PCOS, also known as Stein-Leventhal syndrome, is an endocrine disorder caused by both hereditary and environmental factors. The disease is distinguished by increased androgen production by the ovaries, impaired maturation of female germ cells, and menstrual function.
Causes of PCOS
Polycystic ovary syndrome is one of the most common endocrine disorders in women of reproductive age. Normally, from the first day of a woman’s menstrual cycle, oocyte maturation occurs in the ovarian follicles. After maturation, the egg leaves the burst follicle and moves through the fallopian tube to meet the sperm. In place of the empty follicle begins to form a temporary hormonal gland (corpus luteum), which functions for 14 days and does not depend on the duration of the menstrual cycle. If pregnancy does not occur, the ovum together with the rejected epithelium is removed from the uterus, the next menstrual bleeding begins, and the corpus luteum regresses. If fertilization occurs, the corpus luteum progresses and reaches the highest degree of development.
Currently, two mechanisms of PCOS development are proposed: in patients with normal body weight and in patients with insulin resistance and obesity. Genetic predisposition is of great importance in the occurrence of polycystic ovary syndrome. Changes in the structure of one or more genes that control the metabolic processes of glucose metabolism and genes responsible for the synthesis of steroid hormones and individual tissue sensitivity to androgens can cause the development of clinical symptoms characteristic of polycystic ovary syndrome.
Disease Classification
The European Society of Reproduction and the American Society for Reproductive Medicine has identified the main criteria for PCOS: oligo anovulation, hyperandrogenemia, and polycystic ovarian morphology (according to ultrasound).
The presence of two or more basic criteria indicates a certain phenotype of PCOS: Phenotype A: hyperandrogenemia + ovulatory dysfunction (anovulation) + ultrasound changes; Phenotype B: hyperandrogenemia + ovulatory dysfunction (anovulation); Phenotype C: hyperandrogenemia + ultrasound changes; Phenotype D: ovulatory dysfunction (anovulation) + changes on ultrasound.
Symptoms
The clinical picture of PCOS is characterized by menstrual disorders. primary infertility, excessive male pattern hair (hirsutism), and acne. In the anamnesis, there are transferred neuroinfections and extragenital diseases.
Heredity is often aggravated by type 2 diabetes mellitus, obesity, and arterial hypertension. The first menstruation (menarche) is usually timely – at the age of 12-13 years. The vast majority of women have menstrual irregularities of the oligomenorrhea type, with dysfunctional uterine bleeding present less frequently. In about 30% of women over 30 years of age who have untreated PCOS, after a period of regular or infrequent but intermittent menses, menstruation may cease for 6 months or more (secondary amenorrhea).
Patients with PCOS and obesity are more likely than patients of normal body weight to suffer from a lack of ovulation. Deposition of adipose tissue occurs predominantly in the shoulder girdle, anterior abdominal wall, and mesentery. In most cases, this (visceral) type of obesity is accompanied by insulin resistance. Clinically, insulin resistance is manifested by areas of skin hyperpigmentation in areas of friction (groin, axillae, etc.). Also, the disease is often accompanied by hirsutism – excessive growth of terminal hair on the male type – from scanty to pronounced. At palpation of the mammary glands in most patients are determined signs of cystic fibrosis mastopathy; at gynecological examination – enlarged ovaries.
Diagnosis
The diagnosis of PCOS can be made based on the presence of at least two of the three main criteria: chronic anovulation, hyperandrogenemia, or echographic signs of polycystic ovaries. To clarify the diagnosis, the doctor may recommend tests, including antimüllerian hormone and pelvic ultrasound.
What Doctors to See
If you suspect endocrine disorders and the presence of manifestations of polycystic ovary syndrome should contact an obstetrician-gynecologist or endocrinologist. The aim of treatment is to eliminate hirsutism, and acne, normalization of body weight and correct metabolic disorders, regulate the menstrual cycle to prevent endometrial hyperplasia, restore of ovulatory menstrual cycle and fertility, and prevent late complications.
Patients with insulin resistance at normal body weight are prescribed PCOS supplements to reduce peripheral insulin resistance, improving glucose utilization in the liver, muscle, and adipose tissue. Patients planning pregnancy after correction of metabolic disorders are prescribed selective estrogen receptor modulators, an ovulatory dose of chorionic gonadotropin, follitropin beta or follitropin alpha, and gestagens. Gonadotropins are administered to clomiphene-resistant patients planning pregnancy.
Conclusion
PCOS is a serious endocrine disorder that can significantly affect women’s reproductive health. Early detection and comprehensive treatment can help minimize symptoms and improve the quality of life for female patients. If you suspect that you have PCOS, it is important to see a qualified specialist to get timely help and prevent possible complications in the future.
