Polycystic ovaries or polycystic ovarian syndrome (PCOS) is a set of symptoms related to a hormonal imbalance that can affect women and girls of reproductive age. It is diagnosed by a combination of the symptoms presented by the patient, by the presence of an excess of androgens (male hormones), disorder of the function and shape of the ovaries and by means of ultrasound.
To better understand what polycystic ovary syndrome is, this disorder is not defined primarily by ovarian cysts. PCOS is defined by at least two of three diagnostic criteria: hyperandrogenism (excess androgens), impaired ovarian function, ovaries with polycystic morphology, and by the exclusion of other medical conditions that may mimic PCOS symptoms.
Causes and risk factors
Some of the risk factors that may predispose a woman to polycystic ovarian syndrome include:
If a first-degree blood member (mother or sister) has polycystic ovaries, the likelihood of a woman having PCOS increases.
Diet has been shown to be a risk factor for the development of PCOS. Dietary fats and proteins by reacting with glucose (sugar) in the blood, a process called advanced glycation end products (AGEs), contribute to increased stress and inflammation in the body (cellular aging), which is known to be related to the development of diabetes mellitus and cardiovascular disease. It is therefore best to limit exposure to EFAs.
Foods of animal origin with high fat and protein content are generally rich in AGEs, and therefore when exposed to cooking, they increase stress and inflammation in the body. On the contrary, foods that have a low glycemic index, such as vegetables, fruits, whole grains, contain relatively few cellular aging elements (few AGEs), even after being subjected to cooking.
It is important for women to limit the consumption of foods that promote inflammation in the body, such as dairy products, gluten-containing foods and foods with a high glycemic index such as potatoes, white bread, desserts and sweets.
Since obesity has been recognized to aggravate PCOS, it is advisable to lose weight, especially waist and abdominal fat. Physical activity helps reduce many of the symptoms of PCOS, such as depression, inflammation and excess weight. The Centers for Disease Control and Prevention (CDC) recommends 150 minutes of moderate physical activity per week or 75 minutes of high-intensity exercise per week.
Environmental exposure to endocrine-disrupting chemicals can lead to reproductive health problems, including polycystic ovary syndrome. Studies indicate that certain endocrine-disrupting chemicals may pose an increased risk of exposure during prenatal and early postnatal development when organ systems are developing. These chemicals can be found in many everyday products, including plastic containers, metal food can linings, detergents, cosmetics and pesticides.
Signs of PCOS
The presence of a high level of androgens leads to the appearance of several dermatological signs and symptoms. These include:
1. Hirsutism (hair growth in typically male areas, such as the face, chest, abdomen, and back).
3. Oily skin
4. Hair loss or alopecia (loss of certain areas of the scalp)
5. Discoloration of the skin (acanthosis nigricans).
It should be noted that in adolescent girls, some of these dermatological symptoms may be caused by puberty rather than PCOS.
Menstrual disorders in PCOS can vary widely from a complete absence of menstruation (amenorrhea), to interruption of the menstrual period for more than 30 days, scant menstrual bleeding (oligomenorrhea), or intermenstrual bleeding (menorrhagia). In fact, women who have irregular menstrual cycles have a greater than 90% chance of having PCOS, and are even 15% more likely to suffer from infertility.
Implications for women’s health
Polycystic ovary syndrome can affect many areas of a woman’s life
1. Psychological disorders: Anxiety and depression.
2. Dermatological disorders: Hirsutism and acne.
3. Sleep disorders: Insomnia, sleep apnea
4. Reproductive disorders: Infertility
5. Obstetrical and gynecological disorders: miscarriage, preeclampsia
Between 5% and 26% of women are affected by PCOS, depending on the diagnostic criteria applied:
1. Higher body mass index in white women, especially in North America and Australia.
2. More severe hirsutism in Hispanic, Middle Eastern and Mediterranean women.
3. Increased abdominal fat, insulin resistance, diabetes, acanthosis nigricans (darkening of the body folds).
4. Increased prevalence of PCOS in black adolescent and young adult women.
Obesity and cardiovascular risk
The metabolic disorders caused by PCOS, particularly increased abdominal fat and insulin resistance, increase the risk of type 2 diabetes and cardiovascular disease. In women with PCOS, 50-80% have insulin resistance, 61% are overweight, or obese, and may have diabetes before the age of 40.
In addition to physical symptoms, women with polycystic ovaries are at increased risk for mental health problems, such as anxiety and depression, associated with infertility, obesity and hirsutism.
Anxiety. Anxiety has been shown to be significantly higher in women with polycystic ovaries compared to healthy women. PCOS may add further complexity to the psychological profile and should be taken into account when assessing women’s mental health.
Depression. The prevalence and risk of depression in women with PCOS is 40-60%, much higher than in women without polycystic ovaries.
There is no specific test to definitively diagnose PCOS. As indicated above, some diagnostic criteria should be applied, along with physical examination by the specialist physician (gynecologist).
Blood tests may be requested to measure hormone, sugar, cholesterol and triglyceride levels, among others.
This imaging study allows detecting the presence of polycystic ovaries, in addition, it visualizes the uterus and fallopian tubes (pelvic ultrasound).
The diagnosis is made when two of the following symptoms are present:
1. Irregular, infrequent menstrual periods or complete absence of menstruation.
2. Increased facial or body hair and blood tests showing elevated androgen (testosterone) levels.
3. An ultrasound showing the presence of polycystic ovaries
Currently, there is no definitive treatment for polycystic ovary syndrome, although symptoms can be controlled with lifestyle modifications and medication. Physical activity should be increased, and a diet high in fiber and low in sugar and fat should be consumed. It is important to avoid consumption of processed foods and trans fats. If there is obesity, it is preferable to follow a nutritional regimen with a specialist, to reach the goal of a healthy weight. Smoking cessation should be encouraged.
Some of the drugs that may be used in the treatment of PCOS include:
1. Oral contraceptives containing drospirenone or containing only progestogens.
2. An inositol supplement (nio-inositol, D-chiro-inositol, or a combination of both), which help control the symptoms of PCOS, such as hirsutism, acne, difficulty conceiving, among others.
3. Metformin. This drug is used in the treatment of type 2 diabetes, to improve resistance to insulin action and to lower insulin levels in the blood. In PCOS, metformin can reduce androgen (testosterone) concentrations, which improves ovarian function and promotes fertility.
Long-term medical follow-up
Regular follow-up by a specialist physician (gynecologist) is important for women with polycystic ovary syndrome, as they are more likely to develop diabetes and other health problems. Some of the controls include:
1. Blood sugar test once a year.
2. Glycosylated hemoglobin or hemoglobin A1C test (indicating blood sugar level over the past 2-3 months) once a year or an oral glucose tolerance test every two years.
3. Vitamin D level test.
4. Thyroid function tests.