic factors: PCOS may occur in several women in the same family, therefore it is considered a hereditary disease caused by multiple genes.
• Endocrine or hormonal factors, which may be of several types:
o Neuroendocrine factor: leads to disordered pituitary hormone production in the pituitary (increased LH and normal or decreased FSH). Secondary to this disorder are changes in estrogens, androgens, and progesterone.
o Ovarian and adrenal factor: increased androgen production causing abnormal follicular development and impaired ovulation.
o Metabolic factors: the most important metabolic dysfunction in PCOS is increased insulin secretion, which increases the quantity and activity of androgens.
o Changes in follicle formation and ovulation in the ovary: there is intense replenishment of follicles with a much greater overall number of follicles, but follicular selection (dominant follicle) ceases. That is, follicles mature but do not rupture. If selection of a dominant (mature) follicle does not occur so that it can grow and rupture, anovulation ultimately develops, causing infertility.
o Altered ovarian androgen production: an increase in the number of follicles that continuously grow (but in the absence of ovulation) and produce androgens, causing a clinical picture of androgenization.
o Anti-Müllerian hormone (AMH) changes: the theory explaining the presence of PCOS in daughters of affected women posits that they may carry high amounts of AMH, with abnormal elevation from childhood to puberty. This may lead to such girls having a significant number of follicles from birth. Their large number at such an early age may predispose to the development of PCOS in the future.
Diagnosis
There is no single diagnostic method for this condition. However, the following studies may be recommended:
• Pelvic ultrasound. Transvaginal ultrasound is indicated to detect polycystic ovaries and to exclude other possible causes of symptoms. However, transvaginal ultrasound is not performed in adolescent girls.
• Tests to exclude other endocrine disorders, such as measurement of serum testosterone, follicle-stimulating hormone (FSH), prolactin, and thyroid-stimulating hormone (TSH).
PCOS should be suspected in women who have at least two typical symptoms (for example, irregular menstruation and hirsutism—excess hair growth in a male pattern).
To establish the diagnosis, at least 2 of the following 3 criteria must be present:
• Ovulatory dysfunction causing menstrual irregularity
• Clinical or biochemical signs of hyperandrogenism
• More than 10 follicles in an ovary (detected on pelvic ultrasound), usually located peripherally and resembling a “string of pearls.”
The evaluation consists of pregnancy testing and measurement of FSH, prolactin, and TSH to exclude other possible causes of symptoms.
Treatment of Polycystic Ovary Syndrome
Treatment of PCOS is aimed at controlling the factors that affect the patient’s condition. These may include hirsutism, acne, obesity, or difficulty conceiving. Thus, the physician may recommend lifestyle modification, maintaining a healthy weight and reducing carbohydrate intake. In addition, medications and, in exceptional cases, surgery may be prescribed.
At Expert Clinics we perform monitoring, diagnosis, and treatment of pathologies of the female genital tract using innovative and minimally invasive methods. Our team of highly qualified specialists prescribes personalized treatment aimed at the true cause of the disease.
Prevention
Prevention of PCOS consists in eliminating modifiable risk factors. The most important of these is obesity. In recent years, there has been an increase in PCOS cases, especially among young women and adolescents. This is a direct consequence of changes in societal habits, such as a diet rich in fats and sugary products (especially carbonated drinks), and an increasingly sedentary lifestyle.
Polycystic ovary syndrome (PCOS), also known as Stein–Leventhal syndrome, is a hormonal disorder accompanied by a constellation of characteristic symptoms.
The signs of polycystic ovaries consist of ovarian enlargement and the presence of pathological cysts visualized on ultrasound, during surgery, or on pelvic laparoscopy. These cysts are also visible on pelvic CT or MRI.
Symptoms of Polycystic Ovary Syndrome
Polycystic ovaries warrant consultation with a gynecologist, as the symptoms often cause concern. The main symptoms include:
• Absence of menstruation. It may occur that menarche never happens (primary amenorrhea) and must be induced by treatment. In other cases, menarche occurs and then disappears (secondary amenorrhea). Treatment is also required in this case.
• Irregular duration of menstrual cycles: cycles that are too short, too long, or of unpredictable length.
• Abnormal and irregular bleeding, including intermenstrual bleeding.
• Menstrual pain (dysmenorrhea) as well as pain during ovulation.
PCOS symptoms may appear at different periods of a woman’s life:
• As a rule, the clinical picture may be observed from menarche (the first menstrual period).
• Sometimes PCOS manifests in cases where menstruation appears at a very early age, for example at 8 or 9 years (early menarche).
• In other cases, due to polycystic ovaries, the first menstruation does not occur until 16 or 18 years (late menarche).
• In the first three years after the onset of menses and in early reproductive age, disorders of fertility (infertility) arise.
• Later (in perimenopause), excess insulin exacerbates endocrine disturbances, causing metabolic disorders such as obesity and type 2 diabetes.
There are also several symptoms that may seem unrelated to the disease:
• Excess hair growth on the face, chest, abdomen, or thighs—hirsutism.
• Late-onset or persistent acne that responds poorly to standard treatments.
• Obesity, weight gain, or difficulty losing weight, especially in the waist area.
• Pelvic pain.
• Oily skin.
Throughout life, women with polycystic ovaries are exposed to excess estrogen production, which leads to an increased risk of endometrial (uterine) cancer.
Pain in Polycystic Ovaries
In women with polycystic ovaries, pain may vary in location and intensity.
• Mild pain. Many women develop ovarian cysts at some point in life that cause only slight pain or mild discomfort. However, it should be noted that such sensations are not specific to PCOS, as they may also be caused by many other diseases.
• Sharp pain. Women with ovarian cysts suffer from intense pelvic or abdominal pain. These pains may be sudden or acute, and in other cases more persistent and prolonged, even chronic in nature. Such pain requires treatment.
• Pain between periods coinciding with ovulation. In women with polycystic ovaries this is common and is referred to as periovulatory pain. It is caused by abnormal growth, stretching, or enlargement of the ovarian follicle, which is very difficult or impossible to rupture. In other cases, the follicle ruptures very abruptly, causing severe pelvic and/or abdominal pain, which is a reason for urgent gynecologic consultation.
The types of pain described are common but not exclusive to polycystic ovaries. They may also occur if you have one of the following conditions:
• Peritoneal endometriosis or pelvic endometriosis.
• Pelvic inflammatory disease (PID), which includes infection and inflammation of the ovary and tube, called adnexitis.
• Some benign ovarian tumors, such as functional ovarian cysts, ovarian dermoid cysts, or ovarian teratomas.
• Malignant ovarian tumor (ovarian cancer).
• Ectopic pregnancy.
Thus, there is difficulty in specifically identifying pain due to polycystic ovaries, so it is important to consult your gynecologist when pain appears in the ovaries, abdomen, or pelvic area to determine the cause.
Causes
Although the primary cause of polycystic ovaries is unknown, several aspects may contribute to its development:
• Environmental factors: of particular interest to researchers are female obesity and intrauterine conditions caused by maternal overweight, gestational diabetes, hyperandrogenemia, etc.
• Genetic factors: PCOS may occur in several women in the same family, therefore it is considered a hereditary disease caused by multiple genes.
• Endocrine or hormonal factors, which may be of several types:
o Neuroendocrine factor: leads to disordered pituitary hormone production in the pituitary (increased LH and normal or decreased FSH). Secondary to this disorder are changes in estrogens, androgens, and progesterone.
o Ovarian and adrenal factor: increased androgen production causing abnormal follicular development and impaired ovulation.
o Metabolic factors: the most important metabolic dysfunction in PCOS is increased insulin secretion, which increases the quantity and activity of androgens.
o Changes in follicle formation and ovulation in the ovary: there is intense replenishment of follicles with a much greater overall number of follicles, but follicular selection (dominant follicle) ceases. That is, follicles mature but do not rupture. If selection of a dominant (mature) follicle does not occur so that it can grow and rupture, anovulation ultimately develops, causing infertility.
o Altered ovarian androgen production: an increase in the number of follicles that continuously grow (but in the absence of ovulation) and produce androgens, causing a clinical picture of androgenization.
o Anti-Müllerian hormone (AMH) changes: the theory explaining the presence of PCOS in daughters of affected women posits that they may carry high amounts of AMH, with abnormal elevation from childhood to puberty. This may lead to such girls having a significant number of follicles from birth. Their large number at such an early age may predispose to the development of PCOS in the future.
Diagnosis
There is no single diagnostic method for this condition. However, the following studies may be recommended:
• Pelvic ultrasound. Transvaginal ultrasound is indicated to detect polycystic ovaries and to exclude other possible causes of symptoms. However, transvaginal ultrasound is not performed in adolescent girls.
• Tests to exclude other endocrine disorders, such as measurement of serum testosterone, follicle-stimulating hormone (FSH), prolactin, and thyroid-stimulating hormone (TSH).
PCOS should be suspected in women who have at least two typical symptoms (for example, irregular menstruation and hirsutism—excess hair growth in a male pattern).
To establish the diagnosis, at least 2 of the following 3 criteria must be present:
• Ovulatory dysfunction causing menstrual irregularity
• Clinical or biochemical signs of hyperandrogenism
• More than 10 follicles in an ovary (detected on pelvic ultrasound), usually located peripherally and resembling a “string of pearls.”
The evaluation consists of pregnancy testing and measurement of FSH, prolactin, and TSH to exclude other possible causes of symptoms.
Treatment of Polycystic Ovary Syndrome
Treatment of PCOS is aimed at controlling the factors that affect the patient’s condition. These may include hirsutism, acne, obesity, or difficulty conceiving. Thus, the physician may recommend lifestyle modification, maintaining a healthy weight and reducing carbohydrate intake. In addition, medications and, in exceptional cases, surgery may be prescribed.
At Expert Clinics we perform monitoring, diagnosis, and treatment of pathologies of the female genital tract using innovative and minimally invasive methods. Our team of highly qualified specialists prescribes personalized treatment aimed at the true cause of the disease.
Prevention
Prevention of PCOS consists in eliminating modifiable risk factors. The most important of these is obesity. In recent years, there has been an increase in PCOS cases, especially among young women and adolescents. This is a direct consequence of changes in societal habits, such as a diet rich in fats and sugary products (especially carbonated drinks), and an increasingly sedentary lifestyle.
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