Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS), a common disorder that is still poorly understood. As September is the PCOS Awareness Month we were eager to spread awareness about this disorder as well.
What is it, who has it and what are the long-term consequences?
Let’s find out!
Polycystic ovary syndrome (PCOS) is a common endocrine (hormonal) disorder that affects up to 20% of girls and women of reproductive age. This syndrome is mainly characterized by irregular menstruation cycles, hyperandrogenism (excessive male hormone testosterone) and polycystic ovaries. As it is a multidimensional condition, environmental, lifestyle and genetic factors have a role in the development of PCOS.
PCOS was first reported in literature in 1935 when several women reported symptoms such as amenorrhea (lack of menstruation), hirsutism (excessive hair growth) and enlarged ovaries with multiple cysts. However, only in 1990 the World Health Organization (WHO) included PCOS as a disorder of ovarian functions in the International Classification of Diseases.
In the beginning, PCOS was considered to be a cosmetic or fertility disorder, but studies conducted over the recent years demonstrate that PCOS actually has long-term risks and can lead to deadly consequences.
PCOS facts and statistics
As PCOS is a syndrome, it encompasses various different symptoms. It affects women’s health on multiple levels, such as hormonal, metabolic and cardiovascular
The diagnosis of PCOS is a diagnostic of exclusion. Therefore, the first step of diagnosis is the exclusion of other possible causes such as hypothyroidism, ovarian failure or tumors
PCOS patients report menstrual problems such as oligomenorrhea (infrequent menstruation), amenorrhea (absence of menstruation) or prolonged menstruation. But these are not generalized symptoms, as around 30% of PCOS patients have regular menstruation cycles
Up to 90% of women with oligomenorrhea (infrequent menstruation) and around 40% of women with amenorrhea (absence of menstruation) are diagnosed with PCOS
The absence of regular menstruation and, consequently, ovulation increases the chances of developing endometrial cancer or endometrial hyperplasia (thickening of the uterine lining); the risk of developing endometrial cancer is 2.7 times higher in women with PCOS than in healthy women
Up to 30% of adult women with PCOS suffer from acne
Around 80% of women that present excessive levels of testosterone have PCOS. One consequence of excessive levels of male hormones is hirsutism, and its prevalence among women with PCOS is 70%.
PCOS affects fertility and around 40% of women become infertile; the explanation lies in the process of ovulation which is blocked; women with PCOS have higher risks of miscarriage.
Another PCOS related infertility factor is insulin resistance, as excessive secretion of insulin affects the production of ovarian hormones negatively
1. Family history
Upon observing cases of PCOS amongst several members of the same family, over the years it became clear that it is a genetic disorder
PCOS amongst family members has a prevalence of up to 6%
2. Excessive body weight
Excessive body weight aggravates the symptoms of PCOS, but it can also be a consequence of having this disorder, therefore it becomes a vicious cycle
Having a healthy lifestyle has been shown to reduce body weight, testosterone levels, decreases hirsutism and improves the resistance to insulin in women to PCOS
3. Neurological disorders
Studies suggest that women suffering from epilepsy have a higher chance of developing PCOS
Type 1 and Type 2 Diabetes and Gestational Diabetes (acquired during pregnancy) are associated with a higher chance of developing PCOS
5. Risk factors in children
High weight in newborn girls born from overweight mothers
Congenital virilization: newborn girl that presents masculine characteristics
Low Birth weight
Acanthosis nigricans (skin condition that causes dark discoloration)
Metabolic syndrome (combination of diabetes, high blood pressure and obesity)
PCOS can influence the appearance of other diseases. As PCOS is a syndrome with multiple symptoms that affects multiple organs of the body, associations between PCOS and other conditions can occur.
Insulin resistance: has an essential role in the development of PCOS and is increased by the presence of obesity
Even without the presence of obesity, PCOS is associated with Type 2 Diabetes
Several studies claim that women with PCOS have a higher prevalence of high blood pressure
Women with PCOS are prone to developing psychological disorder such as depression, anxiety, bipolar disorder and eating disorder
Pregnancy complications: gestational diabetes, preeclampsia (high blood pressure during pregnancy) and sleep apnea (breathing repeatedly stops and starts during sleep), higher chance of newborn inspitalization and perinatal mortality (death of the fetus during or immediately after birth)
Subfertility: PCOS is a cause of anovulation (absence of the ovulation process) and in some women an impaired development of eggs was reported
Diabetes mellitus: up to 40% of women with PCOS develop some form of Diabetes (Type 1, Type 2 or Gestational Diabetes) over time
Heart problems: obese women with PCOS have higher risk of developing cardiovascular problems such as high level of cholesterol
Malignancy: women with PCOS may be at a higher risk to develop ovarian and breast cancer
Available treatments do not reverse the underlying causes of PCOS but aim to relieve the symptoms, and are individualized according to the existing symptoms.
Treatment of symptoms related to excessive levels of testosterone
Most common symptoms that appear because of high levels of testosterone are acne, hirsutism (excessive hair growth) and alopecia (hair loss of the scalp or other body parts)
Treatment of hirsutism
Hair removal: mechanically (shaving and plucking) or with laser hair removal
Medical treatment: oral contraceptive pills, especially for women that do not intend to get pregnant during the treatment
Treatment of acne: especially for women that do not intend to get pregnant during the treatment
Oral contraceptive pills
Isotretinoin (vitamin A derivative)
Treatment of alopecia
Minoxidil: stimulates hair regrowth
Treatment of menstrual symptoms
Combined hormonal contraceptive (CHC) containing estrogen and progestin can help inhibit the excessive multiplication of endometrial cells (in order to regulate the menstrual cycle and prevent the apparition of endometrial cancer)
Treatment of infertility
For obese women with PCOS the first-line therapy is weight loss as anovulation (absence of the ovulation process) and miscarriages are associated with obesity
First-line medical therapy (first treatment to be given according to guidelines): Clomiphene citrate, induces the ovulation process
Second-line medical therapy (when the first-line one is not effective): Gonadotropins FSH (follicle stimulating hormone) and LH (lutein hormone) or laparoscopic ovarian drilling (LOD); both options induce the ovulation process
Third-line therapy (when the second-line one is not effective): In vitro fertilization (IVF), studies show that PCOS women and non-PCOS women present similar characteristics when it comes to miscarriages and live-birth rates
All these medical treatments are used as off-label (the drugs are usually recommended for specific diseases but upon clinical results doctors can recommend them - on their own responsibility - to patients suffering from other conditions) as FDA (Food and Drug Administration) and EMA (European Medicine Agency) have not approved any drug that is specifically indicated for the treatment of PCOS until now.
The lack of drugs approved for treating PCOS, is one of the causes of such a high prevalence of PCOS. One explanation of why there is not a drug approved for this yet, might be the fact that PCOS is one of the least understood medical disorders among patients, physicians and researchers. The incomplete knowledge about this syndrome and its long-term consequences are an impediment for allocation of resources for research.
We hope that future researchers will focus on such an important and common disorder.
Before taking any treatment, consult your physician. Do not take medicine without consent and prescription from your doctor!
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