Polycystic ovary syndrome (PCOS), which is very common in women of reproductive age, is among the most important causes of infertility, as it reveals the problem of not being able to ovulate. Benign cysts that form in the ovaries cause hairiness, excess weight gain and acne along with menstrual irregularity. This disease can be combated with diet and exercise under the control of a dietitian, and appropriate drug treatment.
What is polycystic ovary syndrome?
Polycystic ovary syndrome, which is an important ovulation problem in women, is seen in one of every 10 women. This problem, which is common in women of reproductive age, manifests itself as benign cysts that occur in the ovaries. Polycystic ovarian syndrome, which is diagnosed with the appearance of more than 10 cysts smaller than 1 centimeter in ultrasonography, which is a imaging technique, can lead to infertility, diabetes, coronary artery diseases and blood pressure disorders if not treated in women of reproductive age.
How does polycystic ovary syndrome develop?
Two ovaries, which are for reproduction in the female body, develop a mature egg suitable for fertilization in one menstrual period. The egg develops and matures in a vesicle filled with fluid called follicle. A follicle is selected every month in women, it grows and ovulates. In women with polycystic ovarian syndrome, this follicle cannot be selected and therefore there is no ovulation every month. In the ultrasound examination, the ovaries are seen as many vesicles with undeveloped eggs, that is, many cysts.
Which situations should be suspected?
It turns out that about 20% of women who apply to IVF centers have a problem of ovulation. Polycystic ovarian syndrome is the leading problem of ovulation in women who are examined by specialist physicians to have children. Women who have menstrual irregularities, overweight and hairiness problems should be diagnosed after physical examination and ultrasound to be performed. During adolescence, sometimes menstrual irregularity occurs as a normal condition. However, the presence of this disease in adolescent girls with menstrual irregularities can be revealed thanks to laboratory tests as well as imaging techniques.
What are the symptoms?
In adolescence, after one or two periods no menstruation, irregular menstruation (menstruation less rare than 35 days), unusual bleeding.
Excessive pimples on the face and back, visible changes in skin tissue, maculation on the hand. Polycystic ovary syndrome is mostly the cause of recurrent acne, especially in the 20s.
As a result of this disease, excessive hair growth and deepening of the voice in the body are thought to be due to the male hormone (androgens). The hormone testosterone, which is present in a certain proportion in every woman, increases during this period, causing hairiness and thickening of the voice.
Male hormone, the level of which increases in the body due to polycystic ovary syndrome, can adhere to the receptors in the hair follicles (receptor) and cause male pattern hair loss.
Especially as a result of decreasing female hormones and increasing male hormone, breast sizes may reduce over time.
Difficulty or infertility in getting pregnant is an important symptom. This problem, which is seen in 10% of young women, is one of the most important causes of infertility.
Excessive weight gain. Half of the women with polycystic ovaries were found to be obese.
What causes polycystic ovary syndrome?
Despite numerous clinical and experimental studies, it is not known exactly what caused the disease. However, the disease is thought to be caused by the 'insulin' hormone that regulates carbohydrate metabolism. It is thought that excess weight causes insulin resistance and insulin resistance triggers polycystic ovary syndrome. Insulin, the main hormone that enables sugar, the main food source in the body, to enter the body cells (muscle, fat and liver cells) from the blood to provide energy, is secreted from beta cells in the pancreas. Secretion of high levels of insulin that occur in the body with insulin resistance increase the production of male hormone (androgens) in the ovaries.
How is the treatment of the disease?
When planning treatment, these patients should be reduced to ideal weight under the supervision of a dietician. If necessary, 'metformin' drug treatment used in diabetics to break the insulin resistance is used in this period. As a result of medical treatment and weight loss, there may be a significant improvement in the number, and sometimes the pregnancy may occur spontaneously when the ovulation problem disappears. However, if menstrual irregularity persists after these procedures, ovulation stimulating drugs and hormone needles can be applied. Pregnancy is tried to be created by suggesting a normal intercourse from the eggs that develop as a result of these follow-ups or by vaccination method. If pregnancy could not be achieved with 3-4 times follow-up and vaccination, it is recommended to switch to IVF.
What should be recommended to women?
It is absolutely important for women with polycystic ovary syndrome skip gynecological follow-ups after pregnancy and to continue annual examinations. In these patients, some diseases, especially diabetes, may occur in older ages. To prevent this, excess weight gain should be prevented, regular exercise should be recommended and if necessary, regular menstruation should be provided with medications.
FREQUENTLY ASKED QUESTIONS ON POLYCYSTIC OVARY SYNDROME
I use a drug used in diabetics, is there any harm to the body?
The drug called metformin used in diabetes is given to many women diagnosed with polycystic ovary syndrome to provide ovulation. In addition, studies have shown that this drug reduces the risk of miscarriage in pregnant women.
Is there a cure for the disease?
There is no definitive cure for polycystic ovary syndrome. In the disease that occurs due to many parameters, complaints are reduced by weight control to be achieved with drug therapy and diet.
Besides infertility, does this disease have other negative consequences?
One of the most important consequences of polycystic ovarian syndrome is that the body develops resistance to insulin. Due to the long duration of insulin resistance, many women become diabetics in the long term. It has been determined that the risk of high blood pressure and heart diseases arises due to the disease.
Is there any harm in irregular or absent menstruation?
The body is exposed to high estrogen effects for a long time because ovulation is rare or absent in women with rare menstruation due to this disease. Progesterone secreted after ovulation will suppress the effects of estrogen, resulting in the possibility of uterine cancer.
Is there a good side of this disease?
In the studies conducted, it was determined that the number of ovaries in women with PCOS is better (AMH values are higher) and that these patients maintain their egg count better than other women and menopause age is advanced even in the later ages.
9 December 2020
17 June 2020