The polycystic ovary syndrome

The polycystic ovary syndrome – Not just a disorder caused by an imbalance of reproductive hormones

The polycystic ovary syndrome (PCOS), the most common endocrinopathy in women of reproductive age (5-8% of women), was first described in 1935 by Stein and Leventhal. Seventy-five years later, it’s known as an heterogeneous endocrine and metabolic disorder of unknown etiology. Many medical research projects are carried out due to the frequent clinical heterogeneity as well as its long-term metabolic and cardiovascular effects.

Polycystic ovary syndrome is a clinical diagnosis that has at least two of the following three characteristics:

  1. Chronic anaphylaxis (which manifests itself in case of amenorrhea or postmenopause, ie less than six cycles over a year).
  2. Biochemical hyperandrogenemia (increase of androgen levels in blood) or hyperandrogenism (clinical hyperandrogenemia without similar biochemical findings)
  3. Polycystic ovarian morphology during ultrasound scan

An important condition for the correct diagnosis of PCOS is to exclude the presence of any other endocrine disorder and / or the use of drugs that can cause anovulation and clinical or biochemical hyperandrogenemia.

The aetiopathogenesis of PCOS has not yet been clarified, although there are several theories about its causes. The most important are ovarian and adrenal function disorder, insulin resistance and compensatory hyperinsulinemia, Gonadotropin-releasing hormone (GnRH) and  luteinizing hormone (LH) and three of them cause androgen excess. In case of the familial appearance of the syndrome, sometimes we found a positive family history of PCOS in our patient.

As mentioned above at the diagnosis characteristics, patients usually visit us if they has symptoms such as menstrual disorders (heavy periods or irregular frequent bleeding / absence of menstruation), infertility, hirsutism, androgenetic alopecia, acne. The recognition of the syndrome in its complete clinical expression has no pathognomonic signs and its phenotypic heterogeneity is a diagnostic challenge. Here, the assessment of the patient by an Endocrinologist plays an important role in ensuring that the medical history, objective examination and appropriate examinations make the right diagnosis and hence correct and personalized treatment.

As far as the patient’s therapeutic approach is concerned, it is important to bear in mind that PCOS is primarily a reproductive and metabolic disorder. 30-75% of women with PCOS are obese and in most cases have an abdominal body fat distribution, which is beneficial for well-known to all of us metabolic syndrome. Also in overweight and obese premenopausal women, the prevalence of PCOS is four times higher than in the general population. Women with PCOS and the absence of menstruation (obese and no) have an increased risk of Type 2 diabetes, which is even higher when obesity and family history of diabetes occur. In addition, PCOS is accompanied by a risk of high cholesterol, while postmenopausal women with PCOS have a high blood pressure levels.

In summary, the multisystemic clinical expression of PCOS implies a multidimensional therapeutic approach, and here, besides personalized medication, a change of a lifestyle, by adapting a right nutrition and physical activity, plays also an important role.