Polycystic Ovary Syndrome

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder that is manifested by obesity, hirsutism (excessive hair growth), infertility, disorders of menstruation (amenorrhea, among others) and by increasing the volume of the ovaries, which become fibrotic (lose elasticity) and shows numerous cysts.

In some cases, menstrual disorders signals the disease since adolescence, in others, the syndrome is identified later because affected women infertility. Signs and symptoms of this syndrome are caused by damage to the menstrual cycle, which normally culminates monthly release of an egg from the ovary (ovulation). Syndrome name derives from the presence of numerous cysts in the ovaries, follicles or bags filled with liquids that contain immature eggs.

Polycystic ovary syndrome denotes a hormonal imbalance that affects normal ovulation. The cause is not fully understood by scientists, although it is believed that genetic factors are involved.

Treatment aimed at regulating hormonal imbalances SOP and control your weight. Exercise and healthy nutrition are an essential part of PCOS treatment.

PCOS is one of the most common hormonal imbalances, affecting between 5 and 10% of women of reproductive age. Early diagnosis and treatment of PCOS may reduce the risk of complications, such as diabetes and heart disease.

Signs and symptoms:

Polycystic ovary syndrome is manifested by a wide range of signs and symptoms and degree of severity can vary. To be diagnosed with PCOS, women must submit at least two of the following signs:

"Disorders of menstruation. This is the most common sign of PCOS. Disorders refers to absence of menstruation (amenorrhea), or less than eight menstrual cycles a year, which means a longer interval of 35 days between cycles.
"Increasing the level of male hormones - is manifested by signs such as excessive hair growth on the face, chest, abdomen, back, arms (hirsutism), acne and male pattern hair loss (alopecia). It should be noted that not all women with PCOS physical signs of excess male hormones.
"The presence of numerous cysts in the ovaries and increase their size (polycystic ovarian syndrome). However, a woman is not necessarily polycystic ovaries polycystic ovarian syndrome. And a woman with PCOS can have normal looking ovaries. To be diagnosed with PCOS, she must have irregular menstrual cycles or excessive levels of male hormones.

Other conditions may present with similar signs and symptoms of PCOS:

»Hypothyroidism - defined by deficient levels of thyroid hormones, which leads to the absence of menstruation (amenorrhea).
»Hyperprolactinemia - a condition characterized by excessive secretion of prolactin - a hormone that stimulates milk production and suppress ovulation - by the pituitary gland.
"Some tumors - tumors of the ovary or adrenal glands may be responsible for the excessive androgen.
"Many women with PCOS are obese. Fat distribution appear to affect the severity of symptoms. Women with android type obesity - fat accumulated in the abdominal region - shows a higher level of male hormones, carbohydrates and fat than women who accumulate fat in other parts of the body (the hips, limbs).

Conditions that may be associated with PCOS are:
»Infertility
»Acantozis nigricans - appearance of dark spots on the neck, underarms, thighs, vulva or chest
»Chronic pelvic pain

Polycystic Ovary Syndrome

Causes
The menstrual cycle is regulated by the level of hormones produced by the pituitary gland (hypophysis) - luteinizing hormone (LH) and follicle stimulating hormone (FSH) - and ovaries.
The ovaries produce female sex hormones - estrogen and progesterone, and a small amount of male hormones or androgens - testosterone and dehydroepiandrosterone (DHEA).

In polycystic ovary syndrome, the body produces excess male hormones, and the ratio LH / FSH is abnormally high. Therefore, the release of eggs from the ovaries (ovulation) occurs less frequently than normal (oligomenorrhea), or the ovaries stop releasing eggs (anovulation). In the absence of ovulation, menstrual cycle is irregular or absent.

The cause of PCOS is not known, but studies indicate a possible link with excess insulin - the hormone produced by the pancreas that allows cells to use sugar (glucose), the main energy source of the body. Excess insulin leads to increased secretion of androgens by the ovaries. According to studies, genetic factors are involved in polycystic ovary syndrome.

Polycystic ovary syndrome was first described in literature in 1930 by Irving Stein and Michael Leventhal, who wrote about a group of women with amenorrhea (absence of menstruation), whose ovaries were enlarged and had a polycystic appearance . Therefore, polycystic ovary syndrome is also called Stein-Leventhal syndrome.
Diagnosis
Polycystic ovary syndrome is manifested by a variety of symptoms and can be diagnosed by a single test. The doctor will ask questions about medical history, symptoms and menstrual cycles and perform a clinical examination including a gynecological examination.
Polycystic Ovary Syndrome
Other tests:

Blood tests - to measure levels of hormones (testosterone, DHEA, LH, FSH, progesterone, prolactin and TSH). Determination of androgens (male hormones) in the blood, showing their excessive secretion by the ovaries. Other blood tests may consist in measuring fasting glucose, cholesterol levels and triglycerides.
Laparoscopy - is to visualize the abdominal cavity through a thin tube equipped with an optical system. Laparoscopic exploration, the ovaries appear enlarged, with a look of porcelain and are covered by a fibrous capsule containing numerous cysts.
Ultrasound - a method of exploring an organ, tissue or anatomical structures using ultrasound - allows observation of the ovaries, which in the case of PCOS are enlarged and shows numerous cysts.
Complications
PCOS increases the risk of infertility, hipercolesteromie, hypertension, sleep apnea, cardiovascular disease, endometrial cancer and diabetes (1 in 10 women is diagnosed with type 2 diabetes before 40 years).

Because PCOS affects the menstrual cycle and the uterus exposed to constant concentrations of estrogen, women with PCOS are at high risk of abnormal uterine bleeding and endometrial cancer (lining of the uterus).

PCOS treatment can reduce these risks.
Women with PCOS who want children may need fertility treatments. During pregnancy, they have an increased risk of miscarriage and gestational diabetes (due to high levels of insulin).
Medications
Treatment aims to control symptoms of PCOS, infertility, hirsutism, acne or obesity. In the long run, the most important aspect of treatment is to control cardiovascular risks such as obesity, hipercolesteromia (high cholesterol), diabetes and hypertension.
Women who suffer from PCOS, especially those with surplus weight, need advice about healthy nutrition. Obesity worsens insulin resistance. Weight loss can reduce both insulin levels and on the male hormones and can even restore ovulation. However, weight loss is more difficult for women with PCOS who should consult a nutritionist to adopt a weight control program.
Polycystic Ovary Syndrome
Drug treatment for regulate the menstrual cycle

In women who do not want a pregnancy, treatment may consist of oral contraceptives that combine estrogen and progesterone. They decrease the secretion of male hormones and contribute to fighting the effects of continuous estrogen concentrations. This reduces the risk of endometrial cancer and abnormal bleeding.
Another possibility is the use of progesterone for 10 -14 days a month. It regulates the menstrual cycle and protects against endometrial cancer, but does not reduce androgen levels.


Treatment of hirsutism (excessive hair growth reduction)

Your doctor may prescribe other medications to reduce the effects of androgen excess. Spironolactone (Aldactone) blocks the effects of hormones and reduce the production of hormones. Spironolactone is a diuretic, and among the side effects include fatigue, headache. Other medications are antiandrogen finasteride (Propecia, Proscar) and flutamide (Eulexin).
To slow facial hair growth in women, the doctor may prescribe cream Vaniqa (active ingredient eflornithinum). The cream is applied twice daily and is not recommended during pregnancy.
Polycystic Ovary Syndrome
Treatment to achieve pregnancy

To obtain a pregnancy, women with PCOS need drugs that stimulate ovulation. Clomiphene (Clomid, Serophene) is an anti-estrogen that is administered for 5 days in the first half of the menstrual cycle. If clomiphene is not effective, may be associated with metformin to stimulate ovulation.
If treatment with clomiphene and metformin fails, you can use gonadotropins (FSH and LH) in the form of injections. Because many women with PCOS have high levels of LH, the doctor may recommend treatment with FSH only.
Surgery
If drug therapy does not help in getting pregnant, your doctor may recommend an operation called laparoscopic ovarian drilling.

In this procedure, the surgeon makes a micaincizie in the abdomen and inserts a thin tube equipped with a video camera (laparoscope). Camera offers detailed picture of the ovaries sialic neighboring organs. Then, using electrocautery or alaserului, enlarged follicles are destroyed on the surface of the ovaries.

The goal of surgery is to stimulate ovulation by reducing levels of LH and androgens.
Infertility and PCOS
If you suffer from PCOS and have an above average normal weight, try to lose weight to increase your chances of getting pregnant.
Your doctor may also prescribe drugs to lower insulin levels, a common problem for women with polycystic ovary syndrome caused by an inability to recognize insulin. High levels of insulin over a long period can lead to diabetes.

Clomid is a drug used to stimulate ovulation. If does not work, your doctor may prescribe hormones which you can inject intravenously home alone. Your doctor will monitor blood hormone levels will require Reproductive performance of ultrasound. Women who use hormone therapy develop more hair, so there is a risk of multiple pregnancies.

In vitro fertilization (IVF) is another treatment for women with polycystic ovary syndrome who wish to become pregnant.